Pharmacology and toxicology of synthetic cathinones ("bath salts")

Synthetic cathinones, frequently referred to as "bath salts," are amphetamine-like psychostimulants that emerged onto drug markets in the late 2000's as "legal" alternatives to illicit stimulants such as cocaine and amphetamines. While their pharmacological mechanisms of action are similar to those of the drugs they are intended to mimic, their adverse psychiatric effects can be more severe and result in agitated delirium, psychosis, and violent behaviors. These problems are further complicated by a constantly shifting landscape of newer cathinone analogues designed to circumvent legislative control efforts. In this chapter, we will review the known pharmacological mechanisms of action of first- and secondgeneration Synthetic cathinones in the central nervous system in comparison to those of cocaine and amphetamines. We will also review their use patterns, adverse psychological and physiological effects, and recent studies that have assessed the potential toxic effects of Synthetic cathinones as well as their ability to induce neuroinflammation and cognitive dysfunction.