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08-08-11 Where is Djibouti and what does it have to do with bath salts?

Question of the Week
August 8, 2011
Where is Djibouti and what does it have to do with bath salts?
Djibouti, an independent state in the Horn of Africa, is bordered by Eritea in the north, Ethiopia in the west and south, and Somalia in the southeast.  The remainder of the border is formed by the Red Sea and the Gulf of Aden.  Population is 818,159 of which 66% live in the capital city (also called Djibouti) and the remainder are nomadic herders.  Djibouti provides services as an international transshipment and refueling center, has military and economic agreements with France, is 94% Islamic, and has an unemployment rate of is 50%.  Food shortage is a frequent problem when there is little rain.
But Djibouti has a Khat Plane. Khat is grown in the highlands of Ethiopia and Kenya.  The Khat plant can be smoked or chewed and contains an addictive stimulant that offers a high, frequently followed by hallucinations. 
One of the unique characteristics of the khat plant is that it begins to lose its potency 48 hours after it is picked.  So it is important that the plant be smoked shortly after picking.  And it is.  Every day a plane (from Ethiopia) lands in the capital city carrying 11 tons of khat that is distributed throughout the city in about 45 minutes.  (The khat plane is the only plane that isn’t shot in Somalia) About half of the adult male population of Djibouti consumes khat and many use it daily.  By 2 pm the country’s daily khat ration is gone and the city is in a stoned daze. 
Bath salts, currently one of the most popular recreational drugs, contain mephedrone and other chemicals that are related to the Khat plant.
According to the American Association of Poison Control Centers, US Poison Centers received 3,470 calls about bath salts from January-June 2011 compared to 303 calls received in the entire year of 2010. If you look on Erowid, an internet site that has blogs of personal experiences while using drugs, one sees that many of the experiences with bath salts have not been positive.   Clinically, patients are hallucinating, hypertensive, and tachycardic. They are extremely agitated and require large amounts of sedation or even intubation.  (see Question from 1/31/2011 {“Are bath salts for more than bathing?”}.  All questions available on our website: www.tnpoisoncenter.org) Reputation may be misleading. 
According to the New York Times, twenty five states have banned bath salts, usually sold for $25-$50 per 50 milligram packet.   A law banning the sale of bath salts in TN was passed two months ago.  TN stores selling bath salts can be fined up to $1500.  But take a look - it is quite easy to buy bath salts over the internet, and many of the convenience stores have not received the memo regarding the law banning sale of bath salts.   As clinicians, we may be in for a long soak.
This question  prepared by: Donna Seger, MD  Medical Toxicologist