A 24-year-old Carlton man suffers a heart attack and renal failure, and later is involuntarily committed to a mental health facility. Two years later, he’s diagnosed as psychotic and committed again.

A 24-year-old Carlton man suffers a heart attack and renal failure, and later is involuntarily committed to a mental health facility. Two years later, he’s diagnosed as psychotic and committed again.

A 26-year-old man from Duluth spends three weeks in a coma and two months in a nursing home.

Both cases have been linked to the use of synthetic drugs — substances such as so-called bath salts and incense that have been sold at Duluth’s Last Place on Earth.

Under an ordinance the City Council passed this month, Duluth businesses must obtain a license to sell the products. The council also made it illegal for anyone to smoke, ingest, inject or snort any product labeled not for human consumption, which is how the incense and bath salts are marked. The Last Place on Earth has filed suit against the city, arguing the license requirement unconstitutionally amounts to self-incrimination.

But regardless of how synthetic drugs are sold or distributed, how safe are they?

While there’s a wealth of anecdotal evidence about their health effects, a more complete picture is hard to come by, for two reasons:

“The drugs are just too new and the chemicals are too varied,” said Muskadee Montano, a Ph.D student at the Duluth campus of the University of Minnesota College of Pharmacy who is researching synthetics.

Yet some tentative conclusions are emerging, experts say.

“I think we now know both anecdotally and based on some studies that are out there what this is doing in real time to people,” said Dr. Nick Van Deelen, an emergency room physician at St. Luke’s hospital.

The studies

Two studies examine synthetic drugs in two broad categories: synthetic cathinones, typically marketed as bath salts, screen cleaners, plant food or water pipe cleaners; and synthetic cannabinoids, sold as incense.

The study on cathinones was published in the journal Clinical Toxicology in 2011. It examined 236 confirmed cases in which patients came into hospital emergency rooms after ingesting bath salts. It found 78 percent of those patients were male, the mean age was 29, and 49 percent were treated in the ER and released. There was one fatality, 12 percent were admitted to mental health units and 21 percent were transferred to intensive care.

“That’s very, very high for any drug of abuse,” Van Deelen said. “For those of us who have been around long enough to remember the peak of crack cocaine and the peak of methamphetamine, this stuff just is worse.”

The study on cannabinoids was published in 2012 in the Annals of Emergency Medicine. Its authors used 1,898 reports to the National Poison Center over nine months of 2010 for its analysis.

Again, the patients were mostly male — 74.3 percent — and somewhat younger — a mean age of 22.5. There was one fatality, a 3.8 percent seizure rate and 7.3 percent were in life-threatening situations.

What Van Deelen sees in the emergency room, he said, is the difference between synthetic cannabinoids and the marijuana they mimic.

“We almost never see people in the emergency department because of marijuana abuse,” Van Deelen said. “At worst, they might get a little paranoia if they’re a first-time user.”

And smoking the incense produces far different behavior from smoking marijuana, Van Deelen said.

“The typical stoner is kind of mellow and just wants to eat some potato chips and what have you,” Van Deelen said. “But this stuff makes people very anxious, aggressive, paranoid, delusional.”

Also, two recent reports — one by nephrologists at the University of Alabama at Birmingham and the other from the Centers for Disease Control and Prevention — have shown evidence of a link between smoking synthetic marijuana and acute kidney injury, Montano said.

Carlson’s perspective

How people regard the information that is available depends on their perspective.

It’s not surprising that Jim Carlson, owner of Last Place On Earth, expresses skepticism about the harm.

Carlson said he thinks the products he sells often have been wrongly blamed because users don’t want to admit to using an illegal substance.

The government has gone overboard in giving synthetics a bad name, he said.

“To me, what the government is doing, I compare it to the ‘Reefer Madness’ days,” Carlson said. “Misinforming the media, and then the media misinforms the public.”

For example, the infamous incident last year in which one Miami man chewed the face off another was attributed to the assailant’s use of bath salts. But when the toxicology report came out, it showed no sign of bath salts, Carlson said.

Two mothers’ view

The opposite perspective comes from some who say their loved ones have been harmed by synthetics.

Lynn Habhegger of Carlton said she has become an activist against synthetics because of what happened to her son, Corey Kellis.

Kellis, whose 27th birthday passed last week at a mental health facility in Fergus Falls, was 24 when he started using bath salts two summers ago, Habhegger said. He used bath salts at least three times that May and June, she said, and ended up in emergency rooms three times.

The third time, he almost didn’t make it.

Police found Kellis at a local motel where he’d created a disturbance by knocking on doors, she said. By the time they found him, he had suffered a heart attack, and had a complete renal failure and rhabdomyolysis, a breakdown of muscle fiber that results in the fibers being released into the bloodstream, damaging the kidneys, she said.

She recalled finding him late that night at St. Luke’s in intensive care. “They told me that had they not found him, he would have been dead in approximately two hours,” she said. The doctor attributed the medical trauma to the bath salts, she said.

Kellis was in the ICU for 10 days. He fully recovered physically, but not mentally; doctors had him committed to a mental health facility for six months, the time allowed by Minnesota law.

Within the past year, he was diagnosed with anxiety, mood, post traumatic stress and psychotic disorders, Habhegger said. Last month, he again was involuntarily committed to six months in a mental health facility, this time at the instigation of family members working with doctors.

Although there’s no proof, Habhegger is convinced the mental health problems stem from his use of bath salts.

“Has it ever been medically linked? No,” she said. “But he never had it before he did the synthetics. … The psychosis manifested itself during the abuse of the bath salts. And it’s never dissipated. It’s only gotten worse.”

Patricia Sundeen of Superior, Wis., told the Superior City Council last week about her son’s struggles with synthetics.

The son, Tyler Parks, 26, of Duluth, slipped into a coma and was placed on a respirator after smoking synthetic marijuana last November, she told councilors as they considered ordinances related to synthetics. He remained in a coma for three weeks, spent two weeks in a nursing home and now is in adult foster care with lingering effects of partial paralysis on his left side and difficulties with short-term memory.

“I wouldn’t want any parent to have to go through what I’ve been through,” Sundeen told the council.

Quantifying the effects

But as anecdotal evidence mounts, understanding the scope of the problem is still a challenge. That’s true even in Duluth, where veteran emergency room physicians like Van Deelen say they’ve never seen anything like the current situation.

“Someone will say: We’re being inundated with cases in the emergency department,” said Jon Roesler, an epidemiologist for the Minnesota Department of Health. “So what’s that mean? How many cases? And no one really has a precise number.”

Roesler is leading an investigation to try to determine the answer, specifically at Duluth’s hospitals. But the question is more complicated than it might appear.

For one thing, it’s believed some patients are reluctant to admit they’ve used synthetic drugs, Roesler said. Second, “ED docs are notoriously busy, and their documentation is less than fantastic.”

Third, the international coding system that identifies the conditions for which patients are treated has no code for synthetic drugs. St. Luke’s emergency doctors are petitioning to correct that, Van Deelen said, but in the meantime, there’s no ready-made source of data on ER trips attributed to synthetics.

Nonetheless, Roesler has a process in mind that he thinks will give a good indication of the actual impact of synthetics in Duluth. He said he might be in town as early as this week to begin that process. He’s tasked with completing preliminary data by September, when Carlson, his son, his girlfriend and a former shop employee face federal criminal counts of distributing controlled substances related to synthetic drugs.

But Roesler cautions about the “whack-a-mole” effect: When one substance is brought under control, it invariably is replaced by another.
“We need to deal with the underlying problem,” Roesler said. “To the extent that we can delay first use of these substances, the more likely it is that our youth will have the skills to prevent this becoming lifelong problems. Research is very clear on that. So part of the thing is protecting our youth.”