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Most deaths from a certain type of "bath salt" in 2020 occurred in just two states, CDC researchers reported.

That year, deaths of 343 people in the U.S. involved eutylone, and three-quarters occurred in Florida (182) and Maryland (77), R. Matt Gladden, PhD, of the National Center for Injury Prevention and Control, .

"Rapid increases in drug products containing eutylone, coupled with the concentration of eutylone-involved deaths in a few states, warrant enhanced surveillance for new outbreaks in other states involving emerging or known synthetic cathinones, including eutylone," the researchers wrote.

Eutylone is a synthetic form of cathinone, a compound found in the khat plant grown in East Africa and southern Arabia, where its leaves are chewed for mild stimulant effects, . Other examples of synthetic cathinones include N-ethylpentylone and N,N-dimethylpentylone. Substances containing these compounds are sold as "bath salts" but are typically ingested, smoked, snorted, or injected to produce effects similar to amphetamines and cocaine.

Some of these are unregulated because they're chemically distinct from compounds on the Controlled Dangerous Substances (CDS) Schedule.

Eutylone, though, is now a schedule I CDS in the U.S. , it emerged on the U.S. illegal drug market in 2014, and reports of its abuse have risen sharply since 2018.

According to NIDA, illicit drug dealers have been misrepresenting some eutylone products as "Molly," the pure form of MDMA. Eutylone is also distributed under street names of Red Bull and Blue Playboy, according to the DOJ.

"Eutylone is especially risky to users because it looks nearly identical to other drugs like Ecstasy or Molly but produces a weaker effect, tempting people to take more, and leading to severe adverse effects such as tremors, seizures, or even death," said the U.S. Attorney of western Virginia, Christopher Kavanaugh, in the DOJ statement.

Gladden and colleagues reported that from 2017 to 2021, the supply of eutylone increased rapidly in the U.S. During January-June 2017, eutylone was detected in fewer than 10 drug items, such as powders, capsules, or tablets, obtained through law enforcement seizures, arrests, or undercover buys. But from January-June 2021, eutylone was detected in 8,379 drug items, making it the seventh most identified drug during this period.

The researchers looked at 2020 data from the State Unintentional Drug Overdose Reporting System (SUDORS) with contributions from 43 states and the District of Columbia.

Eutylone-involved deaths commonly co-involved illicitly manufactured fentanyls (including both fentanyl and fentanyl analogs), with 77.3% of deaths involving both substances. More than half of eutylone-involved deaths (53.1%) also involved cocaine or methamphetamine.

A total of 183 of the deaths had a medical examiner or coroner report, and 23 of these (12.6%) had negative MDMA toxicology findings, but still had evidence of MDMA use before the overdose or a history of MDMA use -- suggesting the tablets may have been deceptively sold as "Molly."

The researchers noted that recent international scheduling of eutylone by the WHO and the United Nations may be contributing to its replacement with a newer synthetic cathinone, N,N-dimethylpentylone. They pointed to reports stating prevalence of N,N-dimethylpentylone has increased while eutylone declined in 2022.

Gladden and colleagues concluded that the risk of unintentional exposure to eutylone might be mitigated by boosting knowledge of synthetic cathinones among people who use MDMA, and "supporting rapid dissemination of results from enhanced toxicology testing of illicit drug products, including those sold as MDMA."

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