One night a little more than two years ago, a 24-year-old man was rushed into the emergency room at Tulane University Medical Center in Louisiana. He was extremely agitated and hallucinating.
Dr. Corey Hebert figured the man was on drugs, probably PCP or a stimulant. But a few minutes later, the man became paranoid.
"He started doing some self-mutilating actions [and] was pulling out his eyebrows and eyelashes," Hebert tells weekends on All Things Considered host Laura Sullivan.
Hebert then thought maybe the patient had taken methamphetamine, but his symptoms changed again. Even more surprising, a drug scan of the patient showed up clean. Hebert and his colleagues were puzzled.
After talking to the man's friends, Hebert learned he had taken a new drug that goes by the street name "bath salts."
In the months that followed, Hebert's emergency room became ground zero for bath salts patients. Every few days another patient arrived. Soon emergency rooms nationwide began seeing them, too.
The synthetic drug's popularity has been growing. National poison control centers had 304 calls about bath salts in 2010, nearly a third of them from Louisiana. Last year, there were more than 6,000 calls.
'We're Playing Whack-A-Mole'
The problem is that bath salts — which have nothing to do with the crystals you'd put in your tub — aren't one kind of drug or something you can test for and treat.
Unlike a drug like cocaine, which is made with a natural process, bath salts are made in a lab and constantly changing. The drug is designed specifically to skirt the law and test the bounds of new chemicals — with often deadly results.
"Cocaine is cocaine ... all the time, and it's always illegal," says Jill Head, a senior forensic chemist with the Drug Enforcement Agency. "But these products are continuously changing ... so what we see this week can be very different from what we're going to see a month from now."
This is a problem for police, prosecutors and the DEA, which is trying to track what the drugs are and where they come from.
Making matters worse, the compounds in the drugs aren't necessarily illegal. Because the components keep changing, drug makers can stay one step ahead of law enforcement. Even on a rush basis, it can take months to get a compound banned as a controlled substance. The DEA has gotten three compounds put on the list so far, but the agency's chemists have identified more than 60 in the past two years.
"Basically, we're playing whack-a-mole," says Arthur Berrier, a senior research chemist for the DEA. "They make one drug ... or one compound, and we smack it down, and the next week, something else pops up."
Now the scientists at a DEA lab in Northern Virginia are doing something unusual: They're making their own bath salts.
Berrier tells Sullivan that in order to fully identify a compound, scientists need what is called standard material, or an authenticated drug with a known structure.
"So typically what we would do is if we identify something in a bath salt material, we'd have to have a standard [to compare it to] to really identify it," he says.
The compounds scientists are finding are generally legal compounds not specifically controlled by the DEA, Berrier says. They show up in gas stations, pipe shops and all over the Internet as plant food, incense, hookah cleaner and, of course, bath salts.
Berrier says sometimes store owners know that what they're selling is really drugs, but sometimes they don't. The key for drug seekers is small packaging and the phrase "not for human consumption," which is supposed to hint at the opposite.
"[But] there's no legitimate use for these particular compounds that we know of," Berrier says.
What DEA chemists are doing in beakers, bath salt makers are doing in vats. Officials believe many of those facilities are in China, India and Pakistan. Producers ship the drugs in bulk to the U.S., where officials suspect the final mixing and packaging is done.
To try to bring criminal cases against suppliers, sellers and users of what are essentially legal compounds, the DEA and prosecutors have had to reach way down into the annals of the nation's drug laws.
DEA lab director Jeff Comparin tells Sullivan that the challenge is that if a substance is not specifically listed in Title 21 of U.S. Code, which governs food and drugs, it can be classified as legal — but there's a loophole.
"Because of the nature of the structure, the way the chemicals are designed, the controlled-substances act also has a clause called the 'analog' part, where we can try these chemicals as if they were a controlled substance," Comparin says.
That means the agency can try to show the user or supplier intended to ingest or sell the product as a drug — usually through circumstantial evidence. Comparin says the DEA has successfully prosecuted some analog cases.
This trend of synthetic drugs is new and developing, Comparin says, and it's hard to say how long it will last.
"Who's to say what effect the ultimate control of these chemicals will have on their continued manufacture, importation and trafficking in the U.S.?" he says. "But as you can see right now, we just detect the new compounds and address the threat as best we can."
Just this week, Congress moved to ban more of the compounds the DEA's lab has identified. In the meantime, officials are hoping users will realize that if scientists in the nation's drug lab can't keep up with what drug manufacturers are making, users shouldn't be so sure what they're getting.
LAURA SULLIVAN, HOST:
This is WEEKENDS on ALL THINGS CONSIDERED from NPR News. I'm Laura Sullivan, in for Guy Raz.
A little over two years ago, Dr. Corey Hebert was manning the ER at Tulane University Medical Center in Louisiana when a patient was rushed through the door.
DR. COREY HEBERT: This guy, he was 24 years old, extremely agitated. He came in with hallucinations. He kept seeing things on the wall.
SULLIVAN: Dr. Hebert figured drugs, probably PCP or a stimulant. But then a few minutes later...
HEBERT: He was very paranoid, but he started doing some self-mutilating actions, meaning that he was pulling out his eyebrows and pulling out his eyelashes.
SULLIVAN: Hebert thought marijuana, methamphetamine? But then...
HEBERT: They would go in and out of lucidity. So it was an odd thing because he had every different type of drug toxicity, but nothing that we could pinpoint directly.
SULLIVAN: His drug scan showed up clean. Hebert called in his colleagues.
HEBERT: It's very rare to see five doctors in a room puzzled.
SULLIVAN: Then one of the 24-year-old's friends stepped forward.
HEBERT: And said, you know, he bought this stuff and we bought it at this head shop. It was some kind of thing called vanilla sky. He snorted it and he's just not been the same. He's not been the same for 12 hours. And that's when we got very nervous. Twelve hours of a high and you don't know really what it was that you snorted, that's a scary, scary thing and that's when we knew this is going to be a problem.
SULLIVAN: In the months that followed, Dr. Hebert's emergency room became ground zero for a new kind of drug called bath salts. And emergency rooms nationwide quickly followed suit. That's our cover story today: the emergence of synthetic drugs made in labs, produced in vats, sold in gas stations designed specifically to skirt the nation's drug laws often with deadly results.
(SOUNDBITE OF MUSIC)
SULLIVAN: Bath salts have nothing to do with what you would actually put in a bath, and they're not one drug. It's a family of compounds hard to detect and easy to alter to stay ahead of law enforcement. Two years ago, poison control centers had 304 calls for bath salts, nearly a third of them were from Louisiana. Last year, there were more than 6, 000 calls.
Inside a little-known lab in Northern Virginia, scientists with the Drug Enforcement Agency are on the front lines of a new war. This is not like the drugs of the past 40 years. Take cocaine made from a plant.
JILL HEAD: So the leaves that are there in that first picture have been harvested.
SULLIVAN: Jill Head is a senior forensic chemist here, and she's standing in front of a wall of photos in the hallway.
HEAD: So they pick them from the fields and from the plants. And then in that next picture, the leaf was ground up.
SULLIVAN: There's a guy standing in the pile with a weed eater. The next photo shows him pouring gasoline on the pile.
HEAD: Something that can extract out or pull out those cocaine alkaloids and pull the cocaine out of the leaf.
SULLIVAN: Get rid of the gasoline...
HEAD: And so they have to then press out all of those solvents and dry the brick.
SULLIVAN: Like squeeze it.
HEAD: That's exactly what they're doing. So they're squeezing it to get rid of all that solvent so that we get dry powder as a finished product.
SULLIVAN: And then they wrap it up and it's ready to be shipped.
SULLIVAN: A natural process. But walk into the labs of the DEA where scientists are trying to figure out what bath salts are made out of, and it's an entirely different process. Instead of weed eaters and leaf piles in the jungle, there are beakers and burners and industrial labs and usually advanced degrees in chemistry, chemists who know how to move a single molecule to alter a drug.
HEAD: That's how it's different from cocaine.
SULLIVAN: Again, scientist Jill Head.
HEAD: Cocaine is cocaine all the time. It's always illegal. But these products are continuously changing to skirt the law. So what we see this week can be very different from what we're going to see a month from now.
SULLIVAN: It's a problem for police, for prosecutors, for companies that want to drug test employees and for the DEA, which is trying to track what the drugs are and where they come from. And making matters worse, the compounds in the drugs aren't necessarily illegal. Because they keep changing, drug makers can stay one step ahead of law enforcement.
Even on a rush basis, it can take months to get a compound banned as a controlled substance. The DEA has gotten three compounds put on the list so far, but chemists in this lab have identified more than 60 in the past two years. So the scientists here are doing something you might not expect from the Drug Enforcement Agency: They're making drugs.
ARTHUR BERRIER: Arthur Berrier, a senior research chemist. I make drugs.
SULLIVAN: Arthur Berrier looks over the shoulder of one of his chemists making the latest bath salt.
BERRIER: Basically, we have a flask in there that contains the solvent in the drug. And what we're doing is we're applying a vacuum to it and a little bit of heat, and the solvent evaporates and collects over here. And then when all the solvent's gone, Donald just simply have his drug in the flask there.
SULLIVAN: What do you make?
BERRIER: We make all these drugs that we're seeing. In order to fully identify a compound, we need what we call a standard material, which is an authenticated drug that we know the structure of. So typically, what we would do, if we would identify something in a bath salt material, we'd have to have a standard to really identify it. So we make standards here.
SULLIVAN: And the compounds are generally legal compounds.
BERRIER: They're not specifically controlled, yes.
SULLIVAN: They show up in gas stations, in pipe shops, mom and pop stores and all over the Internet as plant food, incense, hookah cleaner, bath salts. Berrier says sometimes store owners know what they're selling is really drugs, but sometimes they don't. They key for drug seekers is small packaging and the phrase not for human consumption, which is supposed to hint at the opposite.
Do those compounds have any actual use in the world?
BERRIER: Just to get high. There's no legitimate use for these particular compounds that we know of.
SULLIVAN: So do you ever think about your counterparts in a lab somewhere across the world?
BERRIER: Yeah, all the time.
SULLIVAN: What do you think?
Well, I - they do a pretty good job at it. They're just doing different things.
So they're making what he does in beakers, they're making in vats.
BERRIER: Yes, exactly. So they're using a chemical processing facility.
SULLIVAN: Law enforcement officials believe many of those industrial facilities are in China, India and Pakistan. Producers ship the drugs in bulk to the United States, and officials suspect the final mixing and packaging is done here. To try to bring criminal cases against suppliers, sellers and users of what are essentially legal compounds, the DEA and prosecutors have to reach way down into the annals of the nation's drug laws. Jeff Comparin runs the DEA's lab.
JEFF COMPARIN: There's a challenge when we, as a Drug Enforcement administration try to enforce the nation's drug laws, Title 21 of United States Code, if it's not specifically listed in that code, it can be classified as legal, not unlawful. But because of the nature of the structure, the way these chemicals are designed, the Controlled Substances Act also has a clause called the analog part where we can try these chemicals as if they were a controlled substance.
SULLIVAN: In other words, the analog part, it means they can show the user or supplier intended to ingest or sell a legal product as a drug, usually with circumstantial evidence, which is difficult for prosecutors.
Have you been able to bring any cases yet successfully using this analog law?
COMPARIN: Yes. The agency has successfully prosecuted some analog cases.
SULLIVAN: How do you differentiate someone who is making plant food that is meant to be used as a drug and somebody who's making plant food?
COMPARIN: Wow. I think the catchy marketing terms, like plant food or electronics cleaner, that's all code. And the fact that they say not for human consumption, they don't really mean that. It's vastly different from the plant food you can buy at a garden store.
SULLIVAN: In terms of like fighting the war on drugs, is this the future? Is this where we're headed?
COMPARIN: Were certainly in the midst of this trend right now. I don't know how long it'll last. Who's to say, you know, what effect the ultimate control of these chemicals will have on their continued manufacture and importation and trafficking in the U.S.? But as you can see right now, we just detect the new compounds and address the threat as best we can.
SULLIVAN: It seems like the fight against illegal drugs has been the same for 40, 50 years, really, since the 1960s. And all of a sudden now it's synthetic drugs, which is totally different for you guys.
COMPARIN: It's relatively quiet, like you mentioned, for a long time with just the standard heroin, cocaine, meth and marijuana problems, you know, occasional LSD breakout every now and then. But this is new and developing for us. We seem to be in the midst of this synthetic trend, and it's hard to say how long it will last. But you can certainly recognize the impact just by the sheer number of increase in poison control calls that come in. You know, somebody's ingested something and they're reacting badly. Hospital room reporting, emergency departments, those calls are up.
SULLIVAN: Do you think that there could be a time when it becomes difficult to make drugs illegal if this trend continues where the compounds change so fast that there's just no way to make them illegal anymore?
COMPARIN: That's hard to say. You would think that there would be an end point to discovery of, you know, the sheer number of compounds that would be active on the human body, that somebody would want to abuse to feel different to alter their state. So you think there would be an end point somewhere. And if that's the case, we could identify and control those substances.
SULLIVAN: What if you can't find that end point?
COMPARIN: Hire more guys like Arthur until we get there.
SULLIVAN: But even chemist Arthur Berrier is frustrated by how quickly the drug is constantly changing.
BERRIER: Basically, we're playing whack-a-mole, you know? They make one drug or one compound, and we smack it down. And then the next week, something else pops up, and we smack that one down. And then the third week, something else pops up.
SULLIVAN: Just this week, Congress moved to ban more of the compounds this lab has identified. In the meantime, officials are hoping users will catch on that if even the scientists in the nation's drug lab can't keep up with what drug manufacturers are making, users shouldn't be so sure what they're getting either.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.