Analysis of Synthetic Cathinones Commonly Found in Bath Salts in Human
Performance and Postmortem Toxicology: Method Development, Drug Distribution
and Interpretation of Results
Laureen J Marinetti* and Heather M Antonides
Montgomery County Coroner’s Office (MCCO)/Miami Valley Regional Crime Laboratory (MVRCL), Dayton, Ohio
*Author to whom correspondence should be addressed. Email: firstname.lastname@example.org
To date, the Toxicology Section of the Montgomery County
Coroner’s Office/Miami Valley Regional Crime Laboratory has
identified six synthetic cathinones, commonly found in bath salt
products, in 43 cases. Thirty-two cases will be reviewed here, in-
cluding all of the postmortem cases, all of the human performance
cases that had blood specimens submitted, and one urine-only
human performance case. The following compounds have been
confirmed: 3,4-methylenedioxypyrovalerone (MDPV), 3,4-methylene-
dioxymethcathinone (methylone), pyrovalerone, pentylone, alpha-
pyrrolidinopentiophenone (alpha-PVP) and methedrone. The method
also screens for mephedrone, butylone and 3-fluoromethcathinone.
Case demographics show 42 white males and females ranging in
age from 19 to 53 years. The remaining case was that of a 34-year-
old Hispanic male. The 43 cases represent 17 driving under the
influence, two domestic violence, four suicides, 12 overdoses, six
accidents, one drug-facilitated assault and one homicide. Data
will be presented on the distribution of some of these cathinones
in various matrices. After review, blood concentration does not
appear to predict outcome regarding fatalities or impairment. The
highest MDPV concentration occurred in a suicide by hanging and
the highest methylone concentration was in a driver. The confirm-
ation method is a liquid–liquid extraction with detection by liquid
chromatography triple quadrupole mass spectrometry using electro-
spray ionization in multiple reaction monitoring mode.
Cathinone is a naturally occurring beta-ketone amphetamine
analogue present in the leaves of the Catha edulis plant.
The synthetic cathinones are derivatives of this compound
(Figure 1). Recreational use of synthetic cathinones is relatively
new to the United States (US), commencing in approximately
2009. They are marketed as research chemicals, bath salts,
jewelry cleaner, ice melter, hookah pipe cleaner or plant food,
with the words “not for human consumption” printed on the
label. Most of the synthetic cathinone supply originates in China
or India; however, where it enters the US, or if it is also manu-
factured here, is not clear (1). The synthetic cathinones are mar-
keted to drug users as legal alternatives to methamphetamine,
cocaine or 3,4-methylenedioxymethamphetamine (MDMA). Syn
-thetic cathinones are usually in the form of white or off-white
powder or small candy-like objects that are supplied in small
plastic containers or small Ziploc bags. Users generally snort,
inject, smoke or orally consume synthetic cathinones.
The desired effects of synthetic cathinones are euphoria,
rush, alertness, talkativeness, sexual arousal, focused mind and
an overall positive feeling. The effects occur within 30 to
45 min of administration and the desired effects last from 1 to
3 h; however, the undesirable side effects of synthetic cathi-
none use can last from hours to days. The side effects are
neurological and cardiovascular in nature and include the fol-
lowing: anxiety, insomnia, fatigue, mydriasis, agitation, aggres-
sion, combative behavior, panic, disorientation, confusion,
memory loss, blackouts, myoclonus, excited delirium, paranoia,
hallucinations, increased suicidal ideations, chest pain, tachy-
cardia, breathing difficulties, hyperthermia, sweating and hy-
pertension. Local hospital emergency room staff and first
responders have reported that synthetic cathinone users are
often violent and uncontrollable, exhibiting paranoid behavior
and delusions. The synthetic cathinone users have physically
attacked the first responders, biting and hitting them (2, 3).
Examples of paranoid or odd behavior that have been reported
include swimming in a snow bank to get away from snipers
and believing people were hiding in walls. One user broke into
a home, decorated it with Christmas decorations, then sat
down and watched television (3–7). The behavior of synthetic
cathinone users is similar to behavior exhibited by users of
methamphetamine, cocaine, phencyclidine (PCP) and/or lyser-
gic acid diethylamide (LSD), or in those suffering from excited
delirium syndrome. When treating these users, common
methods of chemical submission are often not effective, thus
making treatment a challenge.
The first Montgomery County Coroner’s Office (MCCO)/
Miami Valley Regional Crime Laboratory (MVRCL) case in
which synthetic cathinones were detected in biological speci-
mens was a driving under the influence (DUI) fatality in March
2011. Since that time, 42 additional cases involving synthetic
cathinone use have been confirmed in postmortem and human
performance specimens, including data from an embalmed
body. The Chemistry Section of the MVRCL also began receiv-
ing submissions of products containing synthetic cathinones in
early 2011. Working together with the Chemistry Section, au-
thentic standards were obtained for as many of the synthetic
cathinones as possible to identify them in both dosage form
and in toxicology casework. The most prevalent synthetic cath-
inones identified by the Chemistry Section were incorporated
into a method by the Toxicology Section to screen blood,
urine and other biological specimens.
Initially, local hospitals were averaging one admission per
day due to synthetic cathinone use. Once some of the synthet-
ic cathinones were controlled in the fall of 2011, the incidents
dropped to one per week (2). Ohio state law has scheduled six
synthetic cathinones in Schedule I: 3,4-methylenedioxymeth-
cathinone (methylone), mephedrone, 3,4-methylenedioxypyrovaler-
one (MDPV), methedrone and 3- and 4-fluoromethcathinone.
# The Author . Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com
Journal of Analytical Toxicology 2013;37:135–146
doi:10.1093/jat/bks136Advance Access publication January 29, 2013
Federal law has scheduled methylone, mephedrone and MDPV in
Schedule I and pyrovalerone in Schedule V.
In addition to the scheduled cathinones, the Toxicology
Section has encountered cases with the unscheduled synthetic
(alpha-PVP) (8). The MVRCL Chemistry Section has encoun-
tered cases with several more synthetic cathinones than those
listed previously, including: 4-methylethcathinone (4-MEC),
pentedrone, 4-methyl-alpha-pyrrolidinopropiophenone (MPPP)
and 5,6-methylenedioxy-2-aminoindane (MDAI). Purchasing
certified standards to confirm and quantify every synthetic
cathinone can be difficult and expensive. New chemicals are
evolving regularly; the trend seems to indicate that the illicit
manufacturers will simply move on to another similar chemical
or isomer that is not yet controlled.
The MCCO/MVRCL Toxicology Section performs analyses in
both human performance and postmortem forensic toxicology.
Cases are received from the southern half of the state of Ohio,
which includes urban, suburban and rural areas. The majority
of the presented cases originated from suburban or rural areas.
The toxicology analyses of each case included: volatile analysis
to include methanol, ethanol, isopropanol and acetone; an
enzyme-linked immunoassay (ELISA) screen comprised of am-
phetamine, methamphetamine, barbiturates, benzodiazepines,
cannabinoids, carisoprodol, cocaine metabolites and opiates; a
basic drug screen by gas chromatography–mass spectrometry
(GC–MS) on blood, urine or liver. Cases that had a history indi-
cative of synthetic cathinone use or in which subject behavior
suggested synthetic cathinone use were analyzed by the liquid
chromatography–mass spectrometry-mass spectrometry (LC–
MS-MS) confirmation method, independent of the GC–MS drug
screen findings. The synthetic cathinones were not always
detected in the GC–MS drug screen due to the limit of detec-
tion of this method for these chemicals. Meyer et al. also found
that to reliably detect some synthetic cathinone metabolites by
GC–MS, enzyme digestion and derivatization were required
(9). MDPV could be detected by GC–MS down to 10 ng/mL. In
addition, GC–MS also detected the high methylone case and
the alpha-PVP cases. To avoid missing low concentrations of
synthetic cathinones, it is best not to rely solely on a GC–MS
drug screen for detection. Mass spectral data from the GC–MS
basic drug screen to include the total ion chromatograph
(TIC), library matches, and ions from 3 mL of blood and the
TIC from 2 mL of urine from Postmortem Case 1 is shown in
Figures 2A and 2B, respectively. Figure 3 shows the basic drug
screen of 2 mL of urine from Postmortem Case 16, including
the TIC and ions and library matches of both pentylone and
MDPV. As shown in Figures 2A and 3, the higher concentra-
tions of pentylone and methylone were detected by spectral
library match. However, although pyrovalerone was confirmed
in Case 16 by LC–MS-MS, it was not detected in the GC–MS
basic drug screen in the urine.
The analytical method was developed by a modification of
the Toxicology Section’s current sympathomimetic procedure
using literature published by Meyer et al. and Katagi et al.
(10–12). Whole blood, plasma, urine, vitreous, cerebrospinal
fluid (CSF), bile and tissue homogenates were analyzed in this
procedure. MDPV, methylone, methedrone, mephedrone, buty-
lone, pyrovalerone and 3-fluoromethcathinone were extracted
into an organic solvent from an alkalinized specimen. The
organic solvent was reduced to residue, reconstituted with
methanol, and injected onto an Agilent 6410 LC–MS-MS instru-
ment. Detection and quantitation were performed in the mul-
tiple reaction monitoring (MRM) mode. Time segments were
determined by the specific column and instrument conditions,
with a total run time of 12 min. In addition, pentylone and
alpha-PVP ions were included in the method to screen all cases
for these chemicals. The lab is currently awaiting the availabil-
ity of a certified standard to quantify pentylone and alpha-PVP.
A limited quantity of authentic standard for pentylone and
alpha-PVP was obtained from standards purchased by the
Figure 1. Cathinone and synthetic cathinone structures.
Marinetti and Antonides
Table III Continued
CaseAge/gender/race/COD SynopsisToxicology (ng/mL)Distribution (ng/mL or ng/g)
Autopsy findings: cervical pressure
furrow and pulmonary congestion
The decedent was found dead, hanging from an electrical
cord on a fence in a field. He had a recent falling out with
his girlfriend and his brother. He was a heavy bath salt user
and has had multiple interactions with local police.
Chlorpheniramine , 50
Heart blood: 133
CSF . 200
Bile . 200
Heart blood: 56
Perforated esophageal ulcer
The decedent was found lying unresponsive and nude in an
empty bathtub. There was no sign of trauma. A jar of K-2
spice herbal incense was present. He had overdosed on K-2
three weeks ago. He had a history of drug abuse and had
recently been released from a drug rehabilitation center.
BE . 1,000
Dextromethorphan , 50
Midazolam , 10
Hydromorphone , 5
Ethanol: 0.012 g/100 mL
Amphetamine , 50
Urine also contained MDPV
Multiple drug intoxication
The decedent had a history of CHF, COPD, diabetes,
hypertension, was oxygen dependent, and had bipolar
disorder. She was found unresponsive.
She was initially released as a natural death until adult
children and a sister alleged the decedent’s husband had
caused her death by choking her or by an overdose of
medication. The body was embalmed.
Autopsy findings: several large B/L
PEs and chest wall contusions
The decedent was involved in a minor car crash. He did not
seek medical help for 2 days. He then went to ER for
headache and chest pain. He was given Vicodin and sent
home. Five days later he has increasing SOB, went to the
ER and died after intubation in the ER. He was known to use
marijuana and prescription medications recreationally.
Urine . 200
The decedent was last known alive when he went upstairs
to his room. The next morning he was found suspended
from a pole attached to his bed by a rope. It was reported
by his brother that he had been using bath salts and there
was evidence of cross-dressing.
Heart blood: 59
All positive for pentylone: waiting for
standard to be able to quantify
The decedent was discovered suspended by a braided rope
from a tree. He reportedly abused Vicodin, Percocet, cocaine
and bath salts. Several suicide notes were discovered in his
The decedent had a history of bipolar disorder, previous
attempted suicide, abuse of Oxycontin and was on
numerous medications. There was also a past history of
domestic violence. Her boyfriend admitted that he had been
abusing bath salts.
MDPV was the only drug detected
Multiple drug intoxication
Hydrocodone : 29
Clonazepam , 10
Codeine , 20
Multiple drug intoxication
The decedent was a known abuser of multiple drugs
including intravenous drug abuse. She had earlier stated that
she wanted to “party.” She was found unresponsive in bed.
A spoon with residue and a syringe with what appeared
to be blood were found in her vehicle at the scene.
Multiple drug intoxication
The decedent was found unresponsive on a sofa in her living
room. She had a history of heroin abuse.
All were positive
Analysis of Synthetic Cathinones Commonly Found in Bath Salts in Human Performance and Postmortem Toxicology 145
The authors would like to thank Brooke Ehlers and Jennifer
Watson, chemists in the MVRCL Chemistry Section, for all of
their help and the sharing of their authentic synthetic cathi-
none standards. The authors would also like to thank MCCO
forensic toxicologist Elizabeth Kiely for all of her editing assist-
ance with this manuscript.
1. Microgram Bulletin. (2011); 44(9).
2. Meetings of: The Designer Drugs Task Force, Greater Dayton Area
Hospital Association, Fall 2011 and Jan 2012.
3. Decker, T. (2011) Docs glad “bath salts” are banned. Columbus
Dispatch, Oct 18.
4. Caudill, M. (2011) Police deal with new bath salt drug threat. News
Journal, Jan 30.
5. Caulfield, P. (2011) Burglar high on bath salts breaks into home,
puts up Christmas decorations. New York Daily News, Nov 14.
6. Smith-Hebson, B., Frolik, C., Larsen, D. (2011) Bath salt, spice injur-
ies steady as Ohio ban nears. Springfield News-Sun, Sept 8.
7. Marinetti, L., Antonides, H., Watson, J. (2011) More on bath salts.
Tox Talk, 36, 11–13.
8. Maurer, H.H., Kraemer, T., Springer, D., Staack, R.F. (2004)
Chemistry, pharmacology, toxicology, and hepatic metabolism of
designer drugs of the amphetamine (ecstasy), piperazine, and pyr-
rolidinophenone types—A synopsis. Therapeutic Drug Monitoring,
9. Meyer, M.R., Peng, D., Schuster, F., Maurer, H.H. (2010) Studies on
the metabolism of the alpha-pyrrolidinophenone designer drug
methylenedioxy-pyrovalerone (MDPV) in rat and human urine and
human liver microsomes using GC-MS and LC-high-resolution MS
and its detectability in urine by GC-MS. Journal of Mass
Spectrometry, 45, 1426–1442.
10. Kiely, E., Lee, C.J., Marinetti, L. (2009) A fatality from an oral ingestion
of methamphetamine. Journal of Analytical Toxicology, 33, 557–560.
11. Katagi, M., Zaitsu, K., Shima, H., Kamata, T., Kamata, K., Nakanishi,
H. et al. (2010) Metabolism and forensic toxicological analyses of
the extensively abused designer drug methylone. TIAFT Bulletin,
12. Meyer, M., Peters, F., Maurer, H. (2010) Detection of beta-keto
amphetamines in urine within the systematic toxicological analysis
(STA) using GC-MS. TIAFT Bulletin, 40, 36–38.
13. Sørensen, L.K. (2011) Determination of cathinones and related
ephedrines in forensic whole-blood samples by liquid-chromatography-
electrospray tandem mass spectrometry. Journal of Chromatography
B, 879, 27–36.
14. Logan, B.K., Couper, F.J. (2003) 3,4-Methylenedioxymethamphetamine—
Effects on human performance and behavior. Forensic Science Review,
15. Isenschmid, D.S. (2002) Cocaine—Effects on human performance
and behavior. Forensic Science Review, 14, 91–92.
16. Logan, B.K. (2002) Methamphetamine—Effects on human perform-
ance and behavior. Forensic Science Review, 14, 141–143.
17. Brandt, S.D., Sumnall, H.R., Measham, F., Cole, J. (2010) Analyses of
second-generation “legal highs” in the UK: Initial findings. Drug
Testing and Analysis, 2, 377–382.
18. Kasick, D.P., McKnight, C.A., Klisovic, E. (2012) “Bath salt” ingestion
leading to severe intoxication delirium: Two cases and a brief
review of the emergence of mephedrone use. American Journal
of Drug and Alcohol Abuse, 38, 176–180.
19. Spiller, H.A., Ryan, M.L., Weston, R.G., Jansen, J. (2011) Clinical ex-
perience with and analytical confirmation of “bath salts” and “legal
highs” (synthetic cathinones) in the United States. Clinical
Toxicology (Philadelphia), 49, 499–505.
20. Lo ´ pez-Arnau, R., Martı´nez-Clemente, J., Pubill, D., Escubedo, E.,
Camarasa, J. Comparative neuropharmacology of three psychosti-
mulant cathinone derivatives: Butylone, mephedrone and methy-
lone. British Journal of Pharmacology, April 18, 2012.
21. Prosser, J.M., Nelson, L.S. (2012) The toxicology of bath salts: A
review of synthetic cathinones. Journal of Medical Toxicology, 8,
Table III Continued
Case Age/gender/race/CODSynopsisToxicology (ng/mL)Distribution (ng/mL or ng/g)
Autopsy findings: 3 GSWs to the
torso and left hand
The decedent had a past prison history. He stole a police
car, was chased, escaped and when found was shot by
BE , 50
22The decedent resided with his girlfriend and was last known
to be alive when they argued. He was found in the
basement hanging from his neck by a rope through the
The decedent was a morbidly obese, known drug user who
was found unresponsive on the floor at home. She was
taken to the ER and pronounced. Drugs and paraphernalia
were found in her pockets to include heroin and bath salts.
Multiple drug intoxication
Autopsy findings: cardiomegaly and
findings consistent with an overdose
Nordiazepam: 12 ng/mL
Free morphine: 37 ng/mL
Dextromethorphan not detected
6-MAM: 7 ng/mL in vitreous
*Note: white (W), Hispanic (H), male (M), female (F), atherosclerotic cardiovascular disease (ASCVD), chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), bilateral (B/L), not
available (NA), pulmonary emboli (PE), diphenhydramine (DPH), benzoylecgonine (BE), not detected (ND), 6 monoacetyl morphine (6-MAM), gunshot wounds (GSWs), unsuitable specimen for analysis
(UNS), shortness of breath (SOB), Hypertension (HTN).
Synthetic Cathinone Distribution (ng/mL or ng/g)
VitreousLiver BrainBile CSF Spleen
n ¼ 13
14 to 940
n ¼ 1
n ¼ 8
12 to 6,080
n ¼ 1
n ¼ 6
16 to 896
n ¼ 1
n ¼ 3
140 to 1,880
n ¼ 1
n ¼ 4
14 to 105
n ¼ 0
n ¼ 1
n ¼ 0
Marinetti and Antonides