Bath salt use in the military: Experiences with synthetic cathinone use among justice-involved Veterans.

Introduction: Ring-substituted cathinone derivatives emerged in Europe in the mid-2000s. These synthetic stimulants, colloquially called bath salts, reached the United States and Canada around 2008 and may have been disproportionately used by populations facing strict screening programs for traditional recreational drugs. Military personnel in most countries are subject to frequent drug tests, but the hypothesis that routine drug screens affect bath salt use decisions within the military has not been assessed. Methods: Between 2016 and 2018, 312 U.S. Veterans charged by civilian authorities with a criminal offence were interviewed. Respondents were drawn from eight sites within three states. Results: Bath salt use was reported by 2.3% of the sample. Instrumental reasons for use (increasing focus and staying awake) were commonly reported, followed by recreational purposes. All bath salt users reported extensive prior substance use histories. Qualitative analysis of responses identified four major themes: 1) bath salt use is limited (to one event or a brief time frame), 2) bath salts are associated with an intense effect relative to other drugs, 3) bath salts are perceived as a passable substitute for cocaine or methamphetamine, and 4) drug testing policies did not affect bath salt use. Discussion: Even among Veterans with extensive substance use histories, bath salt use is limited. There was no indication bath salt users were actively trying to elude detection in the military. This suggests current testing programs are not leading service members to substitute potentially more risky drugs for traditional substances.