Changing trends in drug abuse present diagnostic and therapeutic challenges in psychiatry. Issues surrounding synthetic stimulants highlight a convergence of both new and old clinical problems. Although "bath salts" (or "plant food"), named for their white crystalline-pellet appearance, are the latest class of widely available abusable substances, they have ancient, natural origins. The majority of psychoactive substances in these products are cathinones-derivatives of phenethylamines found in the khat (also gat and qat) plant, Catha edulis. Natives of East Africa and the Arabian Peninsula have chewed the leaves of this shrub for centuries to experience a combination of stimulation and relaxation in a manner that is at least widely tolerated, if not socially sanctioned. Interestingly, the demographic group that indulges in this practice in Ethiopia, Egypt, Saudi Arabia, and elsewhere is analogous to those who most commonly abuse synthetic derivatives of the same in the West-mostly unmarried men in their early 20s to late 30s.
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