Transcript Methamphetamine Abuse: Is This Increasing the Strain on Rural

Methamphetamine Abuse:
Is This Increasing the
Strain on Rural
Healthcare?
Kevin D. Brooks
Advisor: Dr. Bill Grimes
Current Rural Healthcare Strains
• Mal-distribution of healthcare
professionals in rural areas
• Providers in Rural Areas
• Lowered Socioeconomic Status
Quick Methamphetamine History
• 1950’s – OTC treatment for Asthma
• 1960’s – Used therapeutically to elicit weight loss in obese persons
• 1970’s – Government restrictions on methamphetamine
manufacturing and selling increase and “underground” laboratories
emerge as main production method
• Late 1970’s – Recreational use begins on West Coast and moved
Eastward, eventually stalling in Midwestern and Eastern U.S.
• Today – Methamphetamine derivatives are used to treat narcolepsy
and Attention-Deficit Disorder
Why the Stall in Rural America?
• Illegal Clandestine Laboratories
• Drug Effects
How Does it Work?
Clinical Implications
• Cardiovascular
• Mental Disturbances
• Dental Complications (Meth Mouth)
• Electrolyte Abnormalities
• Pulmonary complications
• Infectious Disease
Social Implications
• Toxic exposure to family members
and neighborhoods
• Users often lose control of their lives
Shifting Gears
• What does this mean for Rural
Healthcare?
• How is my Specialty Affected?
• What Can we do about this problem?
Pediatric Medicine
• Quick Stat – “During 2002, more than 2,000 children
were reported living in a house or apartment with a meth
lab: 1,300 were exposed to toxic chemicals; 26 were
injured and 2 were killed” (ASTHO, 2005).
Emergency Medicine
• Quick Stat – Over 10,000 emergency room visits per
year can be attributed to methamphetamine (A&E
Documentary)
OB/GYN Medicine
• - Quick Stat – babies born to methamphetamine user
mothers are 3-3.5 times more likely to be born
underweight (Osterweil, www.brown.edu, 2006)
Psychiatric Medicine
• Self-Induced schizophrenic symptoms (hallucinations and delusions)
• Pediatric developmental and learning disabilities
• Increased need for Adolescent psychiatric services
Primary Care
• “The Gateway to Healthcare”
• Will potentially handle all aspects of healthcare
aforementioned
• Be ready for all aspects of healthcare in which
Methamphetamine effects.
What Has Been Done?
• March 2006, Combat Methamphetamine Epidemic Act implemented
which “bans the over-the-counter sales of cold medicines that
contain the ingredient pseudoephedrine, which is commonly used to
make methamphetamine” (FDA website, 2006)
• Methadone used as treatment for methamphetamine addicts, but
currently ~$13 a dose and usually requires patient to take the drug
at the clinic, because of high abuse potential.
• Some State Medicaid programs cover Methadone treatment, KY
DOES NOT
What Can We (as providers) Do ?
•
As Dr. Grimes would say, “BE AN ASTUTE PA!!”
- Be aware of the signs and symptoms of methamphetamine use (i.e. odors,
crank bugs, etc.)
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Obligations to Report
- HIPPA Guidelines mandate that any comments made by a patient during a
visit, which jeopardize the health and well-being of the patient or others,
must be reported
•
The use of a practitioners clinical judgment is the key factor to detecting and
reporting potentially hazardous methamphetamine problems
Suggestions
• Possible establishment of healthcare provider
educational programs in conjunction with local law
enforcement agencies could more thoroughly alert
healthcare providers to the “Red Flags” of
methamphetamine abuse
• Educational pamphlets in provider waiting rooms, could
educate patients to the problem of methamphetamine,
as well as provide information for reporting
methamphetamine related incidents in the community
Summary
• Methamphetamine is a dynamic problem that threatens
to heavily impact healthcare delivery in rural areas of
America.
• All areas of medicine hold stake in the management of
methamphetamine use and abuse in rural areas.
• With proper recognition and treatment, the healthcare
system of rural America can help to thwart the influence
of methamphetamine in the rural areas of America, areas
already in desperate need of medical services.
References
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Association of State and Territorial Health Officials. (2005). Cleaning-up clandestine
methamphetamine labs: the role of state public health agencies. Washington,
DC: Author, 1-5.
Brown University. (2006). Methamphetamine use stunts fetal growth, study finds.
Retrieved September 6, 2006, from http//www.brown.edu.
Cline, S. J. (2005, Fall). Illegal methamphetamine laboratories as a public health hazard. Popular
Government, 24-28.
Derlet, R. (2006, July). Toxicity, methamphetamine. Retrieved January 24, 2007, from
http://www.emedicine.com.
Elmore, L. (2005, Fall). Protection of children exposed to methamphetamine
production. Popular Government, 28-30.
Hetzel, F.R. (2005, Fall) Law enforcement’s response to the spread of
methamphetamine Use. Popular Government, 31-35.
Hollins, B. (2007, January). Drugs of abuse. Lecture presented to the University of Kentucky
Physician Assistant Program, Lexington, KY.
Intercultural Cancer Council. “Rural Healthcare” (date unknown).
http://iccnetwork.org/cancerfacts/cfs6.htm (accessed March 16, 2006).
McCarty, D.,Frank, R.G., Denmead, G.C. (1999). Methadone maintenance and state
Medicaid managed care programs. The Milbank Quarterly, 77, 341-362.
McKetin, R., McLaren, J., Lubman, D.I., Hides, L. (2006). The prevalence of psychotic
symptoms among methamphetamine users. Addiction, 101, 1473-1478.
References cont.
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Methamphetamine use in America. (2006, September 23) An A&E documentary.
[Television Broadcast].
Narconon of Southern California.(date unknown). Meth statistics. Retrieved January 24,
2007, from http://www.drug-statistics.com/meth.
O’Dea, P.J., Murphy, B., Balzer, C. (1995). Traffic and illegal production of drugs in
rural America. Drug Enforcement Administration. Arlington, VA, 79-89.
Osterweil, N. (2006). Methamphetamine stunts fetal growth. Retreived November 3,
2006 from http://www.medpagetoday.com/OBGYN/Pregnancy/tb/4058.
Romanelli, F. (2006, July). The latest rave: sextasy, crystal, and other club drugs. Lecture
presented to University of Kentucky Physician Assistant program, Lexington,
KY.
Shi, L., Singh, D. 2005. Essential of the US healthcare delivery system.
Massachusetts: Jones and Bartlett Publishers.
U.S. Food and Drug Administration. (2006). Legal requirements for the sale and purchase
of drug products containing pseudoephedrine, ephedrine, and
phenylpropanolamine. Retrieved February 21, 2007, from
http://www.fda.gov/cder/news/methamphetamine.htm.
Vogt, T.M., Perz, J.F., Van Houten, C.K., Harrington, R., Hansuld, T., Bialek, S.R., et al.
(2006). An outbreak of hepatitis B virus infection among methamphetamine
injectors:the role of sharing injection drug equipment. Addiction, 101, 726-730.
Questions?