Methamphetamine Abuse: Methamphetamine Abuse: Is This Increasing the Is This Increasing the

Strain on Rural Strain on Rural Healthcare?Healthcare?Kevin D. BrooksKevin D. Brooks

Advisor: Dr. Bill Grimes Advisor: Dr. Bill Grimes

Current Rural Healthcare StrainsCurrent Rural Healthcare Strains

• Mal-distribution of healthcare professionals in rural areas

• Providers in Rural Areas

• Lowered Socioeconomic Status

Quick Methamphetamine HistoryQuick 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?Why the Stall in Rural America?

• Illegal Clandestine Laboratories

• Drug Effects

How Does it Work?How Does it Work?

Clinical ImplicationsClinical Implications

• Cardiovascular • Mental Disturbances

• Dental Complications (Meth Mouth)

• Electrolyte Abnormalities

• Pulmonary complications

• Infectious Disease

Social ImplicationsSocial Implications

• Toxic exposure to family members and neighborhoods

• Users often lose control of their lives

Shifting GearsShifting Gears

• What does this mean for Rural Healthcare?

• How is my Specialty Affected?

• What Can we do about this problem?

Pediatric MedicinePediatric 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 MedicineEmergency Medicine

• Quick Stat – Over 10,000 emergency room visits per year can be attributed to methamphetamine (A&E Documentary)

OB/GYN MedicineOB/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 MedicinePsychiatric Medicine

• Self-Induced schizophrenic symptoms (hallucinations and delusions)

• Pediatric developmental and learning disabilities• Increased need for Adolescent psychiatric services

Primary CarePrimary 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?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 ?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.)

• 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

SuggestionsSuggestions

• 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

SummarySummary

• 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.

ReferencesReferences• 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.References cont.• 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, andphenylpropanolamine. 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?Questions?