METHAMPHETAMINE ABUSE

Lineberry TW, Bostwick JM. Methamphetamine abuse: a perfect storm of complications. Mayo Clin Proc. 2006;81:77-84.

Summary

According to the Substance Abuse and Mental Health Services Administration, emergency department (ED) visits related to medical and psychiatric complications of methamphetamine use increased nearly 75% between 1999 and 2002. Because methamphetamine can be manufactured locally from common household ingredients, users and producers are often one and the same. Users can experience various injuries to multiple body systems as well as psychiatric symptoms, since methamphetamine is a neurotoxin; producers are also at risk for injuries from fires and explosions that result when volatile chemicals are combined.

This article reviews the consequences, including medical, psychiatric, and social, of a single hypothetical methamphetamine-associated incident from the vantage point of a local ED.

Commentary

The article by Drs Lineberry and Bostwick is timely and instructive for the emergency mental health professional, since it provides a useful compendium of the acute physical and mental effects stemming from methamphetamine abuse in their full spectrum. To sketch the extent of the methamphetamine problem around the country, the authors describe a hypothetical methamphetamine lab accident involving the abuser, his family, and crisis rescuers. Throughout the article, the authors argue that the spread of home-based laboratories, especially those in isolated rural settings, is responsible for the massive increase in methamphetamine-related ED visits.

Overall, the article offers a clear review of the main features of methamphetamine intoxication and their similarities with dysphoric, manic, and psychotic episodes. Among these, the intensification in libido is identified as being responsible for the increased risk of sexually transmitted diseases (STDs) among users and their partners. As a result, the value of STD screening for these persons assumes a vital preventive role. By underscoring the importance of collateral medical history to uncover the patterns of abuse, the authors acknowledge the limits of drug screening as the key diagnostic tool.

The description of long-term methamphetamine abusers is also accurate, both in their mental and physical status and in their resemblance to that of a chronically mentally ill patient in a cachectic, disheveled state. Poor dentition, skin excoriations, skin ulcers from compulsive picking, and needle tracks are listed as some of the hallmarks of methamphetamine abuse.

The authors also accurately describe the systemic acute and chronic problems of exposure to methamphetamine-related toxic compounds. In particular, they stress the frequent skin burns that so often need to be managed in hospital-based burn units.

The saddest picture emerging from the article is that of children living in methamphetamine-tainted environments. Unfortunately, they are the most vulnerable to methamphetamine's toxic effects and the host of environmental consequences, including STDs; malnutrition; and physical, emotional, and sexual abuse.

In addition, the authors stress the need for constant awareness of the possibility of violence in intoxicated persons. ED staff should consider carrying out routine searches for weapons, placing anxious and agitated abusers in quiet and calm surroundings, and using effective psychopharmacologic agents. Essentially, the article calls for awareness of the complex biopsychosocial effects of methamphetamine abuse and for the implementation of a multidisciplinary treatment approach that involves mental health professionals, internists, primary care physicians, social workers, and child and adult protective services if necessary.

It is worthwhile to stress that although the "methamphetamine storm" is tragic in its consequences, it is just part of an enduring "hurricane cycle" of substance abuse issues plaguing our society.

Marcello A. Maviglia, MD, MPH

Medical Director

ValueOptions

Albuquerque