With methamphetamine use spreading across the country like a flu epidemic, hospitalists see more meth addicts and deal increasingly with the physical and psychiatric conditions common in these individuals. In overcoming the challenges and frustrations of working with these patients, hospitalists in regions where meth use is rampant have become experts of sorts, and they have messages for their colleagues nationwide: Learn our lessons, because you could be next.
The Meth Evolution
Methamphetamine has become popular for obvious reasons. The drug is cheap, and because it is manufactured using common and easily obtained ingredients, it is accessible anywhere.
The meth epidemic is not a new phenomenon. It started in the 1970s in the American heartland—Iowa and parts of Missouri. Since then, it has spread from West to East—hitting California and Hawaii in the ’80s and moving to Southeastern states such as Georgia and South Carolina in the late ’90s.
According to Richard A. Rawson, PhD, associate director and professor-in-residence for the Integrated Substance Abuse Programs at the Semel Institute for Neuroscience and Human Behavior in the David Geffen School of Medicine at the University of California at Los Angeles, “The spread of meth in the U.S. looks much like that of an infectious disease. It has spread in a very systematic way.”
It is a particular problem in rural communities, where it’s easily accessible and cheap. In fact, Dr. Rawson suggests that the drug doesn’t really present a major problem in urban areas—with the exception of cities that have a concentration of gay men. “Meth use in this population is a unique phenomenon that doesn’t follow the same homogenous spread from west to east,” he says.
Compounding this problem is the fact that HIV and sexually transmitted diseases often accompany meth use. “The drug is uniquely connected to sexual behavior because it increases sex drive, sexual performance, and pleasure,” observes Dr. Rawson. At the same time, hepatitis C is a broad concern in communities in which users inject the drug instead of smoking it. In fact, he says, about 50% of meth injectors are hepatitis-C-positive.
Meth Addicts: Routine for Some Hospitalists
For those hospitalists who see many meth users, working with these patients is fairly routine. As Emory University, Atlanta, assistant professor of medicine and hospitalist J. Allen Garner, MD, says, “As many as 30% of the patients I deal with on any given day are addicted to something—cocaine, alcohol, meth. I can’t say it’s a greater burden than anything else.”
Establishing rapport with these patients can be challenging. “Some say, ‘I’m really strung out and need help.’ Many come in with some physical complaint and don’t tell me that they’re high on meth and haven’t slept for 72 hours,” says Dr. Garner. “Basically, this has to do with the denial that goes along with chemical dependency.
Even patients who readily admit that they have a problem are often in denial about the depth of their addiction. “They’ll say that they have it under control, that they only did it once, or that someone slipped them the drug—all ‘party lines’ that take the heat off of them,” he says.
Gaining the trust of meth addicts is a major challenge, “because the drug produces paranoia, agitation, and nervousness,” says Dr. Rawson, noting that “quick urine tests” can be used to identify meth users, and drug use shows up for hours. These tests are great because they only cost $5-$10 each.