Smoking Out Meth Use

The Hospitalist. 2006 December;2006(12):

December 1, 2006 | The Hospitalist

Many meth patients come into the hospital because of a physical ailment. “They present with chest pain, palpitations, and/or shortness of breath, although these conditions clear up pretty quickly,” says Dr. Garner.

Tip-offs that the problem might be drug related include poor hygiene, disheveled appearance, and edgy, antsy behavior. Additionally, says Dr. Rawson, “Weight loss, skin sores and scabs, dental disorders, nervous behavior, and paranoid ideation are blue-ribbon signs of meth use. In places where users inject meth, look for needle marks. In regions where users smoke meth, pulmonary disease and coughing are common.”

In the patients Dr. Garner sees, meth’s lasting effects affect their physical health less than their mental health and quality of life. “Meth deteriorates them to the point that they can’t work, and they detach themselves from family, friends, and society as a whole,” he explains. “They require a lot of deep-seated [psychiatric] therapy to deal with multiple issues.”

While most of the meth users Dr. Garner sees are poorly educated and come from the working class, meth is increasingly popular among college students and professionals. In fact, he says, “I know of several doctors for whom meth was the drug of choice.” It is important for hospitalists to remember that addiction knows no socioeconomic boundaries. Many clinicians view meth addicts in an unsympathetic light and as people who have caused their own problems. This is a barrier that needs to be overcome, stresses Dr. Garner.

Meth and the Pediatric Hospitalist

Pediatric hospitalists are not immune to meth problems. “We see a lot of meth use among expectant and new mothers,” says Dr. DiRenzo-Coffey. Few of these women admit to their drug use, but Dr. Di-Renzo-Coffey suggests that the signs are pretty clear. “If I see a mom with no teeth who is underweight, my radar goes up,” she explains.

One of the biggest challenges she faces with these patients is that she has to get permission from the parents to test a baby for meth exposure. “You can only do drug testing on the baby if you have good reason,” she explains. “If we want to test and the mother says no, that only increases our suspicion. If the baby has symptoms, we can say that we have to test the baby to determine the cause. Sometimes, the mother will confess at that point.”

Another challenge to the hospitalist is that symptoms of meth exposure may not appear in a newborn for weeks, and the symptoms are hard to detect. “You just may see a fussy, irritable baby for the first eight weeks,” says Dr. DiRenzo-Coffey. “Once these babies become irritable, they also are hypersensitive to light and touch.”

Most meth babies go into the foster care system. Foster parents need extensive education and support to help control these babies’ responses to stimulation and help them adjust to become normal infants. “These babies need a quieter, calmer environment to sleep, and they need to be on a solid routine,” explains Dr. DiRenzo-Coffey. This is especially important in the first three months. “If these things aren’t addressed, they [these children] can become socially isolated as they grow.”

Pediatric hospitalists also are likely to see poor nutrition in some meth babies. “Many are poor eaters from day one. Others may have problems later because they are hyperactive and burn off all the calories they take in,” states Dr. DiRenzo-Coffey. “Later in life, the incidence of attention deficit disorder in school is high with these children, and this is something pediatric hospitalists are likely to see.”

When it comes to meth babies, hospitalists generally face the same challenges as any pediatrician dealing with newborns. “But as a hospitalist, you don’t have a relationship with the parents. You have to ask a lot of questions,” she explains. “I do this casually, and I tell them that I ask all moms these questions.” If she has strong suspicions about drug use, it is mandatory that she report it to Child Protective Services (CPS).

As for working with meth babies, Dr. DiRenzo-Coffey admits, “My contact is brief. I do detective work up front, but I’m not involved in follow-up until it’s time to go to court if it comes to that. As a pure hospitalist, there is only so much you can do. But if you bring the situation to the attention of the authorities, that’s a good start.”—JK