1. Methamphetamine Michael J. Sise, MD Scripps Mercy Trauma San Diego, CA Speed for the 21 st Century

2. Meth: History WWII - fatigued GI’SWWII - fatigued GI’S Korea - meth and heroinKorea - meth and heroin 1960’S - used iv ~ LSD1960’S - used iv ~ LSD 1970’S - biker gangs1970’S - biker gangs 1990’S - Mexican supply1990’S - Mexican supply

3. Precursors EphedrineEphedrine PseudoephedrinePseudoephedrine Red phosphorusRed phosphorus Hydorchloric acidHydorchloric acid Meth: Production

4. Easy to make, sell, and buyEasy to make, sell, and buy Cheaper than cocaineCheaper than cocaine Mexican connectionMexican connection Readily availableReadily available It’s everywhereIt’s everywhere Meth: Sale

5. Before - blue collar white menBefore - blue collar white men Now - women, teens, college age, older men, minoritiesNow - women, teens, college age, older men, minorities Meth: Users

6. 42 yr old construction worker driving in fast lane I-8, slumps over the wheel, drives into median divide. Bystander CPR - brought to the Trauma Center Meth: Users

7. METH ADMSSIONS SAN DIEGO COUNTY 2003

8. METH: MEDICAL COSTS CALIFORNIA HOSPITALIZATIONS 2003

9. Meth: the drug DesoxynDesoxyn Amphetamine classAmphetamine class DEA Class IIDEA Class II Rx: obesity, ADD, narcolepsyRx: obesity, ADD, narcolepsy

10. Meth: the drug Ingested – 1 to 3 hoursIngested – 1 to 3 hours Snorted – rapid onsetSnorted – rapid onset Smoked - immediateSmoked - immediate Injected - immediateInjected - immediate

11. Meth: the drug San Diego County

12. Meth: the drug Fat solubleFat soluble Well absorbed by mouthWell absorbed by mouth Liver degrades itLiver degrades it Kidneys excrete itKidneys excrete it

13. Meth: the drug Meth and metabolites active & excretedMeth and metabolites active & excreted Meth amphetamineMeth amphetamine Half life = 10 – 30 hoursHalf life = 10 – 30 hours

14. Meth: the drug Acts like cocaineActs like cocaine Alters brain chemistryAlters brain chemistry Excites nerve cellsExcites nerve cells Prolonged highProlonged high

15. Meth: the drug d-Meth Most common formMost common form Ephedrine methodEphedrine method Very powerful effectsVery powerful effects

16. Meth: the drug d-Meth Releases adrenalinReleases adrenalin Dopamine “high”Dopamine “high” Depletes both chemicalsDepletes both chemicals

17. Meth: the drug Profound effects… Racing heart beat, high blood pressureRacing heart beat, high blood pressure Dilated pupils, sweatingDilated pupils, sweating Psychotic behaviorPsychotic behavior

18. 28 yr old man frequent meth user jumps from a freeway overpass when his girl friend leaves him… Meth: Users

19. Back and ankle fractures three operations, months of rehabilitation… Meth: Users

20. 25yr old mother of two, Meth O.D. stroke, heart attack, dead bowel. To O.R., ICU, for days of care - eventual brain death. Meth: Users

21. StrokeStroke Heart attackHeart attack Paranoid psychosisParanoid psychosis SeizuresSeizures HyperthermiaHyperthermia Meth: Toxicity

22. Malignant hyperthermiaMalignant hyperthermia Thermal – positional asphyxiation:Thermal – positional asphyxiation: death in custody Meth: Toxicity

23. Develops rapidlyDevelops rapidly Neurochemical depletionNeurochemical depletion High doses teleratedHigh doses telerated “Highs” decrased“Highs” decrased Psychosis risk growsPsychosis risk grows Meth: Tolerance

24. 26 yr old male student - low speed car crash, cuts and abrasions. Drug screen - Crystal Meth Meth: Users

25. Low intensity Swallow or snortSwallow or snort Weight loss, fatigueWeight loss, fatigue Teens, shift workers, truck driversTeens, shift workers, truck drivers Meth: Use patterns

26. 30 yr old gay man bingeing on Meth, left leg turns cold and numb, waits two days. In E.R. - no blood flow to leg, to O.R. twice - leg saved, poor prognosis Meth: Users

27. Binge users AddictedAddicted Smoke or injectSmoke or inject Stage: rush, high, tweakng, crashStage: rush, high, tweakng, crash Meth: Use patterns

28. High intensity Repeatedly bingeRepeatedly binge Try to prevent crashTry to prevent crash Weight loss, pale skin sweating, skin soresWeight loss, pale skin sweating, skin sores Meth: Use patterns

29. Dangerous tweakers Keep your distanceKeep your distance Don’t shine bright lightsDon’t shine bright lights Move, speak slowlyMove, speak slowly Keep the tweaker talkingKeep the tweaker talking Meth: Use patterns

30. Not like other drugsNot like other drugs Mainly psychologicalMainly psychological Profound depressionProfound depression Usually restart MethUsually restart Meth Meth: Addiction

31. Precursors toxicPrecursors toxic Meth labs covertMeth labs covert “Toxic dumps”“Toxic dumps” Long term impactLong term impact $$$millions clean up$$$millions clean up Meth: Toxic waste

32. High index of suspicionHigh index of suspicion Vital signs, appearanceVital signs, appearance Mental status – tweakingMental status – tweaking Drug screen – +’ve 2-3 daysDrug screen – +’ve 2-3 days Meth: Diagnois

33. Mild intoxication reassurance, quietMild intoxication reassurance, quiet Moderate – ValiumModerate – Valium Overdose – Emergency!Overdose – Emergency! Meth: Treatment

34. Overdose ABC’s – call 911ABC’s – call 911 Control blood pressureControl blood pressure Agitation – ValiumAgitation – Valium Fever – DantroleneFever – Dantrolene Meth: Treatment

35. Overdose Keep patient hydratedKeep patient hydrated Acidify the urineAcidify the urine Watch for psychosisWatch for psychosis Meth: Treatment

36. Poor! Less than 10% quitLess than 10% quit High death rateHigh death rate Many complicationsMany complications Meth: Prognosis

37. Severe medical effectsSevere medical effects Psychotic behaviorPsychotic behavior Child abuse – neglectChild abuse – neglect Violent resultsViolent results Meth means death

38. 35yr old man shot in the head and face during robbery by three neighbors on meth… Meth: Users

39. 42 yr old man, unemployed, on Meth and alcohol, drives wrong way on I-8, head on collision… He breaks leg, arm; other car - mother, 2 teenage sons Christmas shopping, dead at scene… other car - mother, 2 teenage sons Christmas shopping, dead at scene… Meth: Users

40. The worst of it… Meth:

41. Growth retardationGrowth retardation Prematurity, lethargyPrematurity, lethargy Late effects: dystonia learning disabilitiesLate effects: dystonia learning disabilities Meth: Pregnancy

42. Meth = neglect, abuseMeth = neglect, abuse Children exposedChildren exposed Toxic environmentToxic environment Unbelievable results…Unbelievable results… Meth: Child abuse

43. METH MEANSDEATH…

44. What can we do about it?

45. METH For every complex social problem there is a simple, elegant solution that is just plain wrong…

46. METH Community problems are solved by communities… everybody has a role…

47. National – precursor controlNational – precursor control State – drug labs, dealersState – drug labs, dealers Local – prevention intervention, treatmentLocal – prevention intervention, treatment Meth: Strategy

48. PreventionPrevention InterventionIntervention TreatmentTreatment InterdictionInterdiction ApprehensionApprehension IncarcerationIncarceration Meth: Strategy

49. Who pays for all this?

50. Apprehension Interdiction Incarceration Meth: Strategy? Prevention Intervention Treatment

51. San Diego County Meth Strike Force Multi-agencyMulti-agency Public and private sectorsPublic and private sectors CollaborativeCollaborative Community resourcesCommunity resources Service based leadershipService based leadership National ModelNational Model

52. Who pays? Meth: Strategy Alcohol and drug abuse $3.9 billion San Diego County 1998

53. Meth: Strategy Anyone for cutting government spending? Prevention – a business plan with a +’ve ROI

54. Apprehension Interdiction Incarceration Meth: Strategy Prevention Intervention Treatment

55. San Diego’s Meth Strike Force

56. Meth Strike Force Define the problemDefine the problem Create a Meth Hot LineCreate a Meth Hot Line Include the MediaInclude the Media Find what worksFind what works Measure effectivenessMeasure effectiveness

57. Meth Strike Force Report Card 1.Meth deaths 2.ED visits 3.Drug Rx admits 4.Meth + arrestees 5.Juveniles meth + 6. Labs taken down 7. Meth arrests 8. Meth price etc. 9. Hotline calls 10. Media stories

58. HomesHomes SchoolsSchools StreetsStreets BusinessesBusinesses HospitalsHospitals Meth: Prevention

59. 16 yr old male skateboarder, falls, concussion and bruises Drug screen - Crystal meth Drug screen - Crystal meth Meth: Users

60. Teenagers Talk about itTalk about it Be there every dayBe there every day Consider testingConsider testing Be relentlessBe relentless Meth: Prevention

61. Teenagers Avoiding high risk behavior… 95% just being there

62. Teenagers Meth: Prevention DDE strategy Delay, Deter, Exhaust

63. How do we reach teens? Communication strategy?Communication strategy? Who, when, how?Who, when, how? What works?What works? Signs of trouble?Signs of trouble?

64. Communication strategy Age appropriateAge appropriate Make clear rulesMake clear rules Good role modelsGood role models Teachable momentsTeachable moments

65. Age appropriate message Pre-teens Complex drug factsComplex drug facts Rehearse scenariosRehearse scenarios Myths vs. realityMyths vs. reality

66. Age appropriate message Early teens Long term drug effectsLong term drug effects Focus on appearanceFocus on appearance “not everyone does it”“not everyone does it” Know their friendsKnow their friends

67. Age appropriate message Early teens Explain deadly consequencesExplain deadly consequences Alcohol poisoning meth deathsAlcohol poisoning meth deaths

68. Age appropriate message Late teens Savvy by this ageSavvy by this age Casual us vs. addictionCasual us vs. addiction Emphasize choiceEmphasize choice Need better informationNeed better information

69. Age appropriate message Better information Link with birth defectsLink with birth defects Dangerous combinationsDangerous combinations Future consequencesFuture consequences Not a victimless crimeNot a victimless crime

70. A few basic rules… Be firm on alcohol, drugsBe firm on alcohol, drugs Use teachable momentsUse teachable moments Good parental monitoringGood parental monitoring Be available, stay involvedBe available, stay involved See help for problemsSee help for problems

71. Warning signs… Developmental problemsDevelopmental problems Inappropriate behaviorInappropriate behavior School problemsSchool problems Depression, psychosisDepression, psychosis

72. METH There is so much at stake…

73. METH everybody has a role…

74. So much at risk… METH