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Methamphetamine: Who Really Gets Burned Nathan Kemalyan, MD FACS Medical Director, Oregon Burn Center Credits: Kelli Salter, M.D. Surgical Resident, OHSU.

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Presentation on theme: "Methamphetamine: Who Really Gets Burned Nathan Kemalyan, MD FACS Medical Director, Oregon Burn Center Credits: Kelli Salter, M.D. Surgical Resident, OHSU."— Presentation transcript:

1 Methamphetamine: Who Really Gets Burned Nathan Kemalyan, MD FACS Medical Director, Oregon Burn Center Credits: Kelli Salter, M.D. Surgical Resident, OHSU

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3 Methamphetamine Drug Pharmacology A central nervous system stimulant that promotes the release of neurotransmitters (dopamine, norepinephrine, and serotonin) which control the brain’s messaging system for reward and pleasure, sleep, appetite and mood 1500% more potent than cocaine Purely a synthetic compound Faster, Faster until the thrill of speed overcomes the thrill of death Hunter S Thompson

4 "Appalachian Methamphetamine Lab" Pieter Boggle VIII Methamphetamine: Historical Aspects Adolf Hitler JF Kennedy

5 Methamphetamine: Historical Aspects 1887: Amphetamine synthesized in Germany 1919: Methamphetamine synthesized in Japan : Performance enhancer in WWII 1930s: Treatment for nasal passage inflammation, narcolepsy, attention deficit disorder, obesity and fatigue 1960s: First recreational use 1970s: Legal production > 10 billion tablets ( ~1000X legitimate medical use) 1970: Amphetamine/Methamphetamine classified as a Schedule II drug 1980s: Illegal street forms popularized (injected, inhaled or taken orally)

6 Methamphetamine Historical Aspects 1988: Smokable form (ice or glass) introduced from Hawaii Prior to 1990s: Manufacture controlled by the “White Motorcycle Gangs” using phenyl-2-propanone (P2P) 1998: Federal Chemical Diversion and Trafficking Act placed P2P under federal control 2003: Ephedrine (precursor) banned in its pure form in US (increased restriction on pseudoephedrine) 2004: Identification required (in many states) to purchase over-the-counter cold medications that contain pseudoephedrine Today: 90% of the Methamphetamine available in United States transported from Mexico

7 Current Methamphetamine Statistics The second most common illicit drug used worldwide 35 million regular users 12 million Americans have tried Methamphetamine 40%  from 2000; 156%  from million regular users 2003 National Survey: 5% of 8 th graders and 15% of 12 th graders have tried Methamphetamine once in their lifetime > clandestine labs seized in United States in 2004 (100%  from 2002 and ~ 600%  from previous decade) Over 50 recipes extracted from Internet Search

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9 Oregon Statistics Number of Methamphetamine lab seizures in Oregon increased from 67 in 1995 to 591 in 2001 Oregon was third in the nation for number of children (241) found at Methamphetamine labs during : 2750 children (> half of all foster cases) were taken from parents using or making Methamphetamine Between 4300 and 5350 children retrieved from Methamphetamine homes have circulated in foster homes since : 472 labs and ~ 35 Kg Methamphetamine seized in state of Oregon (7,000,000 dosage units)

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11 Methamphetamine Addiction Statistics 100 people: alcoholic drink/day X 3 weeks = 8/100 addicted 100 people: oral or snort Methamphetamine or Cocaine daily X 3 weeks = 14/100 addicted 100 people: smoke or inject Methamphetamine twice = 90/100 addicted Methamphetamine addict that wants to quit: After 11 months of not using, 100% of recovering addicts will use Methamphetamine if offered

12 Methamphetamine Associated Hospital Admissions (2002)

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14 General Impact on Burn Centers Need for decontamination (treat chemical and thermal burns) Clandestine production (“cooking”) of Methamphetamine involves > 30 different chemicals Increased incidence of trauma from explosions/projectiles Emergency medical personnel injury Withdrawal (higher sedation/narcotic use) Majority of patients uneducated and uninsured Extended length of stay Greater excision and graft failure Increased cost of treatment

15 Users and Cooks Cooks –Adult Male –Undernourished –Paranoid ideation –Agitated, impulsive –Vague, Implausible history of injury –Big burns, lots of critical care

16 Legitimate Organic Chemistry Production Highly Educated, Sober Operator Safety-Designed Facility Personal Protective Equipment Process Control Safety Practice Decontamination Facility and Emergency Response Plan

17 Methamphetamine Production Facility Hotel Room, Rental Apartment, Trailer, Tent High School Dropout Judgment is Impaired-High on Methamphetamine, Cannabis, etc. Agitated, impulsive, impatient Smoking a Cigarette Garbage Cans, Dry Ice and Kitchen Utensils No Ventilation, No Plexiglas Shield, No PPE

18 Users and Cooks Cooks –Adult Male –Undernourished, poor dentition –Paranoid ideation –Agitated, impulsive –Vague, Implausible history of injury –Big burns, lots of critical care

19 Users –All ages –Males and Females –Uneducated –Poly-substance users –Poor social/family resources –Difficult to discharge –Erratic follow-up, rehabilitation

20 Burn Center behavior patterns Recreational User –Goes to sleep, awakens 2-3 days later Hard Core User/Cook –Tachycardia, Hypertension, Agitation –Weeks in duration

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22 Methamphetamine Associated Solvents Absorbed after ingestion, inhalation or dermal contact Associated Pathologies: Pneumonitis; Respiratory depression CNS depression Hepatotoxicity Renal toxicity (pyuria, hematuria, acute renal failure) Ventricular arrhythmias

23 Methamphetamine Associated Caustics (Acids and Alkalis) Chemical Burns: Direct contact, ingestion, inhalation Associated Pathologies: Pneumonitis; Respiratory depression CNS depression Hepatotoxicity Renal toxicity (pyuria, hematuria, acute renal failure) Ventricular arrhythmias

24 Methamphetamine Associated Metals and Salts Multiorgan toxicity Skin burns Eye and Respiratory tract irritations Nervous system: Headache and seizures Gastrointestinal irritations (nausea, vomiting, diarrhea) Renal Hematological

25 Methamphetamine-Associated Burn Injuries: A Retrospective Analysis Retrospective review of medical records (507 burn patients) 34 patients (6.7%) identified Mean Age: 31.9  7.65 years; 92% male 41% tested positive for other illicit drugs (excluding alcohol) Mean % TBSA: 18.9 %  % (range: %) 70.6% flame injury; 20.6% chemical injury Drug withdrawal: 44.1% (agitation and hypersomnolence) Average length of stay: 15.9  19.2 days (range 0-72) Mean cost/patient: $77,580 (range: $112-$426,386) 69.6% unemployed 11.8% with third-party insurance 44.1% uninsured without government assistance 44.1% supplemented with Medicaid or Medicare 96.8% of cost related to length of stay, %TBSA and total days on ventilator Danks, R. R., Wibbenmeyer, L.S., Faucher, L.D., et al. J Burn Care Rehabil 2004; 25:

26 The Methamphetamine Burn Patient Retrospective study 15 (2%) Age-matched and TBSA-matched patients Mean Age: 30  6 years 10 male; 5 female Results: Methamphetamine patients required at least 2-3X the calculated volume of resuscitation, irrespective of burn size All Methamphetamine patients with  40% TBSA burn died (estimated 60% survival without Methamphetamine) Warner, P., Connelly, J.P., Gibran, N.S., et al. J Burn Care Rehabil 2003; 24:

27 Methamphetamine Laboratory Explosions: A New and Emerging Burn Injury Retrospective study 15 (4%) patients: Age-matched and TBSA-matched patients to 45 patients Mean Age: 35.5 years (range 21-48) Mean burn size 36% TBSA

28 Methamphetamine Laboratory Explosions: A New and Emerging Burn Injury 87% Men 93% Caucasian 73% unemployed 73% uninsured 87% no college education

29 Methamphetamine Laboratory Explosions: A New and Emerging Burn Injury Tox Screen 100% Methamphetamine 66% two or more drugs (opiates, benzodiazapines, cannabis)

30 Methamphetamine Laboratory Explosions: A New and Emerging Burn Injury Results: Methamphetamine patients required at least 1.5-2X the calculated volume of resuscitation, irrespective of burn % 73% with inhalation injury: Mean 33 days on ventilator (17 days for control) Skin graft loss 33% (12.5% for control) Higher predicted need for sedation/pain control Longer hospital stay: Mean 30 days (21 for control) Higher mean cost/patient: $228,732 ($74,799 for control) Santos, A.P., Wilson, A.K. Hornung, C.A., et al. J Burn Care Rehabil 2005; 26:

31 The Faces of Methamphetamine

32 “Meth Mouth” Source: New York Times, June 11, 2005

33 3 years, 5 months later

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35 “Methamphetamine: You wished it would have killed you the first time” - unknown author


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