Ice_ Ice Baby_

Ice, Ice Baby: Methamphetamine Madness in the New Millennium Rachel Norris, MD November 7, 2007 Senior Grand Rounds Northwestern University Emergency Medicine Residency Objectives • Discuss history, chemical properties, and synthesis of meth • Discuss prevalence of use and societal effects • Discuss adverse physiologic effects and how to recognize it in ED The Basics • d-phenylisopropylmethylamine hydrochloride • Schedule II drug • Forms: powder, pills, capsules, crystals The Basics • Synthetic stimulant – Enhances release, blocks reuptake of catecholamines History 1887: Amphetamine synthesized in Germany 1893: Methamphetamine synthesized in Japan 1930s-40s: Used during WWII for performance-enhancement 1940s: IV meth abuse epidemic in Japan 1950s: Methedrine legally manufactured in U.S. 1960s: Increased availability of injectable meth 1967: 31 million prescriptions in U.S. 1970: Controlled Substance Act restricts production 1980s: Illicit use endemic to California, Oregon 2006: Combat Methamphetamine Epidemic Act of 2005 Statistics • 1 in 10 high school students used meth CDC Youth Risk Behavior Surveillance 2001 • >12 million people over 12yo have used meth US Dept of Health and Human Services 2002 • 166,000 reported heroin use in last month • 607,000 reported meth use in last month National Institute on Drug Abuse 2003 Statistics • DEA spent over $18.6 million on lab clean-ups • 12,715 meth lab incidents reported in 46 states Drug Enforcement Administration 2004 Routes of Administration • • • • Intravenous injection Intranasal insufflation Smoking Ingestion Routes of Administration • Transrectal – “Booty bumping” – “Keistering” – “Butt whacking” Cantrell et al: Ann Intern Med 2006 Street Names – – – – – – – – – – Meth Speed Chalk Yaba Ice Crystal Glass Crank 222 All Tweakend Long Physiologic Effects • Dental – Meth mouth Dry mouth bacteria + thirst Mountain Dew decay American Dental Association News Release 2006 Treatment • • • • • • • Decontamination IVF Aggressive cooling Benzodiazepines Benzodiazepines Benzodiazepines Antipsychotics Solutions • • • • Combat Methamphetamine Epidemic Act 2006 Stronger drug trafficking control Funding for treatment Educating healthcare professionals Solutions • • • • Combat Methamphetamine Epidemic Act 2006 Stronger drug trafficking control Funding for treatment Educating healthcare professionals http://www.findtreatment.samhsa.gov References Hendrickson RG, Cloutier R, McConnell J, “Methamphetamine-related emergency department utilization and cost”, Acad Emerg Med, publication pending McGee et al, “Spontaneous Intracerebral Hemorrhage Related to Methamphetamine Abuse; Autopsy Findings and Clinical Correlation”, Am J Forensic Med Pathol 2004;25: 334-337 Kaye et al, “Methamphetamine and cardiovascular pathology: a review of the evidence”, Addiction, 2007, 102, 1204-1211 Cooper et al, “Nationwide Increase in the Number of Hospitalizations for Illicit Injection Drug Use-Related Infective Endocarditis”, Clinical Infectious Diseases, 2007;45:1200-1203 Wako et al, “The Emerging Epidemic of Methamphetamine-Induced Aortic Dissections”, J Card Surg 2007;22:390-393 Brannan TA, Soundararajan S, Houghtor BL, “Methamphetamine-Associated Shock with Intestinal Infarction”, MedGenMed 2004;6(4):6 Tominaga et al, “Toll of Methamphetamine on the Trauma System”, Arch Surg, Vol 139, Aug 2004, 844-847 Matteucci et al, “Methamphetamine Exposures in Young Children”, Pediatr Emerg Care, Vol 23(9), Sept 2007, 638-640 Burgess JL, Barnhart S, Checkoway H, “Investigating clandestine drug laboratories: adverse medical effects in law enforcement personnel”, Am J Ind Med, Oct 1996; 30(4): 488-94 Lineberry TW, Bostwick JM, “Methamphetamine Abuse: A Perfect Storm of Complications”, Mayo Clin Proc, Jan 2006;81(1):77-84 Thompson et al, “Structural Abnormalities in the Brains of Human Subjects Who Use Methamphetamine”, J Neurosci, June 2004; 24(26):6028-6036 Miyashita et al, “A fatal case of pontine hemorrhage related to methamphetamine abuse”, J Forensic Leg Med, 2007;14(7):444-7 References Thompson et al, “Structural Abnormalities in the Brains of Human Subjects Who Use Methamphetamine”, J Neurosci, June 2004; 24(26):6028-6036 Miyashita et al, “A fatal case of pontine hemorrhage related to methamphetamine abuse”, J Forensic Leg Med, 2007;14(7):444-7 Hart et al, “Acute Physiological and Behavioral Effects of Intranasal Methamphetamine in Humans”, Neuropsychopharmacology, 2007 online Rothman RB, Baumann MH, “Methamphetamine and Idiopathic Pulmonary Arterial Hypertension”, Chest, 2007; 132:1412-1213 Santos et al, “Methamphetamine Laboratory Explosions: A New and Emerging Burn Injury”, J Burn Care Rehabil 2005;26:228-232 “Increasing Morbidity and Mortality Associated with Abuse of Methamphetamine – United States, 1991-1994”, MMWR Weekly, Dec 1995/44(47);882-886 “The Meth Epidemic in America II”, National Association of Counties, January 2006 “Meth in Illinois”, Indiana Criminal Justice Institute, December 2005 Zernike, Kate, “Hospitals Say Meth Cases Are Rising, and Hurt Care”, The New York Times, January 2006 Davey, Monica, “Grisly Effect of One Drug: „Meth Mouth‟”, The New York Times, June 2005 “Methamphetamine”, Office of National Drug Control Policy, Drug Policy Information Clearinghouse Fact Sheet, Nov 2003 References News Release: “Congressional staff are briefed on methamphetamine”, BMJ 2007;335:535 News Release: “Meth abuse causes more emergency room visits than all other drugs: Need for meth treatment programs growing dramatically”, National Association of Counties, January 2006 News Release: “First Arrest in the Nation for Violating the Combat Methamphetamine Act: Over 29 grams of ephedrine purchased within a month”, U.S. Drug Enforcement Administration, March 2007