Methamphetamine Abuse as a Health Issue

"We are all too familiar with methamphetamine abuse as a psychosocial or criminal problem. Itis easy to forget that the health aspects are at least as important in the population that weserve."

That was the warning on Saturday morning from Janet Williams, MD, professor of pediatrics atthe University of Texas Health Science Center at San Antonio. Population surveys show that whilenonmedical methamphetamine use is relatively stable in the general population, neonates and teenagersare among the highest risk groups.

The two most popular amphetamine analogs are methamphetamine, or meth, andmethylenedioxymethamphetamine, or MDMA. Both are widely used in social settings, most often in raveparties by older adolescent heterosexuals and by slightly older gay or bisexual men.

"There is usually a lot of poly drug use in these settings," Dr. Williams said. "We aredealing with a multi-drug culture."

The annual Monitoring the Future (MTF) survey shows annual meth use by about 8% of 12thgraders, down from a high of 20% in 1982. MDMA use peaked at 9% of 12th graders in 2001, and hasfallen to about 4% currently.

"These are really best-case studies," she pointed out. "MTF surveys kids who stay in school.We think use is much higher in kids that drop out of school before their senior year."

Methamphetamine abuse typically presents in the emergency department, she continued, but alertpediatricians can frequently spot and intervene early in the abuse cycle. Patients use the drug toattain euphoria, but also experience fatigue, dehydration, hyperthermia, tremors, irritability,anxiety, aggression, and similar symptoms.

Chronic use typically depresses dopaminergic and serotonergic function. High-risk behavior is acommon effect of both casual and chronic use, leading to increased incidence of sexually transmitteddisease, pregnancy, accidental injury, and death.

"As physicians, we need to be award of how meth can affect your local pediatric population," Dr.Williams said. "You can't just treat the drug issue in isolation. Having an ongoing rapport with yourpatients can make a tremendous difference."