What Hospitalists Can Do
Meth users often aren’t even admitted to the hospital. “Treatment is mostly supportive. There is no drug you can give them to bring them down,” says Dr. Garner. “Withdrawal is a terrible thing—a sensation like Satan is crawling up their chest. We give them valium, but they basically have to weather it out.”
Even if the hospitalist addresses the physical effects and discusses treatment options with the meth user, it’s common for these patients to go back to their drug use when they leave the hospital. “Because meth doesn’t have life-threatening withdrawal symptoms—although you feel like you’re going to die—it’s easy for them to keep going back and using. Detox centers generally won’t touch these people,” says Dr. Garner. As a result, many patients end up in a catch-22, repeatedly going back to meth use.
While Dr. Garner does everything he can to help these patients, “they already are slaves to the drug by the time I see them,” he says. “Meth is highly addictive, and many people get hooked after using it just once or twice.”
This lack of available treatment for meth addicts is one of the greatest frustrations Dr. Garner faces as a hospitalist. “We keep putting resources into catching addicts as criminals and not getting them treatment and help before they become burdens on society,” he says.
He is pleased to note that this is changing in some states. “A few of the courts in our locale are starting to incorporate treatment programs through the court systems,” he explains.
Meth and Youth
While meth has become a popular drug among all age groups, “very few teens end up in the hospital because of meth,” says Wendy Wright, MD, a hospitalist at Rady Children’s Hospital in San Diego. “If kids are high on meth, they generally aren’t admitted when they are coming down. And, unlike many adults, they don’t have physical or medical issues that require hospitalization,” she explains. “Kids tolerate meth really well from the physical standpoint. We don’t see the arrhythmias or heart attacks that we see in adult addicts.”
When teen addicts do come in with medical conditions, Dr. Wright suggests, hospitalists often see problems such as skin or urinary tract infections. Teen meth users more frequently come to the hospital with psychiatric problems. “They have paranoid delusions, and some are fairly aggressive,” says Dr. Wright.
While hospitalists dealing with teens face the usual challenge of establishing rapport quickly, Dr. Wright observes that teens tend to be much more open than adults about their drug use. “They are pretty up front; they tell me right off the bat what drugs they use,” she says. “Of course I’m mostly seeing kids [who] aren’t living in an upper-class environment, and they’re not trying to hide things from their parents. The kids I see are streetwise and no nonsense. They have a sense of what their medical needs are and think nothing of asking for HIV or STD testing.”
Because of their youth and general good physical health, teens don’t necessarily create a burden for the hospitals and professionals who care for them. The biggest burden of meth-using teenagers, she suggests, “has to do with social issues. These kids often don’t grow into productive adults. They also have a lot of mental health issues such as bipolar disorder or severe depression, and these are the biggest burdens on the community as a whole. We also see a lot of chlamydia and gonorrhea in our kids.”
Although Dr. Wright strictly sees young patients, she acknowledges intergenerational meth use in families. Her facility sees many children who are brought into protective custody because their parents are meth users and unfit to care for them.