“These kids end up staying in the system, which is a bad place for them to be,” says Dr. Wright. “They grow up with a lot of insecurities and mental health issues, and many go on to be users themselves. While she sees many kids whose grandmothers and mothers are addicts, she believes the problem is situational and not hereditary. Nonetheless, “We’re not sure how to break this cycle,” she says.
Some kids are hospitalized because they are hurt or sick as a result of being in an unsafe environment where parents are meth users. These children are often malnourished or sick because of neglect.
Helping Hospitalists Manage Meth
It helps hospitalists if their facility has clear protocols for handling meth intoxication. “It is especially good to establish a procedure in the emergency department,” advises Dr. Rawson. He stresses that these procedures should address ways to de-escalate aggressive behavior. There are also clinical training techniques and brief interventions used to treat alcoholics that can be useful for dealing with meth addicts. These interventions involve efforts to change behaviors. Specifically, helping patients understand that their substance abuse is putting them at risk and encouraging them to reduce or stop their drug use altogether. The elements of brief interventions for substance abuse have been summarized in the acronym “FRAMES,” which stands for feedback, responsibility, advice, menu of options, empathy, and self-efficacy.
“These tools can help get people to talk about their meth problem[s] and deal with [them],” says Dr. Rawson. “Some of these brief interventions can be amazing in terms of deferring further drug use.”
Burdens of Meth
What hospitalists see in their meth-using patients depends on the maturity of the problem in their community. “In communities where the problem is newer, you are likely to see younger users and fewer physical problems,” says Dr. Rawson.
In areas where the problem has existed for years, hospitalists can expect to see older addicts with physical problems that range from heart conditions to widespread tooth decay (a condition known as “meth mouth”). The longer a community has had a meth problem, the more likely the epidemic is placing a financial burden on the healthcare system.
Dr. Garner urges his colleagues to learn about meth. “A couple of years ago, this was a nonexistent problem,” he says. “Now it has reached crisis proportions in many communities.”
Gina DiRenzo-Coffey, MD, director of inpatient pediatrics and a pediatric hospitalist at Alegent Health/Bergan Mercy Medical Center in Omaha, Neb., agrees: “You can lull yourself into believing that this can’t happen in your community. But no one has been able to stop meth use [among members of their community], and it keeps spreading. It is our job to learn everything we can about this drug and help meth addicts as much as we can.” TH
Joanne Kaldy also writes about a day in the life of a pediatric hospitalist in this issue.