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Methamphetamine: Who Really Gets Burned

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

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Methamphetamine: Who Really Gets Burned

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

  2. 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

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

  4. Methamphetamine: Historical Aspects • 1887: Amphetamine synthesized in Germany • 1919: Methamphetamine synthesized in Japan • 1930-40: 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)

  5. 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

  6. 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 1996 • 1.5 million regular users • 2003 National Survey: 5% of 8th graders and 15% of 12th graders have tried Methamphetamine once in their lifetime • > 17000 clandestine labs seized in United States in 2004 (100% ­ from 2002 and ~ 600% ­ from previous decade) • Over 50 recipes extracted from Internet Search

  7. 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 2001-2002 • 2001: 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 2001 • 2005: 472 labs and ~ 35 Kg Methamphetamine seized in state of Oregon (7,000,000 dosage units)

  8. 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

  9. Methamphetamine AssociatedHospital Admissions (2002)

  10. 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

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

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

  13. 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

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

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

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

  17. 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

  18. 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

  19. Methamphetamine AssociatedMetals and Salts • Multiorgan toxicity • Skin burns • Eye and Respiratory tract irritations • Nervous system: Headache and seizures • Gastrointestinal irritations (nausea, vomiting, diarrhea) • Renal • Hematological

  20. 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 % ± 20.72 % (range: 1.5-90%) 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: 425-429

  21. 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 ³ 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: 275-278

  22. 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

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

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

  25. 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: 228-232

  26. The Faces of Methamphetamine

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

  28. 3 years, 5 months later

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

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