Covered by opioids, methamphetamine is back and hospitalizations are on the rise

This is a story of Kaiser Health News.

The number of people hospitalized for amphetamine use is skyrocketing in the United States, but the resurgence of the drug has been largely overshadowed by the country's focus on opioids.

Amphetamine-related hospitalizations surged by about 245% between 2008 and 2015, according to a recent study by the Journal of the American Medical Association. This greatly reduces the increase in the number of hospitalizations attributable to other drugs, such as opioids, which increased by about 46%. The most significant increases were registered in Western states.

The increase in the number of hospitalizations and deaths due to amphetamines "has nothing to do with radar," said drug addiction researcher Jane Maxwell. "Nobody pays attention."

Doctors are seeing the drug reappearing in emergency departments, where patients arrive agitated, paranoid and aggressive. Paramedics and police officers see him in the streets, where the suspects' heart rate is so high that they have to be taken to the hospital for a medical certificate before being incarcerated. And forensic scientists see it at the morgue, where in some states, such as Texas and Colorado, overdoses of methamphetamine have overtaken those of opioid heroin.

Amphetamines are stimulant drugs, legally prescribed to treat Attention Deficit Hyperactivity Disorder and illegally processed into Methamphetamine. Most of the hospitalizations during the study were due to methamphetamine use.

Methamphetamine was known in the 1990s, before laws made it harder to access pseudoephedrine, a classic cold medicine needed to make it. In recent years, law enforcement officials have reported that there are fewer methamphetamine laboratories in the country and more methamphetamine is being smuggled from the south of the border.

According to the police, opioids are becoming increasingly difficult to obtain and more and more people have turned to methamphetamine, a cheap and readily available method.

Lupita Ruiz, 25, began using methamphetamine in her late teens, but said she was clean for about two years. When she used, she said, her heart was beating fast, she stayed up all night and she forgot to eat.

Ruiz, who lives in Spokane, Washington, said that she had been taken to the hospital twice after a mental depression related to meth use, including a stay of one year. month in the psychiatric ward in 2016. Once, Ruiz said that she had shouted after and had kicked the police. officers after answering a call to his apartment. Another time, she started walking on the highway without remembering why.

"It made me mad," she said. "I was all messed up in my head."

The federal government estimates that more than 10,000 people died of a drug overdose linked to methamphetamine last year. Deaths due to a methamphetamine overdose usually result from multiple organ failure, heart attacks and strokes, caused by extraordinary pulse rates and spiking blood pressure.

In California, the number of overdose deaths related to amphetamines increased by 127%, from 456 in 2008 to 1,036 in 2013. At the same time, the number of opioid-related overdose deaths increased by 8.4% from 1,784 to 1,934, according to the most recent data from the state's Department of Public Health.

"It taxes your first responders, your emergency rooms, your coroners," said Robert Pennal, retired supervisor of the California Department of Justice. "It's an incredible burden for the health system."

The costs also increase. The JAMA study, based on hospital discharge data, revealed that the cost of amphetamine-related hospitalizations had risen from $ 436 million in 2003 to nearly $ 2.2 billion. dollars in 2015. Medicaid was the main payer.

"There is not a day that passes without me seeing a methamphetamine-addicted person," said Dr. Tarak Trivedi, emergency physician from Los Angeles and Santa Clara counties. "It's a huge problem, and it's pouring 100% into the emergency room."

Trivedi said that many psychiatric patients are also users of methamphetamine. Some act so dangerously that they require sedation or stresses. He also sees people who have been using drugs for a long time and who are suffering downstream consequences.

In the short term, the drug can cause rapid heart rate and dangerously high blood pressure. In the long run, it can cause anxiety, dental problems and weight loss.

"You see people as young as 30 years old with congestive heart failure as if they were 70 years old," he said.

Jon Lopey, Siskiyou County sheriff's coroner in rural northern California, said his officers met frequently with methamphetamine users who were subject to violence and in the midst of what appeared to be psychotic episodes. Many are emaciated and have missing teeth, dilated pupils and a tendency to pinch their skin because of the sensation of something underneath.

"Methamphetamine is very, very destructive," said Lopey, who also sits on the executive board of the California Peace Officers Association. "It's so debilitating that it ruins life and health."

The JAMA study found that amphetamine-related hospitalizations were mainly due to mental health problems or cardiovascular complications. About half of the amphetamine hospitalizations also involved at least one other medication.

Because opioids have attracted so much attention, "we have not been properly monitoring other trends in substance use," said Dr. Tyler Winkelman, author of the study, a physician with Hennepin Healthcare in Minneapolis.

Sometimes doctors have trouble distinguishing the symptoms of methamphetamine intoxication and the underlying mental health issues, said Dr. Erik Anderson, an emergency physician at Oakland Highland Hospital, in California. Patients may also be homeless and use other drugs in addition to methamphetamine.

Unlike opioid addiction, methamphetamine dependence can not be treated with medication. Instead, addicts use counseling in outpatient and residential treatment centers.

The opioid epidemic, which resulted in approximately 49,000 overdose deaths last year, recently prompted bipartite federal legislation to improve access to recovery, extend coverage to treatment and fight against drug trafficking at the border.

Legislation recently focused on methamphetamine or other drugs has not been as important. And there are simply not enough resources devoted to amphetamine addiction to reduce hospitalizations and deaths, said Maxwell, a researcher at the Addiction Research Institute at the University of Texas at Austin. The number of residential treatment facilities, for example, has continued to decline, she said.

"We have really reduced the treatment against methamphetamine," said Maxwell. "Methamphetamine has been completely overshadowed by opioids."

Kaiser Health News is a non-profit news service covering health issues. It is an independent editorial program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.