Data-Free Scare Story Of The Week: Meth Fills Hospitals With Burn Patients

This week's well-hyped scare story seems to be about illicit methamphetamine production and use filling hospitals across the country with accident and burn victims and putting a heavy strain on burn units.

Really? Sounds scary. According to this Jan. 23, 2012 AP news story:

A crude new method of making methamphetamine poses a risk even to Americans who never get anywhere near the drug: It is filling hospitals with thousands of uninsured burn patients requiring millions of dollars in advanced treatment — a burden so costly that it's contributing to the closure of some burn units.

Wow. It's not closures due to corporate takeovers, or that hospitals are cutting spending by cutting back on emergency care and care for the indigent. It's meth.

Read on:

An Associated Press survey of key hospitals in the nation's most active meth states showed that up to a third of patients in some burn units were hurt while making meth, and most were uninsured. The average treatment costs $6,000 per day. And the average meth patient's hospital stay costs $130,000 — 60% more than other burn patients, according to a study by doctors at a burn center in Kalamazoo, Mich.

The influx of patients is overwhelming hospitals and becoming a major factor in the closure of some burn wards. At least seven burn units across the nation have shut down over the past six years, partly due to consolidation but also because of the cost of treating uninsured patients, many of whom are connected to methamphetamine.

Ah. So, it is due to corporate takeovers and cutting services to indigents and the un-/under-insured.

Surely there are some statistics somewhere in this story. Aren't there?

Few people burned by meth will admit it.

"We get a lot of people who have strange stories," said Dr. David Greenhalgh, past president of the American Burn Association and director of the burn center at the University of California, Davis. "They'll say they were working on the carburetor at 2 or 3 in the morning and things blew up. So we don't know for sure, but 25 to 35% of our patients are meth-positive when we check them."

Guy cited a similar percentage at Vanderbilt, which operates the largest burn unit in Tennessee. He said the lies can come with a big price because the chemicals used in meth-making are often as dangerous as the burns themselves.

He recalled the case of a woman who arrived with facial burns that she said were caused by a toaster. As a result, she didn't tell doctors that meth-making chemicals got into her eyes, delaying treatment.

Okeh, not so far, but buried deep in the story we read this:

In Indiana, about three-quarters of meth busts now involve shake-and-bake. And injuries are rising sharply, mostly because of burns, said Niki Crawford of the Indiana State Police Meth Suppression Team.

Indiana had 89 meth-related injuries during the 10-year period ending in 2009. The state has had 70 in the last 23 months, mostly from shake-and-bake labs, Crawford said.

At last, some numbers. Yet, 70 injuries over a nearly 2-year period - in a state which reported some 1,346 clandestine lab incidents and 1,212 lab arrests in 2010 - doesn't sound like it translates into thousands across the US.

Another problem is the period to which this is being compared. The state of Indiana's law enforcement focus on methamphetamine has grown dramatically over the past decade, as shown by that same report by the state of Indiana: 314 lab incidents and 248 arrests in 2000, growing to 1,011 incidents and 860 arrests in 2003, dropping to 766 incidents and 530 arrests in 2007, after which the numbers again begin to climb.

To clarify: I agree that methamphetamine is a nasty drug, and that illicit manufacture and trafficking is a serious concern. I object to scare stories and fear-mongering because rational debate and intelligent, reasonable policies are never forged in a climate of hysteria.

In terms of policy, we have to make more broadly available effective treatment for meth addiction, probably including substitution treatment. See for example this 2010 review of research published in the Annals of the NY Academy of Sciences, Agonist-like pharmacotherapy for stimulant dependence: preclinical, human laboratory, and clinical studies. According to the authors:

Stimulant abuse/dependence should be examined with the view that there may be recurring episodes of variable severity, that return to use might be diminished by agonist-like medications, and that in any case a range of medications should be available. Although stimulant abuse and dependence have substantial risks, ample data indicate that wellmonitored regimens of stimulants for ADHD, narcolepsy, as well as substance abuse treatment, are relatively safe and have a favorable risk–benefit ratio. Conversely, although there has been extensive examination of other medications, such as anticonvulsants or antagonists (usually antipsychotics), results have been disappointing and, like any medication, these agents have significant risks and adverse consequences aswell.With thewide variability in stimulant use patterns and their effects, medication administration should be predicated on a continuum of severity. No single agent will be the panacea for the spectrum of patients. This parallels the differential response to SSRIs across depressed patients; it is poorly understood but clinically apparent. The data and conceptualization suggest that a range of agonist-like agents, from modest to robust, should be explored. At times, stimulant abuse/dependencemay also require combinations of medications. Further, variation in severity of stimulant abuse/dependence, individual differences, and at times collateral conditions, whether acute (e.g., psychosis) or preexisting and enduring (e.g., depression), may dictate instances where several classes ofmedications will be essential for treatment, either briefly or for the long term. In sum, development of a range of agonist-like agents will result in better treatment for stimulant dependence.

Also check out this excellent journal article from Drug and Alcohol Review (2002) 21, 179-185, "Substitution therapy for amphetamine users":

At the beginning of the new millennium, amphetamine use is more prevalent and less easily controlled than ever before. Technological, cultural, social and economic change has driven a recent relentless worldwide expansion of amphetamine use. An incomplete understanding of the natural history of problematic amphetamine use and the more obvious short-term harms associated with heroin use may have delayed a comprehensive public health response to widespread amphetamine use. The advent of polydrug use has refocused public health attention towards effective treatments for amphetamine users, particularly dependent and injecting users. The efficacy of substitution therapy is not known, even though the practice appears to have gained a degree of clinical acceptance at least in the United Kingdom. The literature is not extensive and controlled trials are few. There is a strong and growing case for rigorous evaluation of substitution therapies combined with tailored psychosocial interventions to achieve improved outcomes for amphetamine users.