The Scourge of Methamphetamine: Impact on a Level I Trauma Center

Swanson, Sophia M.; Sise, C. Beth; Sise, Michael J.; Sack, Daniel I.; Holbrook, Troy L.; Paci, Gabrielle M.

doi:10.1097/ta.0b013e318074d3ac

Cited by 46 publications

(46 citation statements)

References 27 publications

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“…Specifically, studies investigating pre-injury amphetamine use have reported inconsistent results. Pre-injury amphetamine use has been significantly associated with increased LOS (13), increased mortality (11), and increased ICU admission (10). However, both the significance and directional trend of these differences varied across studies (10-14).…”

Section: Discussionmentioning

confidence: 99%

The impact of pre-injury controlled substance use on clinical outcomes after trauma

Cheng

Inaba

Johnson

et al. 2016

Journal of Trauma and Acute Care Surgery

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Background A disproportionately high percentage of trauma patients use controlled substances, and they often co-ingest multiple drugs. Previous studies have evaluated the effect of individual drugs on clinical outcomes following trauma. However, the impact of all drugs included in a comprehensive screening panel has not yet been compared in a single cohort of patients. Methods All trauma patients who underwent urine drug screens following admission to the LAC+USC Medical Center (01/2008-06/2015) were identified retrospectively. Univariable and multivariable regression analyses determined the significance of all drugs tested in the hospital’s standard toxicology screen (amphetamine, barbiturate, benzodiazepine, cocaine, opiate, phencyclidine) on clinical outcomes. Results A total of 10,288 patients who underwent admission toxicology screening were identified. While 5,661 patients had completely negative screens, 3,370 patients tested positive for only one drug and 1,257 patients tested for multiple drugs. Univariable analysis indicated that patients who tested positive for multiple drugs had higher rates of operative intervention (p<0.001), longer hospital stay (p<0.001), and longer ICU stays (p<0.001). Multivariable analysis indicated that phencyclidine was associated with higher rates of mortality (p=0.028) while amphetamine was associated with lower rates of mortality (p=0.008). Higher rates of operative intervention were observed in patients testing positive for amphetamine (p<0.001), benzodiazepine (p<0.001), or opiate (p<0.001). Benzodiazepine use was associated with higher rates of mechanical ventilation (p<0.001), but use of amphetamines (p=0.030) or opiates (p<0.001) was associated with lower rates. Conclusions Pre-injury use of amphetamine, barbiturate, benzodiazepine, cocaine, opiate, and PCP have significant and variable impact on clinical outcomes following trauma. Comparing the relative effect of each drug class can help clinicians risk-stratify all trauma patients, including those who test positive for multiple substances.

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Section: Discussionmentioning

confidence: 99%

The impact of pre-injury controlled substance use on clinical outcomes after trauma

Cheng

Inaba

Johnson

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…At a larger societal level, the financial burden of methamphetamine use on communities is significant. In the U.S., the average cost of healthcare per methamphetamine user was 9% higher than that for non-users, and methamphetamine users were less likely to be insured compared with non-users (Swanson et al, 2007). Beyond direct health care costs, resources forgone because of reduced productivity among methamphetamine users may pose a bigger economic burden on a community.…”

Section: Introductionmentioning

confidence: 99%

The impact of methamphetamine (“tik”) on a peri-urban community in Cape Town, South Africa

Watt

Meade

Kimani

et al. 2014

International Journal of Drug Policy

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Background Over the last decade, South Africa’s Western Cape has experienced a dramatic increase in methamphetamine (“tik”) use. Our study explored local impressions of the impact of tik use in a peri-urban township community in Cape Town, South Africa. Methods We conducted individual in-depth interviews with 55 women and 37 men who were regular attendees of alcohol-serving venues. Interviews were recorded and transcribed. A content analysis approach was used to identify themes related to the impact of tik use based on levels of the socio-ecological framework (individual, inter-personal and community). Results Tik use was reported to be a greater issue among Coloureds, compared to Blacks. At an individual level, respondents reported that tik use had adverse effects on mental, physical, and economic well-being, and limited future opportunities through school drop-out and incarceration. At an inter-personal level, respondents reported that tik use contributed to physical and sexual violence as well as increased rates of sexual risk behaviour, particularly through transactional sex relationships. Respondents described how tik use led to household conflict, and had negative impacts on children, including neglect and poor birth outcomes. At a community level, respondents linked tik use to increased rates of crime, violence and corruption, which undercut community cohesion. Conclusions Our results highlight the negative impact that tik is having on individuals, households and the overall community in a peri-urban setting in South Africa. There is a clear need for interventions to prevent tik use in South Africa and to mitigate and address the impact of tik on multiple levels.

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“…Such studies are fraught with testing bias in part because those who acknowledge using substances are usually the ones who are tested [17] . In their retrospective chart review of 4,932 patients, Swanson et al [18] managed to minimize such bias by testing all trauma patients who were cooperative or had a urinary catheter for substance use. They demonstrated that MA-positive patients were twice as likely as those testing negative to have a violent mechanism of injury (e.g.…”

Section: Introductionmentioning

confidence: 99%

Violence among Street-Involved Youth: The Role of Methamphetamine

Martin¹,

Palepu²,

Wood³

et al. 2008

Eur Addict Res

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Aims: This study investigated a possible association between violence and the use of drugs, particularly methamphetamine and alcohol. Methods: Cross-sectional, baseline data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. Subjects were asked whether they had suffered or perpetrated violence in the 6 months prior to the interview. Results: In total, 478 youth were enrolled, with a median age of 22 years (interquartile range = 20.0–23.9); 230 (48%) reported having been victims of violence, while 165 (34.5%) reported having perpetrated violence. Daily methamphetamine use was not associated with either outcome. In a multivariate analysis, daily alcohol consumption was significantly associated with being a victim (adjusted odds ratio = 2.10) and a perpetrator (adjusted odds ratio = 2.02) of violence. A history of abuse, failing a grade, and dealing drugs were also independently associated with violence, while having a regular partner was protective. Conclusion: Contrary to popular media reports that methamphetamine causes violence, we found no association. The association of alcohol with violence, though, has implications for screening and intervention programs.

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The Scourge of Methamphetamine: Impact on a Level I Trauma Center

Abstract: METH use in trauma patients increased significantly and was associated with adverse outcomes and a significant financial burden on our trauma center. Evidence-based prevention efforts must be a priority for trauma centers to help stop the scourge of METH.

Cited by 46 publications

References 27 publications

The impact of pre-injury controlled substance use on clinical outcomes after trauma

The impact of pre-injury controlled substance use on clinical outcomes after trauma

The impact of methamphetamine (“tik”) on a peri-urban community in Cape Town, South Africa

Violence among Street-Involved Youth: The Role of Methamphetamine

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