FORT MYERS, FLA. – Increasing methamphetamine use not only boosts violent injuries and law enforcement altercations among trauma patients, but it can create a significant financial burden for a level I trauma center, according to a study.
Methamphetamine-positive trauma patients were more likely to have a violent cause of injury such as assault, gunshot wound, or stabbing, compared with non-meth users, Dr. Sophia M. Swanson said during poster walk rounds at the annual meeting of the Eastern Association for the Surgery of Trauma.
“Methamphetamine is really increasing nationally,” Dr. Swanson said. “An estimated 10 million people have used methamphetamine at least once in their lifetime.”
During the 3 years of the study (2003–2005), there was a steady increase in methamphetamine use, from 9% to 15% of patients. Methamphetamine replaced marijuana as the most common drug of abuse in 2005 among patients at the University of California, San Diego, where Dr. Swanson was a medical student at the time of the study.
To gauge methamphetamine's impact, Dr. Swanson and her associates reviewed a registry of 4,648 consecutive trauma patients who had both a blood and toxicology screen at admission. This patient population is the 71% of all trauma patients who had toxicology screens.
“We found meth users were more likely to be young, male, more severely injured, and more likely to be Hispanic,” Dr. Swanson said at the meeting, which was jointly sponsored by Wake Forest University.
Methamphetamine users had a higher mean injury severity score (10.9) versus nonusers (9.9); were 56% more likely to require mechanical ventilation; and were 53% more likely to undergo an operation.
The users also were more likely than nonusers to leave the emergency department against the recommendations of physicians (5% versus 2%), and were more likely to die from their injuries (6% versus 3%).
Methamphetamine-positive patients had a fivefold increased likelihood of an altercation with law enforcement. “That is really striking,” Dr. Swanson said.
Methamphetamine-positive patients were twice as likely to have violence as the mechanism of injury (47%, versus 26% of nonusers). This finding included 36% more assaults, 85% more gunshot wounds, and 146% more stab wounds than for nonusers.
Adverse effects are not limited to patients. There is an increasingly significant financial burden to trauma centers, Dr. Swanson said. Despite similar length of stays, costs averaged 7% higher for methamphetamine-positive patients. Methamphetamine users were about twice as likely to be uninsured (54% versus 28%). There was an average of $10,000 of uncompensated care per methamphetamine-positive patient, Dr. Swanson said.
Emergency physicians and trauma physicians can make a difference, Dr. Swanson said. One tactic is screening for amphetamine use and a brief intervention. “It's easy, it's quick, and it can be done in the ED. Lack of reimbursement, however, is a concern.” She also recommended that doctors “get involved in community-based methamphetamine prevention programs.”