Methamphetamine use increasing

When obstetrician-gynecologist Mary F. Holley, MD, left Houston 15 years ago for Guntersville, Ala., she was relieved. No more would she have to deal with cocaine-addicted babies, common in that urban area but rare in her new rural locale.

But this peace did not last.

America's growing methamphetamine crisis hit her area about five years ago. She now estimates that 10% of her patients are addicted to the stimulant. They come to her for help with the depression that is so commonly associated with the drug's use. Sometimes, they are so twitchy that drawing blood is difficult. And she is particularly concerned when a patient is pregnant because the drug is associated with a litany of problems for children.

"We're seeing devastation," she said. "Infant mortality is high. The kids who are born won't feed. They're underweight. They're sick. They are going to have ADHD almost guaranteed, and they grow up in a home with an addicted mother who doesn't care about them."

Dr. Holley, the founder of Mothers against Methamphetamine, and other physicians are seeing the impact of this drug's increasing popularity, particularly in rural areas.

Methamphetamine was initially only available by prescription and was commonly prescribed for weight loss in the 1950s and 1960s. In the 1980s, illegal meth labs started appearing in California, and the drug has been traveling eastward ever since -- arriving with considerable impact in small towns, which had previously been spared the problems experienced in urban areas.

"It has a lot of appeal," said Barry Lester, PhD, professor of psychiatry at Brown Medical School in Providence, R.I., who is investigating the long-term effects of in utero exposure to cocaine and methamphetamine for the National Institute on Drug Abuse. "You can make it in your home and bypass the illegal drug trade. It's cheap. Everything you need to make it you can get between your hardware store and your pharmacy and the recipes are on the Web."

In 2002, more than 12 million Americans reported having used the drug, a significant increase from the 5 million who said the same in 1996, according to the Substance Abuse and Mental Health Services Administration. In general, there is significant concern about the growing number of people using this drug. More specifically, experts are beginning to focus their attentions on use by pregnant women.

"Methamphetamine has really replaced cocaine as the drug of choice for pregnant women," said Dr. Lester. "But the evidence would say that it's at least as bad if not worse."

Experts say that many women who are drug users switch to meth because of the myth that it causes less harm. But much like babies exposed to cocaine in the womb, infants born to meth-using mothers appear to be at a higher risk for low birth weight as well as developmental and behavioral problems.

Once the children are home from the hospital they are also at risk because meth tends to be manufactured where they live. This process is particularly toxic, and mishaps are common. According to a report issued by the Dept. of Justice's Office for Victims of Crime, 26 children were injured and two were killed in meth lab incidents in 2002.

"The chemicals are in the refrigerator, and it's an explosive environment, so there are additional child endangerment issues that have folks concerned above and beyond the drugs," said Lynne Smith, MD, neonatologist and lead investigator on the NIDA methamphetamine study at the Los Angeles County Harbor-UCLAMedical Center.

It is because the dangers are so great that many anti-drug advocates would like to see primary care physicians become better at screening their pregnant patients for addiction and referring to treatment, not just for the health of the parent and child, but also because the time is right. Physicians have found that although meth is a very hard drug to give up, pregnancy may be the most opportune time to break the habit.

"Pregnancy is a powerful motivator, and a prime moment that you find people receptive to treatment," said Randy Stevens, MD, an addictionologist at Hamilton Center in Terre Haute, Ind., and a clinical assistant professor of family medicine at Indiana University School of Medicine.

"If you're able to get away from it during your pregnancy, that can carry over to a time when you're not pregnant," Dr. Steven said.

But doctors also worry that the resources are few and hard to access for most of their patients.

"They need extensive counseling, and I can't do it," said Dr. Holley. "We've got several rehab centers, but they want $1,000 upfront. The total cost will be $20,000. The majority of rehab that goes on here is in the county jail."