Hospital study: Meth leaves users injured, bills unpaid

By: GARY WARTH - Staff Writer | Sunday, August 12, 2007 6:21 AM PDT ∞

The local cost of methamphetamine abuse has long been evident in property crime, broken families and the loss of life, but a less visible toll is the financial strain and additional workload the drug places on emergency rooms.

"It's the nature of the lifestyle," said. Dr. Mike Sise, trauma medical director at Scripps Mercy Hospital in San Diego. "Methamphetamine takes your life away. You lose your job. You lose your family."

With no job and no insurance, meth users have little hope of paying for emergency hospital bills.

"It causes a lot of lost revenue," Sise said about the expense at Scripps Mercy alone. "We calculated the annual uncompensated cost of care went up to over $1.5 million a year."

Adding injury


Compounding the problem, meth users are likely to hurt themselves more severely than other patients admitted to trauma centers, he said.

"All sorts of injuries," Sise said about what emergency room doctors see with patients who use meth. "And they were injured worse."

Meth abusers are more likely to attempt suicide, have a violent injury, have an altercation with law enforcement and be involved in domestic violence, he said.

Scripps Mercy is one of two level-one trauma centers in the county. Besides treating patients, level-one centers teach, conduct research and publish their findings.

The survey was the only one of its kind conducted at a county hospital, and the data did not include patients treated at the emergency room at Scripps Memorial Hospital Encinitas.

Data for the region


Palomar Pomerado Health System does not screen trauma patients for the presence of drugs so it does not have information about the injuries sustained to patients on meth or the cost of treating those injuries, said Andy Hoang, communications manager at the hospital district.

In Riverside County, neither Rancho Springs Medical Center in Murrieta nor Inland Valley Medical Center in Wildomar, just north of Temecula, had data about the effects of meth on emergency rooms, said Teresa Fleege, spokeswoman for the hospital system.

As part of its research, Scripps Mercy analyzed methamphetamine's effects on the hospital by reviewing 4,932 consecutive trauma patients who underwent toxicology screening from 2003 to 2005. The sample represented 76 percent of all trauma patients seen in those three years.

During that time, meth passed marijuana as the most-common illicit drug used by trauma patients. In 2003, about 10 percent of trauma patients tested positive for meth. In 2005, the amount had increased to 15 percent.

A violent world


Patients who were on meth showed a dramatic difference in the severity and types of injuries they suffered. Those patients were twice as likely to have a violence-related injury and twice as likely to have attempted suicide.

Specifically, 47 percent of meth-positive patients had a violent injury compared with 26 percent of patients who tested negative for the drug.

Meth-positive patients had 33 percent more assaults, 96 percent more gunshot wounds and 158 percent more stab wounds than patients who tested negative.

Twice as many suicide attempts and twice as many domestic-violence victims tested positive for meth than those who tested negative.

About 2 percent of patients had an altercation with a law officer and tested positive for meth, compared to 0.3 percent who had an altercation and tested negative.

Watching the scores
Injuries also were more severe with patients on meth. Using a rating called an injury-severity score, trauma doctors gave patients who tested positive a score of 11.2 compared to 10 for patients who tested negative.

Patients who tested positive for meth were 62 percent more likely to receive mechanical ventilation, 53 percent more likely to have surgery and 113 percent more likely to die from their injuries. Patients who tested positive for meth also were twice as likely to leave against medical advice.

"This was something we felt was important to look at because we do see a fair amount of methamphetamine," Sise said about the research. "It's a recurrent theme in the injuries we see."

Sise said he was not surprised by the findings. He and other doctors who compiled the research are publishing their findings in the August edition of the Journal of Trauma. An abstract with the findings already has been presented at scientific meetings, and the hospital's research was published earlier this year in American College of Emergency Physicians News.

Hospitals report
The hospital's findings are similar to other studies on the drug's effects on emergency rooms.

In 2006, a survey in Midwest states revealed an increase in meth-related injuries at emergency rooms and additional costs to treat those injuries.

The National Association of Counties survey found 73 percent of 200 county and regional hospitals had an increase in the number of people visiting emergency rooms for meth-related problems over five years.

Meth-related incidents accounted for 10 percent of emergency-room visits in 70 percent of hospitals in the Midwest and 80 percent in the Upper Midwest, the survey found.

High costs of meth
Of all the hospitals in the survey, 56 percent said their costs have risen because of the drug.

In 2004, the Archives of Surgery, a monthly professional medical journal, published similar findings about trauma patients at the Queen's Medical Center in Honolulu.

The smaller study ---- it looked at 212 patients over 12 months ---- also found meth-positive patients had more and greater injuries than other patients. Of 212 patients in the study, 57 tested positive for amphetamine or methamphetamine.

Of meth-positive patients, 37 percent had self-inflicted injuries or intentional assaults, while 22 percent of patients who tested negative had similar injuries.

That study also found that meth-positive patients had longer hospital stays and had higher hospital charges.

Contact staff writer Gary Warth at (760) 740-5410 or gwarth@nctimes.com.