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Methamphetamine: An Epidemic of Oral Health Neglect, Loss of Access to Care, Abuse, and Violence
EDITORIAL J Oral Maxillofac Surg 63:1253-1254, 2005
Methamphetamine: An Epidemic of Oral Health Neglect, Loss of Access to Care, Abuse, and Violence We have hopefully seen the public service messages by now: the picture of the pretty high school girl ravaged by the effects of methamphetamine in just a few short years; Teeth rotted from “methmouth”, cachexia facies, and the haunted eyes of the paranoid psychiatric patient are nearly pathognomonic. We might actually be lulled by such pictures into the mistaken belief that illegal drugs are a victimless crime in which the only one who is hurt is the user. If that were true, there would be but a few million Americans being brought to ruin by the manufacture, sale, and distribution of methamphetamine. The truth is that our entire society is withering (like the users themselves) under the scourge of illegal drugs, the most vicious of which is methamphetamine. Consider my (necessarily fictionalized) recent holiday weekend on call. ●
● ● ● ● ● ●
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The most horrifying aspect of the drug epidemic is the abuse and neglect of children. This wrenching photograph from the Arizona attorney general documents both neglect and abuse in a child who was taken from her meth-using parents (Fig 1).1 The National Association of Counties (NAC) reports that in some regions more than 50% of inmates are being held on methamphetamine-related crimes.2 One rural county of 11,000 people in Colorado has more than 4 dozen children placed in foster care in just 1 year because of methamphetamine-related abuse and neglect. The NAC also reports that the
Two admissions for severe head and neck infections associated with rampant caries in young adults. A young girl with her face torn off by a moving vehicle. A young man with a self-inflicted gunshot wound to the face. A man beaten senseless by 8 of his “friends.” Another man beaten senseless by strangers. A pedestrian teenager hit by a car on a divided freeway at 2 AM. An elderly woman brought in by her quiet husband who “fell,” fracturing her orbit, nose, supraorbit, maxilla, hand, and scapula with multiple bruises. A six year old with rampant caries and facial swelling. A man in a one-car rollover accident.
While I cannot document the role of methamphetamine and other drugs in all of these cases, I can say with certainty that without these drugs it would have been a quiet weekend. But what was just a weekend at work for me will be a string of irrevocably ravaged lives: children, young adults, and the elderly, who will face disfigurement, brain damage, and the burden of rehabilitation, in some cases for the rest of their lives.
FIGURE 1. Photo courtesy of the Arizona Attorney General’s office.1 Leon A. Assael. Editorial. J Oral Maxillofac Surg 2005.
1253
1254 health care costs for dentistry, psychiatry, and social services are soaring in this patient group. Economic loss due to methamphetamine abuse will fundamentally alter our society. Users are incapable of having meaningful work or sustained personal economic responsibility. In a recent consultation with an orthodontist, he revealed that methamphetamine was becoming a problem in his patients. It is rare to hear fear for the next generation from an orthodontist who has patients who undergo that most optimistic of health care therapies. Difficulty with access to health care is tied to the drug epidemic where users are not eligible for employer-paid insurance, nor are they eligible for Aid to Families with Dependent Children (AFDC) Medicaid when they are no longer raising their children. Violence in the household, whether it is intimate partner violence (as highlighted by Halpern, Susarla, and Dodson in this month’s Journal), or in the violence suffered by our children, is also growing. Methamphetamine has brought violence to our communities on a broader scale than any illegal drug in the past. As Halpern et al points out, intimate partner violence, like the substance abuse that often underpins it, is a hidden epidemic, not revealed in casual patient assessment.3 We must often doggedly pursue the role of drugs and abuse in the patients that we see. Halpern offers some useful screening methods in that regard. While it may not be necessary to do so, I would remind the reader that this editorial is only the opinion of one citizen. I honestly do not know for certain how to eradicate this insidious and advancing epidemic. I do know that the epidemic is advancing at a rate that will envelop us all unless swift and effective action is taken. The US Congress has formed a Meth Caucus, tellingly with leadership of congressmen from Iowa, Utah, and Washington state, among others.4 They are struggling with increasing awareness and are considering legislation that might chart an effective course of action. My opinion is that there will be no simple medical or health care resource solution to the scourge of methamphetamine, a drug that is powerful enough to take down not only families and communities, but also nations. Only removing addicts from the environment that fosters drug
EDITORIAL
use can give our society any hope of being effective in freeing them from the power of meth. At the risk of appearing to be an ideologue, I believe we cannot win the struggle against illegal drugs without recognizing that users are not victims. Methamphetamine users violate the law and are by definition criminals. They are perpetrators of a crime against all of us, but especially their children, parents, and intimate partners. They need to be confined when necessary and rehabilitated. This is the most just and moral way to address the methamphetamine problem. It protects families and our society while offering the only chance the user has to save his or her own life. The only outcome for methamphetamine users that makes any sense must be rehabilitation. As a best practice, some states are now devoting entire correction facilities to drug rehabilitation. Once (or if) rehabilitated, methamphetamine users should return to their communities and families to begin anew. They must also return with mandatory random drug testing for their lifetime as a condition of parole. While many will be recidivist or incorrigible, many will be saved. We must do this to protect children and other innocent victims of drug crimes. As for what our society should offer to those who would profit from the manufacture and sale of this poison to our loved ones, I will leave that to you to ponder. LEON A. ASSAEL, DMD
References 1. Arizona Drug Endangered Children (DEC) Program Web site. Available at http://www.azag.gov/DEC/index.html. Accessed July 4, 2005 2. Berkes H: Study: Meth epidemic fuelling family break ups. Available at http://www.npr.org/templates/story/story.php? storyId⫽4726336. Accessed July 5, 2005 and broadcast on National Public Radio on July 5, 2005 3. Halpern L, Susarla S, Dodson T: Injury location and screening questionnaires as markers for intimate partner violence. J Oral Maxillofac Surg 63:1255, 2005 4. Congressional Caucus to Fight and Control Methamphetamine Web site. Available at http://www.house.gov/larsen/meth/. Accessed July 27, 2005
© 2005 American Association of Oral and Maxillofacial Surgeons doi:10.1016/j.joms.2005.07.001
Methamphetamine: An Epidemic of Oral Health Neglect, Loss of Access to Care, Abuse, and Violence We have hopefully seen the public service messages by now: the picture of the pretty high school girl ravaged by the effects of methamphetamine in just a few short years; Teeth rotted from “methmouth”, cachexia facies, and the haunted eyes of the paranoid psychiatric patient are nearly pathognomonic. We might actually be lulled by such pictures into the mistaken belief that illegal drugs are a victimless crime in which the only one who is hurt is the user. If that were true, there would be but a few million Americans being brought to ruin by the manufacture, sale, and distribution of methamphetamine. The truth is that our entire society is withering (like the users themselves) under the scourge of illegal drugs, the most vicious of which is methamphetamine. Consider my (necessarily fictionalized) recent holiday weekend on call. ●
● ● ● ● ● ●
● ●
The most horrifying aspect of the drug epidemic is the abuse and neglect of children. This wrenching photograph from the Arizona attorney general documents both neglect and abuse in a child who was taken from her meth-using parents (Fig 1).1 The National Association of Counties (NAC) reports that in some regions more than 50% of inmates are being held on methamphetamine-related crimes.2 One rural county of 11,000 people in Colorado has more than 4 dozen children placed in foster care in just 1 year because of methamphetamine-related abuse and neglect. The NAC also reports that the
Two admissions for severe head and neck infections associated with rampant caries in young adults. A young girl with her face torn off by a moving vehicle. A young man with a self-inflicted gunshot wound to the face. A man beaten senseless by 8 of his “friends.” Another man beaten senseless by strangers. A pedestrian teenager hit by a car on a divided freeway at 2 AM. An elderly woman brought in by her quiet husband who “fell,” fracturing her orbit, nose, supraorbit, maxilla, hand, and scapula with multiple bruises. A six year old with rampant caries and facial swelling. A man in a one-car rollover accident.
While I cannot document the role of methamphetamine and other drugs in all of these cases, I can say with certainty that without these drugs it would have been a quiet weekend. But what was just a weekend at work for me will be a string of irrevocably ravaged lives: children, young adults, and the elderly, who will face disfigurement, brain damage, and the burden of rehabilitation, in some cases for the rest of their lives.
FIGURE 1. Photo courtesy of the Arizona Attorney General’s office.1 Leon A. Assael. Editorial. J Oral Maxillofac Surg 2005.
1253
1254 health care costs for dentistry, psychiatry, and social services are soaring in this patient group. Economic loss due to methamphetamine abuse will fundamentally alter our society. Users are incapable of having meaningful work or sustained personal economic responsibility. In a recent consultation with an orthodontist, he revealed that methamphetamine was becoming a problem in his patients. It is rare to hear fear for the next generation from an orthodontist who has patients who undergo that most optimistic of health care therapies. Difficulty with access to health care is tied to the drug epidemic where users are not eligible for employer-paid insurance, nor are they eligible for Aid to Families with Dependent Children (AFDC) Medicaid when they are no longer raising their children. Violence in the household, whether it is intimate partner violence (as highlighted by Halpern, Susarla, and Dodson in this month’s Journal), or in the violence suffered by our children, is also growing. Methamphetamine has brought violence to our communities on a broader scale than any illegal drug in the past. As Halpern et al points out, intimate partner violence, like the substance abuse that often underpins it, is a hidden epidemic, not revealed in casual patient assessment.3 We must often doggedly pursue the role of drugs and abuse in the patients that we see. Halpern offers some useful screening methods in that regard. While it may not be necessary to do so, I would remind the reader that this editorial is only the opinion of one citizen. I honestly do not know for certain how to eradicate this insidious and advancing epidemic. I do know that the epidemic is advancing at a rate that will envelop us all unless swift and effective action is taken. The US Congress has formed a Meth Caucus, tellingly with leadership of congressmen from Iowa, Utah, and Washington state, among others.4 They are struggling with increasing awareness and are considering legislation that might chart an effective course of action. My opinion is that there will be no simple medical or health care resource solution to the scourge of methamphetamine, a drug that is powerful enough to take down not only families and communities, but also nations. Only removing addicts from the environment that fosters drug
EDITORIAL
use can give our society any hope of being effective in freeing them from the power of meth. At the risk of appearing to be an ideologue, I believe we cannot win the struggle against illegal drugs without recognizing that users are not victims. Methamphetamine users violate the law and are by definition criminals. They are perpetrators of a crime against all of us, but especially their children, parents, and intimate partners. They need to be confined when necessary and rehabilitated. This is the most just and moral way to address the methamphetamine problem. It protects families and our society while offering the only chance the user has to save his or her own life. The only outcome for methamphetamine users that makes any sense must be rehabilitation. As a best practice, some states are now devoting entire correction facilities to drug rehabilitation. Once (or if) rehabilitated, methamphetamine users should return to their communities and families to begin anew. They must also return with mandatory random drug testing for their lifetime as a condition of parole. While many will be recidivist or incorrigible, many will be saved. We must do this to protect children and other innocent victims of drug crimes. As for what our society should offer to those who would profit from the manufacture and sale of this poison to our loved ones, I will leave that to you to ponder. LEON A. ASSAEL, DMD
References 1. Arizona Drug Endangered Children (DEC) Program Web site. Available at http://www.azag.gov/DEC/index.html. Accessed July 4, 2005 2. Berkes H: Study: Meth epidemic fuelling family break ups. Available at http://www.npr.org/templates/story/story.php? storyId⫽4726336. Accessed July 5, 2005 and broadcast on National Public Radio on July 5, 2005 3. Halpern L, Susarla S, Dodson T: Injury location and screening questionnaires as markers for intimate partner violence. J Oral Maxillofac Surg 63:1255, 2005 4. Congressional Caucus to Fight and Control Methamphetamine Web site. Available at http://www.house.gov/larsen/meth/. Accessed July 27, 2005
© 2005 American Association of Oral and Maxillofacial Surgeons doi:10.1016/j.joms.2005.07.001