I wrote earlier this month on the regional variations between the different types of heroin we see out west vs back in the midatlantic region. One interesting thing that I would note is that we just don't see much heroin use out where we are, at least not on a comparable basis. Nor, now that I think of it, do we see much cocaine use. I think part of this is that we are in a suburban location -- not the affluent suburbs by any means, more of a gritty, blue-collar exurb -- but a suburb nonetheless. When I do see someone who admits to cocaine use in particular, they are quite commonly "visiting" from the Big City directly to the south of where we work.
Because meth is as hard on the body as it is on the mind -- the relentless expenditure of energy, physical and mental, strips fat from the body, followed by muscle mass, until all that is left is skeletal.
The above photo series is entirely consistent with what I see in the ED. Actually, if anything it understates the physical devastation that meth brings. The phenomenon of "meth mouth" is amazing to see. Nobody really knows why -- whether it's a drug-related toxicity, or due to the incessant grinding of teeth, but meth users have the most astonishing dentition. 20-year olds with all their teeth broken off at the gum line. They're uninsured, practically unemployable, so no dentist will touch them, and as a result they much come to the ER repeatedly for dental pain. It's hard to blame them when you look into their mouths, but what do you do? Write weekly scripts for vicodin for people who are already addicted to one drug? Talk about a catch-22. Also, for some reason, maybe hygiene though I don't really know, but MRSA flourishes in our meth-head population. Facial lesions are common due to nervous picking at the skin, and their faces, already hollow-cheeked and sunken-eyed, become pockmarked and scabrous to boot.
I don't have a conclusion here -- there's no simple, neat, pat answer to this new epidemic. It's a scary thing, which reminds me more of the onslaught of the crack epidemic in the '80s. That seems to have peaked and I hope that out here the same can be said for meth. I see less of it than I did two years ago. But it's a scary glimpse into the dystopian future of designer drugs. Blade Runner had nothing on this stuff.
I seem to have a talent for waxing prolific about the drugs we see in the ER. I'll try to finish my trilogy with some comments on the other popular drug of abuse in our ER -- Oxycodone -- tomorrow. And if history is to be any guide, by "tomorrow" I mean "on our about May 22."