METH & KIDS: METH & KIDS Jim Cecil, DMD, MPH KY Dept for Public Health UK College of Dentistry james.cecil@ky.gov


TODAY’S AGENDA: TODAY’S AGENDA Why is Oral Health important in our discussion? Describe oral health status in KY Describe effects of METH systemic, oral Show some sickening photos Kids in METH labs Costs of METH use/addiction Q & A


Importance of Oral Health: Importance of Oral Health Oral diseases: Infections mostly Linked with CVD Diabetes Stroke Failure to Thrive Pre-term Babies At end point Pain, Swelling, Death in extreme


Oral Disease in Kentucky: Oral Disease in Kentucky Kids 2-4 years old 47% w/ ECC – Baby Bottle Decay Kids in 3rd and 6th Graders Nearly half with untreated decay Adults High levels of untreated decay High levels of gum infections – periodontal Elders 44% without teeth or replacements


Slide5: Kentucky 2-4 Year Olds* 47% have Early Childhood Caries (ECC) 43% have Severe Early Childhood Caries (S-ECC) 39.3% have never seen a dentist 9% URGENT NEEDS 4,500 2 yr olds!!! *Kentucky Children’s Oral Health Profiles 2001 n = 572


Slide6: Kentucky School-Age (3rd & 6th Graders) Children* 3.9% need urgent care (within 24 hours) 28.5% need early dental care (within weeks) 56.1% have a history of tooth decay 28.7% untx decay * Kentucky Children’s Oral Health Profiles 2001


Slide7: What’s a Toothache Look Like??


New Epidemic In Kentucky!: New Epidemic In Kentucky! METH abuse, addiction, & sequelae: 2nd epidemic – last in ’60s and ’70s METH = CNS stimulant, releases high levels of neurotransmitter DOPAMINE METH = highly addictive METH = readily available METH = cheap to user, expensive to society METH = used by diverse persons in all US regions Crystal METH=even newer, more potent, more costly High lasts 12 hours Smoked, injected, or taken orally


New Epidemic In Kentucky!: New Epidemic In Kentucky! Homemade Meth: Small batches, individual labs Unlikely places (car trunks, motels, trailers) By products are toxic Homemade is 45% pure High Tech Meth – Crystal METH, Ice: Big batches Imported from Mexico 85% pure, ^potency – overdose, deaths in unsophisticated users


METH: Health Effects: METH: Health Effects Stimulates release and blocks re-uptake of monoamine neurotransmitters Dopamine, norepinephrine, serotonin Causes feelings of euphoria, pleasure Cerebral edema and hemorrhage, paranoia and hallucinations Creates variety of other systemic and oral effects


METH: Cerebral Effects: METH: Cerebral Effects Short Term Insomnia, hyperactivity, appetite,  respiration & tremors, crawling skin Long Term Psychological addiction, stroke, violent behavior, anxiety, confusion, paranoia, auditory hallucinations, mood disturbances, delusions Eventual depletion of monoamines can have an effect on learning


METH: Systemic Effects: METH: Systemic Effects High doses  both systolic & diastolic blood pressure due to CNS stimulation May lead to arrythmia Other systemic effects: SOB, hyperthermia, nausea, vomiting, diarrhea


METH Lab Indicators: METH Lab Indicators Odors (urine, rotten eggs, ether, other) Windows blackened Open windows even in winter Renters pay cash Traffic, coming and going, at unusual times Excessive trash – duct tape, containers Clear glass containers found in trash


Substances that might indicate a METH lab: Substances that might indicate a METH lab Acetone Alcohol Annhyd ammonia Antifreeze Batteries Battery acid Benzene Bronchodilators Camp stove fuel Chloroform Cold tablets Drain cleaner Diet aids Energy boosters Ephedrine Epsom salts Freon Hot plates


Substances that might indicate a METH lab: Substances that might indicate a METH lab Hydrochloric acid Iodine crystals Isopropyl alcohol Lithium Lye Muriatic acid Phenyl-2-propanone Phenylacetone Propane cylinders Red phosphorous Rock salt Sodium metal Starting fuel Sulfuric acid Toluene/paint thinner White gas Wooden matches


What do METH USERS look like?: What do METH USERS look like? Not a Pretty Picture!


So, What Does “METH MOUTH” Look Like?: So, What Does “METH MOUTH” Look Like? Not a Pretty Picture!


Slide18: New Epidemic in KY!!!!! METH ABUSERS! Signs Open sores From scratching Rampant decay Extreme underwgt Body odor (urine) Nervous, jittery Crawling skin Names: speed, go fast, ice, crystal, tweak, glass, chalk, peanut butter, aka


Slide19: New Epidemic in KY!!!!! Drug Endangered Kids METH KIDS: School problems Delinquency Absenteeism Homelessness Criminal behavior Self esteem Poor peer relations Addiction 75% ^ liver panels (red ph) One-third abused Physical Sexual METH KIDS are survivors Resilient – Clay County


METH MOUTH in ABUSERS: METH MOUTH in ABUSERS Rampant decay Xerostomia – dry mouth Enamel erosion “Snorters” “Smokers” Periodontal disease Missing Teeth Extraordinary Pain Occlusal Attrition – grinding “Cracked teeth” Restorative Care is Difficult/Impossible Halitosis – urine smell Neglect


METH MOUTH Possible Causes : METH MOUTH Possible Causes Direct corrosion from acidic drug Drug’s xerostomic (dry mouth) effect  cravings for high calorie, carbonated beverages ( appetite) Tooth grinding and clenching Long duration of drug’s action leading to long periods of poor oral hygiene When smoked, fumes release lithium, muriatic acid, ether, red phosphorous, lye


WHERE IS METH?: WHERE IS METH? Every neighborhood Rich and poor Educated and un- or undereducated Men and women All races Coming from the West USA via I’s


WHERE IS METH?: WHERE IS METH? Every County in KY-KSP 2003 – 110 children found in meth labs Meth lab seizures: 1999 – 66 2003 ~ 500 In U.S.: 50,000 labs seized since 2001 30% mom & pop labs


If the KSP asks us to screen a child from a METH Lab?: If the KSP asks us to screen a child from a METH Lab? What do we look for?


Costs of METH Use and Abuse?: Costs of METH Use and Abuse? Community Safety: Because of increased violence ^ burglaries ^ domestic violence ^ child abuse, NEGLECT ^ unusual causes of injuries and deaths Need more police


Costs of METH Use and Abuse?: Costs of METH Use and Abuse? Drug-endangered Children: Kids in 30% of homes w/Meth Labs Many kids test + for meth Kids exposed to serious physical/psychological damage In KY, penalties can be enhanced if kids are present during meth production In KY, 40-45% meth cases involve kids 60% kids in burn unit @Vandy are meth kids (2004)


Costs of METH Use and Abuse?: Costs of METH Use and Abuse? Environment: Labs create 5-6 lbs toxic waste/lb Meth Labs generate lethal gases, flammable and explosive environment Toxic vapors permeate walls, and if vented, vapors released into neighborhood Illegal disposal leads to contamination of water, soil, air. Chemicals poured into tubs, sinks, toilets, along roadsides, wells, creeks, (Crab Orchard)


Costs of METH Use and Abuse?: Costs of METH Use and Abuse? Economic Implications: Cleanup is hazardous Prisons are going broke paying dental bills Public funds for prosecution, incarceration $$$ for investigations of child abuse, placement of children in foster homes, etc $$$ for treatment programs, social services, increased law enforcement, health care And even more undetermined costs


Costs of METH Use and Abuse?: Costs of METH Use and Abuse? Individual Users: Brain functioning continues to decline for up to 18 months once METH use is stopped Neurological & cognitive effects of limb control and thought processing – lifetime Severe depression – due to dopamine decreases by brain Difficult for most users to quit – most are lifelong users.


CONCLUSIONS: CONCLUSIONS Methamphetamine is nasty stuff! Consequences of use/abuse are physical, mental, behavioral, ethical Costs of epidemic are enormous to economy, communities, nation Inadvertent exposures to meth affects the whole community Legislation to limit access to meth ingredients makes sense (Jul ’05 in KY)


… about the free Poster : … about the free Poster “Appearance is everything to kids”, Larson said. …What we are trying to do is show them the impact of methamphetamine.” Fayette Commonwealth’s Attorney Ray Larson


Questions?: Questions? Jim Cecil, DMD, MPH UK College of Dentistry KY Dept for Public Health 502 564-3246 james.cecil@ky.gov