drug endangered children: medical effects medical effects · caretaker substance abuse and child...
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Drug Endangered Children:Drug Endangered Children:Medical EffectsMedical Effects
Angela Rosas, MDAssistant Professor of Clinical PediatricsUCDMC CAARE Center
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What is a What is a DrugDrug--Endangered Child?Endangered Child?
Children under 18 years of ageSuffer physical harm or neglect from direct or indirect exposure to illegal drugs or alcoholLive in a house where illegal drugs are used and/or manufactured.
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What is a What is a DrugDrug--Endangered Child?Endangered Child?
Children who ingest or inhale illegal drugs in the homeChildren exposed to the toxic chemicals of home drug labsInfants exposed to illegal drugs in utero
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What is a What is a DrugDrug--Endangered Child?Endangered Child?
Most importantly: Infants/Children who suffer physical abuse and neglect because of their caretaker’s substance abuse.
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Overview:Overview:Meth effects on KidsMeth effects on Kids
Direct physical effects of MethamphetamineDirect physical effects of Meth Lab toxicity and dangersSubstance abuse and child neglectMedical protocols
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Direct Meth effectsDirect Meth effects
Adults– Short term – Long term– Pregnancy
Children– Clinical experience suggests pervasive
exposure, but not well studied
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Adults EffectsAdults Effects
Short-term– Increased energy, sexual arousal, euphoria– Decreased appetite– Increased heart rate, abnormal rhythm, high
blood pressure, heart attack– Dizziness, seizures– Extremely high temperature
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Adults EffectsAdults Effects
Long-term– Powerful addiction: unable to stop use, increased
tolerance of the drug, withdrawal symptoms– Neurotransmitters “turned off”– Tremor, uncontrolled movements (Parkinson’s Disease)– Paranoia, hallucinations– Weight loss– Insomnia– Stroke
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Normal Nerve Cell
Nerve Cell
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MM M M
Nerve Cell
Nerve Cell
M M
M
M
M
M M
Meth on the Brain
Nerve Cell
M M
M
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M M
Nerve Cell
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Adult EffectsAdult Effects
After Meth is stopped At least 6-12 months of symptoms– Profound depression, abnormal mood– Insomnia– Psychosis, paranoia
Permenant brain changes– Brain scans show up to 80% reduction in
Dopamine metabolism
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Brain Changes with Meth UseBrain Changes with Meth Use
Baboon study N=90Given Meth doses equivalent to humansPET scan, decreased dopamine transporter activity in the caudate, 3 weeks after Meth
Villemagne 1997
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Brain Changes with Meth UseBrain Changes with Meth Use
Rhesus and Vervet monkey studies Given 3-6 months Meth doses equivalent to humansDecreased dopamine levels in the caudate by 80% immediately after stopping Meth and up to 6 months later
Seiden 1975, Woolverton 1989, Melega 1996 and 1997
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Brain Changes with Meth UseBrain Changes with Meth Use
PET scans comparing control, Meth users with 6 mo-5years abstinence, and patients with Parkinson’s Disease, showing decreased dopamine transporter activity in the caudate and putamen. 25% decrease for Meth users, and 60% for PD.
McCann 1998
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Meth Lab Human ToxicityMeth Lab Human Toxicity
What toxins are in a home meth lab?– Methamphetamine powder and solution
– Flammable solvents
– Phosphorus
– Lye
– Acid
– Iodine
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Meth Lab Human ToxicityMeth Lab Human Toxicity
Phosphorus -Inhalation of phosphine gas is lethal
Lye or Acid - Concentrated caustic substance produces severe burns
Iodine – eyes, nose, skin irritation or burn, abdominal pain, thyroid disease
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Meth Lab Human ToxicityMeth Lab Human Toxicity
Case report of three fatalities from phosphine gas in a Meth lab. Levels were still toxic when deputies entered. Willers, 1999
Survey of narcotics officers c/o headache, respiratory and skin irritation, more so in active cooking labs and before use of protective gear. Burgess, 1996
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Meth Use During PregnancyMeth Use During Pregnancy
Mother– Poor prenatal care, nutrition– Ruptured placenta– Preterm labor, breech delivery– STDs (HIV, Hepatitis)
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Meth Use During PregnancyMeth Use During Pregnancy
Baby– Low birthweight, birth defects– Drug withdrawal– Developmental disabilities
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Children Who Ingest/inhale Children Who Ingest/inhale Illegal DrugsIllegal Drugs
Children pick up pieces of the raw drug or carry the drug powder on their hands and put their hands in their mouthChildren inhale the smoke in a home with multiple usersMost identified cases are Cocaine and MethamphetamineFew cases reported in the literature
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Children Who Ingest/inhale Children Who Ingest/inhale Illegal DrugsIllegal Drugs
Few cases reported in the literature– 18 children under 7 years old accidentally
ingested methamphatamine .– Their parents had left drugs out in easy access– Symptoms:Increased heart rate, agitation,
irritability and vomiting, muscle breakdown, fever,ataxia, seizure
• Kolecki, 1998
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Children Who Ingest/inhale Children Who Ingest/inhale Illegal DrugsIllegal Drugs
Few cases reported in the literature– 11 month old boy with irritability and blindness
found to have urine + for meth. Symptoms resolved after 12 hours.
• Gospe, 1995
– 10-month-old infant died from “crack” cocaine ingestion. 2-year-old brother fed him “crack”found on floor and crib.
• Havlik, 2000
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Children Who Ingest/inhale Children Who Ingest/inhale Illegal DrugsIllegal Drugs
Few cases reported in the media– Arizona 2002 – breastfeeding infant died from
Methamphetamine overdose
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Children Exposed to Toxins in Children Exposed to Toxins in Home Methamphetamine Home Methamphetamine
LabsLabs
For children, no lab cases are reported in the literature.UCDMC CAARE Center data– 64 DEC victims screened/ >50 ng meth– 50 % of Level I cases are tox positive– 15% of Level II cases positive
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Child Abuse & Neglect and Child Abuse & Neglect and Caretaker Substance AbuseCaretaker Substance Abuse
NeglectPhysical abuseSexual abuseIncreased risk for accidentsIncreased risk for infant mortality
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Caretaker Substance Abuse Caretaker Substance Abuse and Neglectand Neglect
Lack of nurturing and emotional stimulation results in developmental delays, depression and attachment disorderMalnutrition/Failure to Thrive
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Caretaker Substance Abuse Caretaker Substance Abuse and Neglectand Neglect
Poor hygiene and infectious skin conditions (scabies, impetigo)Medical neglect of chronic medical problems (asthma, epilepsy)Little well child care/ Immunization delayNo insurance/ frequent Emergency Room use
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Caretaker Substance Abuse Caretaker Substance Abuse and Child Neglectand Child Neglect
2 yo boy found in filthy home with large quantity of meth, parent under the influence
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Caretaker Substance Abuse Caretaker Substance Abuse and Child Physical Abuseand Child Physical Abuse
Child Homicide in Sacramento County-60% families had current or a history of substance abuseChildren hospitalized for physical abuse injuries at UCD Children’s Hospital commonly have a history of substance abuse
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Caretaker Substance Abuse Caretaker Substance Abuse and Child Sexual Abuseand Child Sexual Abuse
Sacramento County Foster Children: School-aged girls removed for concerns of parental substance abuse/neglect frequently disclose sexual abuse or have findings of sexual trauma on medical examination
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Caretaker Substance Abuse Caretaker Substance Abuse and Increased Risk for and Increased Risk for
AccidentsAccidentsLack of supervision results in increased injury from falls, burns, lacerations, drowningDUIs increases serious risk for injury from MVA w/wo car seat/ seatbeltIncreases risk of injury in house fire
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Caretaker Substance Abuse Caretaker Substance Abuse and Increased Risk for and Increased Risk for
AccidentsAccidents10-month-old female rescued from a house fire in a trailer. Drugs and paraphaneliafound in easy access.This infant and 5 yo sibling urine tox meth+
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Caretaker Substance Abuse and Caretaker Substance Abuse and Increased Risk for AccidentsIncreased Risk for Accidents
Singed hair
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Caretaker Substance Abuse Caretaker Substance Abuse and Increased Risk for and Increased Risk for
AccidentsAccidentsContact burns from falling debris
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Caretaker Substance Abuse Caretaker Substance Abuse and Infant Mortalityand Infant Mortality
Increased risk of SIDSIncreased risk of positional overlayIncreased risk of very premature birth and severe complications
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DEC Medical ProtocolDEC Medical Protocol
Identify children at riskHealth screening– Medical– Behavioral– Developmental
TreatmentLong-term follow-up
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DEC Medical ProtocolDEC Medical Protocol
Health screening– Decontamination if needed: wash down, change
clothing, shoes at scene– Body check health assessment at scene or
immediately to health facility– Urine/Blood tox screen within 12 hours, “any
measurable amount”, >50 ng.– Additional tests, studies as indicated
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DEC Medical ProtocolDEC Medical Protocol
Health screening– Forensic medical examination within 24 hours
Medical problemsPhysical or sexual abuse, malnutritionLabs, X-rays as needed
– Comprehensive medical exam, behavioral and developmental assessment within 30 days
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DEC Medical ProtocolDEC Medical Protocol
Long-term treatment– Medical “home”, follow-up of all health
problems– Mental health treatment, counseling– Developmental delays treatment:Speech/OT/PT
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DEC victims: In summaryDEC victims: In summary
Increasing numbers of children across the U.S. are exposed to home Meth Labs with serious toxicities and dangers that have not yet been well-studied.Adults studies indicate life-threatening toxicities from both Methamphetamine and lab chemicals
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DEC victims: In summaryDEC victims: In summary
Child neglect in substance abusing families can cause serious medical, nutritional, developmental and behavioral problems with long-term sequelae.Caregiver substance abuse increases rates of childhood injury and death
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Questions?Questions?
Drug-Endangered ChildrenAngela Rosas, MDUCD Children’s Hospital