Children in methamphetamine homes: a survey of physicians practicing in southeast Tennessee

Methamphetamine (meth) abuse in the rural South has increased greatly in the last decade. This addiction harms meth abusers and producers and endangers children who live with them. Appropriate medical evaluation and treatment of these exposed children are largely undefined. The objective of this research was to ascertain how emergency medical practitioners view this problem and their management approaches.

A survey of medical practices was mailed to 87 physicians associated with emergency departments and child services in 12 southeastern Tennessee counties with high rates of meth lab seizures. This survey asked about physicians' examination of children in provided clinical scenarios who may have been exposed to meth, their assessment of the severity of the meth problem in their area, and the utility of a standardized protocol for management. Twenty-six practitioners responded.

In a clinical scenario developed to suggest high possibility of meth exposure, the average response regarding likelihood of meth exposure was 8 on a scale of 1 to 10. In a scenario suggesting ambiguous exposure, the physicians' mean response about likelihood of meth exposure was 4 on a scale of 1 to 10. In a third scenario presenting a confirmed meth exposure, physicians ordered the following tests: toxicology screening (96%), complete blood count (88%), oxygen saturation (76%), chest radiograph (72%), and carboxyhemoglobin concentration (52%). Ninety-two percent of respondents felt that medical knowledge of meth could be improved.

Southeastern Tennessee emergency practitioners varied in their estimation of the likelihood of meth exposure to children in different scenarios. In addition, their clinical responses to cases of definite exposure were highly divergent. These practitioners also stated that standardized guidelines would aid in providing care for meth-exposed children.