He was only in his 30s and he was having sudden cardiac arrest at a Honolulu bus stop.

That’s what the police told Dr. Daniel Cheng when they arrived with the patient at The Queen’s Medical Center emergency room at Punchbowl.

Cheng, the medical director of Queen’s Care Coalition, recognized him immediately. The patient had long struggled with an addiction to methamphetamine and had become homeless.

“He had multiple hospitalizations once every two weeks,” Cheng said. “He’d come in both psychotic and in respiratory distress because of his ongoing meth use.”

Person sleeps on bench along Punchbowl Street on opening morning of the 2018 Legislature.
Some of the patients who are taken to the emergency room for treatment for issues caused by methamphetamine use are homeless, the Queen’s Care Coalition medical director says. 

Cessation counseling sessions after each hospitalization had not helped.

Unfortunately, his story was common. Cheng estimates the proportion of patients who enter the Queen’s Punchbowl emergency department doors for methamphetamine issues can range from 20% to 40%, depending on the day.

That’s a tremendous portion of patients requiring attention at a trauma center that is built and prepared for other traumatic emergencies.

The emergency room is just their first point of contact with the hospital. Many of them go on to stay for a week.

According to new data acquired by Civil Beat, meth-related hospitalizations at The Queen’s Medical Center — including admissions at the hospital’s downtown Honolulu and West Oahu campuses — have quadrupled in the past 10 years.

The eye-opening statistics from The Queen’s Health Systems illustrate how methamphetamine, a highly addictive stimulant, is still present in the islands and causing tremendous strain on patients and hospitals alike.

Jason Chang, executive vice president and chief operating officer of The Queen’s Medical Center, said it feels like hospitals are at the “losing end” of the figurative battle against meth.

“It’s shocking when you look at the volume,” Chang said. “Most of this is avoidable but the cost to the health system is just extraordinary.”

Back in 2009, The Queen’s Medical Center Punchbowl discharged 532 patients with a primary or secondary diagnosis related to methamphetamine.

A decade later, the Punchbowl campus saw more than three times that number during the fiscal year that ended this June.

By comparison, when The Queen’s Medical Center West Oahu campus opened in 2014, it discharged 27 patients who had been hospitalized with a methamphetamine-coded primary or secondary diagnosis. This year, there were 463 patients.

Jason Chang Executive VP and COO of Queen’s Health System.
Jason Chang, executive vice president and COO of Queen’s Health System, says the increase in hospitalizations for meth is shocking and has taken a substantial financial toll on hospital operations. Cory Lum/Civil Beat

Methamphetamine is a powerful, highly addictive stimulant that affects the central nervous system. As of 2017, Hawaii ranked No.1 in the nation for the percentage of drug-related treatment admissions related to methamphetamine, according to the national Substance Abuse and Mental Health Services Administration.

The increase in hospitalizations seen at Queen’s echoes a larger trend: nationally, amphetamine-related hospitalizations rose a whopping 245% from 2008 to 2015, according to the Journal of the American Medical Association.

Hospitalizations for meth far outnumber those for other drugs, such as opioids, which rose by 46% during the same period.

From what he’s seen at the busy emergency department, Cheng doesn’t believe the increase in hospitalizations is due to an increase in the number of meth users in Hawaii. Rather, he believes it could be the effects of many years of use.

It’s more common for him to see patients in the 40-70 age range who have used methamphetamine long-term, and now he believes the effects of chronic use are taking a toll on their hearts and bodies.  

The associated costs of hospitalizations for methamphetamine in the U.S. are enormous, rising from approximately $436 million in 2003 to nearly $2.2 billion in 2015 

In Hawaii, the average cost at Queen’s Health Systems to care for a patient who seeks help with complications related to methamphetamine is about $18,000, said Chang. The average length of stay for methamphetamine patients at Queen’s is eight days.

“Typically we’re running at 96% capacity, and we want to reserve our beds for patients coming in with traumatic injuries, heart attacks and strokes — that’s our role,” Chang said. “If someone comes in and takes eight days, are there better ways to take care of this population? The better way is preventing them from showing up in the first place.”

“It’s the chronic use of methamphetamine that creates the long length of stays, cardiac conditions, behavioral health issues, and that’s part of what drives the total cost of care up,” Chang added.

Queens Emergency Room.
About one-third of patient foot traffic at the Queen’s Medical Center Punchbowl emergency department is because of methamphetamine, Dr. Daniel Cheng estimated. Cory Lum/Civil Beat

Dr. Ronald Kuroda, chief medical officer at The Queens Medical Center West Oahu, said the rise in meth-related hospitalizations at the West Oahu campus could be attributed in part to a growing population in the area.

Still, methamphetamine use seems to be pretty common. The age range of methamphetamine users Kuroda has met ranges from 20 to 80.

“It’s not always that they’re psychotic. It’s like alcohol for us in the community,” he said. “It’s something that people use, and it just so happens when they come in we ask for a thorough history and they’ll tell us, ‘Yeah I used meth two days ago,’ after we establish trust.”

Ronald Kuroda, the chief medical officer at Queen’s Hospital West Oahu, said a growing population could be a contributor to the rise in meth-related hospitalizations the hospital has experienced. Jason Kimura

Some patients may not report using meth to their doctors until they find out they are having heart issues at an unusually young age.

“There are younger guys, like 30 years old, where they have no idea that they have heart failure,” Kuroda added.

Chang said that the hospital system is focusing on partnerships that support preventive measures, such as investing recently in a new addiction medicine training program for one University of Hawaii medical student.

Chang said Queen’s is looking to use education and awareness “as a means to reverse the trend.”

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