More than six out of every 10 patients at Hawaii’s only forensic hospital have a history of methamphetamine use, new data from the state Department of Health reveals.
The department’s figures quantify for the first time how much the drug has impacted the lives of Hawaii State Hospital patients, as reported by their caretakers.
When state epidemiologist Amy Curtis became chief administrator of the health department’s Adult Mental Health Division in July, she made a small switch in the clinic’s survey to get a more holistic understanding of methamphetamine’s prevalence by including a new question: Has this patient ever used meth?
Past surveys distributed to clinicians at the state hospital and 16 community mental health centers did not include specific questions about methamphetamine, and meth use tends to be underreported by patients on admission surveys.
The epidemiology department found 63% of patients at the Hawaii State Hospital were identified by clinicians in 2018 as having used meth, compared to the 1% self-reported rate statewide.
Methamphetamine has also had a heavy influence on community health centers.
Among the state’s 16 taxpayer-funded community health centers, 35% of patients were reported to have a history of methamphetamine use.
“I was just kind of shocked at how prevalent it was,” Curtis said. “Meth was just so starkly coming up as an issue and I thought, ‘Wow, why aren’t more people talking about this?’”
Collecting the extra data also made it abundantly clear how methamphetamine has influenced repeat hospitalizations at the forensic facility since 2012.
Among a subgroup of patients who were admitted to the Hawaii State Hospital five or more times during the past seven years, nearly 80% had a history of meth use.
Those who had been admitted to the Hawaii State Hospital just once also had a high meth prevalence. Slightly more than half of them had used meth, the clinicians reported, a proportion Curtis found concerning.
“It’s something I can’t ignore,” she said. “This is a huge percentage of patients who have had severe consequences — both neurological and cardiovascular issues and the loss of planning to make order of your life.”
Run Heidelberg, the Hawaii State Hospital administrator, said the survey’s results sounded conservative. The actual rates of methamphetamine use and history are probably even higher, he said.
Heidelberg has witnessed how patients at the Kaneohe hospital deal with going cold turkey off the drug: the sudden mood swings, paranoia and hallucinations caused by a swift and severe dopamine deficiency.
Their behavior reflects how the drug has altered the structure of their brains, he said.
“They’ll walk and all of a sudden they’ll stop in place, or they’ll be talking in one instance and then stop,” he said. “It’s like someone pressed the pause button — that’s meth.”
Some patients have been readmitted as many as 20 or even 30 times to the hospital, according to Heidelberg.
It can take months to more than a year for people to return to a “baseline” where they recognize what methamphetamine is doing to their minds and bodies.
That’s why patients with a history of meth use have longer hospitalizations, he said.
Curtis found that the median length of stay for those with a meth history was 221 days — 60 days longer than the median hospitalization period for patients who had not indicated using the drug.
Treatment can drag on because methamphetamine addiction has no quick antidote.
Further complicating treatment, it can be difficult to distinguish between mental health issues and the effects of methamphetamine. Mental illnesses may be amplified by meth use.
“We have to determine whether or not their paranoia and delusion is mental illness or substance abuse or both,” said Heidelberg. “Once we get mental illness under control with medication, then we have to address the substance abuse.”
A strong relationship between mental illness, substance use and incarceration rates has been well established. Substance use is often used as a coping mechanism for those who suffer from mental illness, and people with severe mental illness are over-represented in the criminal justice system, said Curtis.
The national Treatment Advocacy Center found that individuals with severe mental illness in Hawaii are two times more likely to be incarcerated than hospitalized, but there is little statewide data on the topic.
He said patient crimes may not be as severe as some people believe. Property crimes, for instance, are slightly more common than offenses against people. Most readmissions at the state hospital are for patients who have committed petty misdemeanors or violated temporary restraining orders, according to Heidelberg.
The Hawaii State Hospital’s most recent annual report shows the most common charge for readmission at the state hospital is categorized as a Felony C, which includes less serious crimes such as the theft of property worth more than $300.
“They’re not the folks out there doing murders or high crime,” Heidelberg said. “We’re talking about the guys sleeping on the sidewalk, having crimes of survival, or like taking a couple of candy bars.”
Methamphetamine use has been recognized by state health officials as a long-standing issue, but it has been difficult to penetrate.
Over the past decade, Hawaii has experienced an increasing number of meth-related deaths, especially among middle-aged men. Local doctors are also noticing long term effects of meth use on the cardiovascular system.
In light of the new data, Curtis said the state Adult Mental Health Division revised its intensive case management policy to better address the needs of people experiencing a meth addiction.
The health department is also making a shift in approach by streamlining communication between departments, since there was a significant overlap of patients among various health department facilities.
“Instead of working together, it was all done very much separately,” Curtis said. “This comes from how the federal government funding streams are siloed and how divisions are created separately.”
Curtis hopes to see more department integration through shared data or electronic medical records.
Heidelberg senses a renewed energy in communication about patient care for people with methamphetamine and substance use disorders.
“I can call Amy and say, ‘We have this patient, we need more housing and case management on this,’” he said. “We have a nice umbrella approach.”
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