According to Watt, Meade, Kimani, Macfarlane, Choi et al. (2013), crystal methamphetamine commonly referred to as ‘tik’ is considered to be the second most widely abused drug worldwide. It is an addictive synthetic psychostimulant that increases energy and feelings of euphoria, among other physiological effects. The physiological impact of this drug as proposed by the clinical and epidemiological research conducted in the United States also include increased wakefulness and physical activity, decreased appetite, hypervigilance, arousal, restlessness, aggression and violent behaviour (Watt, Meade, Kimani, Choi et al., 2013). I selected the above image as it made me reflect back on one of the patients that I encountered in the clinical setting. Upon my initial subjective assessment of this particular patient I was informed that she was indeed a methamphetamine user. The information disclosed to me in no way posed an impact on my willingness to assess and treat this patient. However, upon asking the patient whether she had any children she indicated that she had two children the youngest being 7 months. She went on to say that during the course of her pregnancy with her last born she would often use methamphetamine. Following the disclosure of this information I found myself being quite bothered by the fact that she had used methamphetamine during her pregnancy and with no shame had provided me with this information. I thought about this encounter for quite some time and came to the realization that this particular encounter provided me with the opportunity to educate this patient on the potential dangers of methamphetamine use during pregnancy but how could I have educated her if I myself was not aware what the potential dangers were? My lack of knowledge failed me. As a result I took it upon myself to explore the dangers methamphetamine use poses on the fetus and the child later on in life. In addition, I developed an interest in the factors that may potentially drive women to make use of these substances during their pregnancies.

Methamphetamine can cross the placenta and have a detrimental impact on the fetus as well as related tissue (Anvari et al., 2015). In addition, some effects of the prenatal use of methamphetamine include a reduction in birth weight, cerebral haemorrhage, growth retardation, prematurity, cardiac anomalies, cleft palate and possible death (Anvari et al., 2015). Methamphetamine use possess vasoconstrictive effects which often results in reduced uteroplacental blood flow and hypoxia (Salisbury, Ponder, Padbury & Lester, 2009). According to Behnke and Smith (2019), during the fetal period after structural development is complete, drugs possess subtle effects on the fetus which often includes abnormal growth and maturation, alterations in neurotransmitters and their receptors as well as brain organization. Furthermore, drug abuse often impacts the delivery of substrates to the fetus for nutritional purposes due to placental insufficiency (Behnke & Smith, 2019).  The developing fetus is also more vulnerable to DNA changes (Behnke & Smith, 2019). Prenatal use of methamphetamine may have an impact on children later in life. The effects of prenatal methamphetamine use on the children at a later stage appear as cognitive problems including learning slower than peers, difficulties in organizing work and completing tasks as well as problems with concentrating on tasks that often require sustained mental effort. This often results in educational deficits (Diaz, Smith  & Lester, 2014). As a result of these cognitive problems, behavorial problems may arise as well. Children often display negative externalizing behaviour. According to Diaz, Smith and Lester (2014), the negative externalizing behaviour displayed by children who have been exposed to methamphetamine prenatally is potentially due to the frustration, lack of motivation and confusion they encounter when compared with their peers.

As previously mentioned, this particular encounter has made me ponder about the factors that often influence soon-to-be mothers to make use of crystal methamphetamine. According to Wouldes, Sheridan and Lagasse (2004), maternal drug use is often associated with general psychosocial risk factors which often include poverty, chaotic and dangerous lifestyles, symptoms of psychopathology, history of childhood sexual abuse, and involvement in difficult or abusive relationships with male partners.

After exploring the various effects that crystal methamphetamine use have on the developing fetus as well as the child later on life and the factors that often influence young women to abuse crystal methamphetamine, I now possess the knowledge required in order to educate patients battling with drug addiction. However, now possessing this knowledge it led me to ask myself the following question, ‘are health professionals and/or medical students indeed expected to educate patients battling with drug addiction ?’.

According to Yoast, Filstead, Wilford, Hayashi, Reenan and Epstein (2008), the abuse of substances often results in increased lives lost, illnesses and disabilities which subsequently takes a toll on the health and safety of individuals. This often places a great and unrecognized burden on the health system. Health professionals have the potential to play a positive role in influencing patients’ decisions regarding substance abuse (Yoast et al., 2008).  Screening as well as a brief intervention is considered to be effective especially when conducted in a clinical setting (Yoast et al., 2008).  In order for health professionals to provide education on substance abuse health professionals as well as medical students are required to be knowledgeable about this matter for them to be involved in the prevention, screening and intervention of patients who are battling with substance abuse (Yoast et al., 2008). 

The literature consulted thus indicates that it is imperative that health professionals and/ or medical students should educate patients on the harmful effects of substance abuse. In order for this to be conducted , medical students and/ or health professionals are expected to possess the knowledge on the harmful effects of substance abuse.  In addition, by exploring the factors that often influence the decision to use drugs it emphasizes the importance of taking  into account patients’ social context.

References:

Watt, M., Meade, C., Kimani, S., MacFarlane, J., Choi, K., Skinner, D., Pieterse, D., Kalichman, S., Sikkema, J. (2014). The impact of methamphetamine (“tik”) on a peri-urban community in Cape Town, South Africa. Int J Drug Policy 25(2): 219-225

Anvari, M., Mirjalili, T., Hosseini, M., Golzadeh, J., Halvaei, I., Danafar, A., Khoradmehr, A. (2015). Effect of prenatal methamphetamine administration during gestational days on mice. Iran J Reprod Med 13(1):41-48

Salisbury, A., Ponder, K., Padbury, J., Lester, B. (2009). Fetal Effects of Psychoactive Drugs. Clinics in Perinatology 36(3): 595-619

Bhenke, M., Smith, V. (2013). Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus. Paediatrics 3(131)

Diaz, S., Smith, L., Lester, B. (2014). Effects of prenatal methamphetamine exposure on behavioral and cognitive findings at 7.5 years. J Pediatr 164(6): 1333-1338

Wouldes, T., Lagasse, L., Sheridan, J. Maternal methamphetamine use during pregnancy and child outcome: What do we know?. The New Zealand medical journal 117(1206)

Yoast, R., Filstead, W., Wilford,B., Hayashi, S., Reenan,J., Epstein, J. (2008). Teaching about substance abuse. AMA Journal of Ethics