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Methamphetamine and children: nurses working with families who use methamphetamine need to know what the health risks are for themselves and for the children under their care.

Eight years ago, while working as a Plunket nurse in a rural area, I was interested to research the effect of methamphetamine on children living or born into a household with parents who used it.

I regularly visited a number of infants who were living in households with parents who used methamphetamine. These visits gave me an insight into the effects this drug had on families. These were families with complex needs--some were registered with multiple social agencies, while others avoided contact with them. Working in partnership with these families was sometimes heartbreaking and dangerous. On the other hand, seeing the positive changes people made was so rewarding, particularly seeing the children develop and flourish.

This article highlights what methamphetamine is and the effects it has on the body. Above all, it examines the effects it has on children and what a community health worker/nurse needs to know to keep safe when visiting these homes.

I will never forget my first encounter with one of these families whom I worked with for two years until they moved out of the area.

My clients were a nine-month-old baby boy and his mother, Miss M. I had not met this family before, but had read the client notes from previous Plunket visits. There was nothing to indicate any issue with visiting this house, other than multiple appointments not kept. The notes also advised me to call the mother's cell phone when I arrived at the gate so she could put the dogs away and let me in.

My first visit took place on a winter's morning. I parked outside the property and was met by a two-metre-high fence, chained gate, "dogs will bite" spray-painted on the fence, and two cars (occupied) parked outside the garage. I called the cell number but got no answer. I approached the cars and asked the occupants if Miss M and her baby boy lived at the address. They did not know the names of the people living in the house, they said, but thought there was a baby of about six to 12 months living there.

Miss M came to the gate, escorting someone out. She invited me inside to do the well-child check. I dodged past three, tied-up, growling pit bull dogs. Inside I found a slimly built, nine-month-old baby lying in his cot, wearing a cotton, short-sleeved "onesie", his legs and feet bare. A fourth dog was shut in a bedroom next to the lounge, doing its best to get out. Miss M told me this dog got off its lead when tied up and had previously bitten a nurse on the arm. There was a freshly cleaned, sweet smell in the house. There were no light bulbs in the lounge or hallway. Miss M was pleasant. engaging, nervous and fidgety.

This was the beginning of a bumpy ride for me and this family, involving referral to external child protection agencies and addiction services. However, we also developed a trusting relationship, built on the understanding my priority was to protect the baby's wellbeing. The baby stayed with his mother, and together we made--month-by-month--positive changes that benefited the baby's health and development, the mother's health and the safety of both.

This was not an isolated case for me. The outcomes of others were not always positive for the children or their families. Because of these experiences, I decided to find out how methamphetamine affected these children. My research, conducted via a literature review in 2007 and updated recently, enabled me to improve my knowledge, as well as the knowledge of the families I visited.

By 2005, methamphetamine or "P" had crossed all sections of society in New Zea land. (1) It is also known here as meth, crystal meth, crystal, ice, burn, calk, crank, glass, cristy, shaboo, zip, quartz, louee, goey, whiz, 222 and rush. (2) Essentially pure speed, it is a crystal-like substance that liquefies when heated, or dissolves easily in water or alcohol. It is white, odourless and bitter-tasting. It can be injected, snorted, swallowed, dissolved in a drink or smoked in a meth pipe or light bulb. (1) Meth works by releasing dopamine neurotransmitters in the brain that enhance mood and feelings of satisfaction, pleasure and energy. But when it wears off, it can cause depression, extreme tiredness and violent behaviour. (3,4)

Literature search

Most of the literature describes households where meth is used as chaotic, even though parents try to keep life a normal as possible for the children's sake. In reality, this often results in children picking up the pieces and being in charge of the household, responsible for raising younger siblings, cooking, washing and getting ready for school. (5,6) The children are often neglected and hungry, as parents sleep for days, resulting in children stealing food at school and being absent from school regularly. (6) The houses are often filthy and may have no electricity or phone access. Children may not know when they will be fed, where they will sleep and what will happen from one hour to the next. (7)

The effects of meth on adults include job loss, crime, car accidents, loss of desire to live and depression. For many users, all they can think about is meth and getting the next fTx.g In New Zealand households where parents use meth, there is a higher incidence of violence and abuse. (2) The children are exposed to criminal behaviour and environmental hazards, eg needles, chemicals and lighters. Children as young as 10 have been found buying drugs and prostituting themselves for meth for themselves or their parents. (2) Increasing numbers of children are entering foster care in the United States, due to parental meth abuse. (9) The statistics and incidence of this in New Zealand are not publicly available.

The following quote captures the drug's addictive power. Sadly meth also ruins the lives of the family of the person using the drug. "When you first try it, it's fun. It's exciting. It's exhilarating. It's carefree. It's happy. This stuff's neat. It's also alluring, deceitful and cunning and sneaky, hatefut, relentiess and extreme. It's a liar. Once you do meth, it is in control of you. You never control it. It will ruin your life". (5)

Protecting children

Safety is a major issue for children living in a methamphetamine environment. According to recent police data, children live, or are present in, up to a third of meth labs in New Zealand. (10) Strangers will come and go from the household to use or buy meth, leading to high rates of sexual abuse. (7) Broken glass from the light bulbs used for smoking meth causes other hazards. (5)

The physical effects on children include:

* Thin, hungry, toxic chemical residue on hair, clothes and skin, respiratory problems, emotional problems, and some brain damage if infants are born to users. (6)

* Prenatal complications such as premature birth, altered neonatal behaviour, abnormal reflexes, extreme irritability, congenital deformities. (11,12) Trecia Wouldes from Auckland University has also researched and published on outcomes for meth-exposed infants. (13)

* Disturbed sleep, nightmares, flat affect, and intense worry about parents, fear of the police and adults, grief, hopelessness. (7,14)

* Developmental delay, especially in speech and language skills. (3)

* In New Zealand, school and kindergarten attendance is low in children with parents who use meth. (2)

* If ingested, it can cause irritability, seizures, cardiac arrhythmias and death. On average, children spend three days in hospital after inadvertently being poisoned with meth. (3)

Methamphetamine manufacturing also has a huge impact on the environment. The production of one pound of meth releases poisonous gases into the atmosphere and creates five to seven pounds of toxic waste.n This waste can be hazardous to the health of people living in or visiting a house where meth is manufactured. Symptoms include respiratory and eye irritations, headaches, dizziness, nausea and shortness of breathy n American researchers found more than one third of children living in meth houses tested positive for illicit drugs, due to exposure. (15) The chemicals used in the manufacturing process are highly volatile and flammable, causing house fires and explosions (15,16) Whenever the police in New Zealand shut down a manufacturing operation, the dwelling is condemned.

In New Zealand, around 200 meth labs are found each year. (16) However, they are more common in small rural towns and surrounding areas where the powerful fumes emitted during the manufacturing process are less likely to be detected. Meth is quite easy to produce and instructions can be downloaded from the internet. (15) Meth or P was upgraded from a Class B to a Class A drug in New Zealand in 2003, with manufacturing carrying a sentence of life imprisonment (2)

There are a number of clues for health workers to help them identify households of users. Such clues include empty packets of pseudoephedrine-based medications, no light bulbs in the house, high temperature gas lighters, empty butane refill cans and a strong sweet or chemical smell, ie turpentine, menthol and ether. Users will exhibit various behaviours including grinding teeth, chewing lollipops or babies' dummies, repetitive behaviour (scratching or picking body), appearing anxious, nervous, fidgety, unusually hyper, with impaired speech or incessant talking, moodiness, pupil dilation, numbness, false sense of confidence, disinterest in life, depression, aggressive or violent behaviour. (2,16)

Personal safety is very important when visiting homes where P is manufactured. Due to the many volatile chemicals around, health workers face a high risk of chemical contamination. (16,17) A lab will smell sickly sweet, of cleaning products or cat urine. (2) Health workers may also be confronted by dangerous guard dogs, and angry or threatening meth users during a home visit. Plunket policies were reviewed in 2008 and updated in 2013. If a nurse knows a house is potentially dangerous, she must take a colleague with her. She must always carry her cellphone, park outside the property, not in a driveway, and report any suspected drug manufacturing to police.

However, evidence also shows the value of home visits. They produce better health outcomes for infants, as mothers feel more comfortable to ask questions in the privacy of their own home, especially in low socioeconomic areas. (18) There is also evidence that home visiting can reduce abuse and neglect in children, and benefit the health and life course of the mother and family. Through home visiting and working in partnership with the family, the rates of neglect can decrease, and a relationship based on trust can build between the nurse and client. Home visits can make it easier to promote drug-free lifestyles, and alcohol and drug counselling. (18)

Health professionals have a responsibility to work with social services and police to identify and report the children living in these dangerous conditions. (17) The ultimate aim is to get the parents the help they need to overcome the addiction and possibly reunite families when the environment is safe. Health professionals must understand that law enforcement and child welfare placements or investigations are very distressing to children. Many children reported that the saddest or scariest time in their lives was when the police or child welfare agents came to take them or their parents away. They saw child welfare agents and police as bad people because they split up the family. (9)

The Child Welfare League of America says staff interacting with meth users need resources and training (20)--this would be very helpful in New Zealand too.

Client choice vs child protection

Client choice is a right every parent has. However, the difficulty when working with clients who use or abuse drugs occurs when the line between the right to choose blurs with an obligation to protect the child. Parental abuse of illicit drugs increases risk factors for children. Parenting may be compromised by substance abuse, and parental discipline may be inconsistent and monitoring inadequate. Children whose parents abuse drugs are at risk of early pregnancy, dropping out of school, criminal involvement and anti-social behaviour. (7)

When parents go to prison on meth-related charges, children are usually put into foster care. It would seem beneficial to remove a child from a drug-taking environment, but researchers have found that children in foster care often suffer from significant mental health problems, trauma, inadequate socialisation, post-traumatic stress, anti-social behaviour, lying, stealing, drug use, violence and limited educational achievement (9) Disrupted foster placements can be associated with severe behavioural problems, depression and a weakened sense of belonging. (9)

Meth use is a major health issue in New Zealand. What resources we have primarily explain the physical and emotional effects meth has on users. (21,22,23,24) Overall, there is a pressing need for more evidence-based research about the effects meth has on a child's health and how the health professional can assist the family. My experience shows how hard it is to be an effective nurse when there is little evidence to work from.

* References for this article are on www.nzno.org.nz/resources/kai_tiaki/recent_issues.

This article has been updated from earlier presentations the writer has given, including at regional Plunket meetings.

Rachel Chamberlain, RN, PGCerts, works in the children's ward of Hawke's Bay Regional Hospital and as a relieving Plunket nurse.
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Title Annotation:practice
Author:Chamberlain, Rachel
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Mar 1, 2015
Words:2206
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