In the last few months I have seen an increase in patients coming to the emergency department with drug-related health issues. These are usually youths from across the spectrum of society and not just the typical “druggie” that society associates with drug use. There is an established association between recreational drug use/abuse, mental illness, and violent crime. In Zimbabwe, we have often seen youths coming to mental health treatment facilities with mental illness as a result of alcohol and marijuana abuse. In the medical circles, psychotic illness that results from use of such drugs is referred to as “Substance-Induced Psychosis”. There is a whole spectrum of mental health problems that can arise from drug abuse including anxiety, depression and psychosis. In the last few years, the “substances” being abused by the youth have expanded beyond alcohol and mbanje to include many others.
Crystal Methamphetamine
Crystal Methamphetamine is one such drug that has become popular on the streets of Harare. When I was an intern in Psychiatry 8 years ago, it was unheard of in a local context. In other countries, the street names are ice or glass. In Zimbabwe, most patients I have seen call it mutoriro or just crystal and I have no doubt it has many other street names. People use it by inhaling, smoking, or injecting it. Methamphetamine (just like other amphetamines) is a stimulant of the central nervous system. It gives you a false sense of happiness and well being leading to a strong feeling of confidence and energy. This “high” lasts for a few hours and when you come down from it, you will feel worse than you did before, making you want to take more.
Tolerance, Dependence and Addiction
Some people use these words interchangeably but they have different meanings when describing drug use. Tolerance is when you need more of the drug than you needed before to achieve the same effect. A good example is when someone starts drinking alcohol. A glass of wine might get you drunk initially but after a while you may need 3 glasses to get drunk the same way. This doesn’t mean you are dependent or addicted. Dependence is when your body needs the drug to function properly. Without the drug you start experiencing withdrawal symptoms which are actual physical symptoms. When I was growing up my grandmother used to say that if she doesn’t drink her cup of tea, she would get a headache and her day would be miserable. This is perhaps a classic example of dependence. She however only needed her one cup to get her day going, which means she had not developed tolerance. Addiction, unlike tolerance and dependence, is a disease. It is when you have strong cravings for a drug that you can end up doing anything to get it. It is not uncommon for drug addicts to commit crimes, even murder, just to get a drug. Tolerance, dependence and addiction are not mutually exclusive, more often than not they occur together.
Health Effects
Crystal meth is a party drug, but the party does not last long. The drug has several terrible health effects that might be short-term or long-term. The following list is from The Foundation for a drug-free World
- Short term effects
- Loss of appetite
- Increased heart rate, blood pressure, body temperature
- Disturbed sleep patterns
- Nausea
- Bizarre, erratic, sometimes violent behavior
- Hallucinations, hyperexcitability, irritability
- Panic and psychosis
- Convulsions, seizures and death from high doses
- Long term effects
- Permanent damage to blood vessels of heart and brain, high blood pressure leading to heart attacks, strokes and death
- Liver, kidney and lung damage
- Destruction of tissues in nose if sniffed
- Respiratory (breathing) problems if smoked
- Infectious diseases and abscesses if injected
- Malnutrition, weight loss
- Severe tooth decay (meth mouth)
- Disorientation, apathy, confusion and exhaustion
- Strong psychological dependence
- Psychosis
- Depression
- Damage to the brain similar to Alzheimer’s disease, stroke and epilepsy
Real People
The following are brief accounts of some of the patients I have seen recently for drug-related problems. To maintain their privacy and confidentiality, I will just talk about their illness without identifying them.
My first encounter with a mutoriro user was perhaps a young man in his early twenties from one of the high-density suburbs. He had started drinking alcohol when he was a teenager before adding mbanje to his guilty pleasures. Research has shown that alcohol and cigarettes are gateway drugs for youths to much stronger substances. He had dropped out of high school and started hanging out with what his mother described as “the gang”. The gang introduced him to crystal meth and before long he was stealing money from home to get high. Then he started beating up his mother and threatening to kill her if she didn’t give him money to buy drugs. On the day he was brought to hospital, his mother had reported him to the police and he was brought to hospital in handcuffs. As soon as he was in the hospital, it was clear that he was a danger to himself and to others. He was paranoid, aggressive and his choice of words was liberal to say the least.
Another patient was a middle-aged man in his late thirties. He came from a wealthy family and had a very good education from some of the best schools in the country. He started using drugs in high school and found it easy to finance his habit because of his background. Recently (in the last 2 years) he had started using crystal meth, which he insisted on calling snow. He had never held a steady job since graduating from university. His father had fired him from the family business where he had employed him because he rarely turned up for work and when he did he would be high and aggressive towards everyone. His mother was worried that her son looked older than his father, and he wasn’t brushing his teeth (meth mouth). On the day he was brought to hospital his family said he had not slept in the last 5 days. He would play loud music all night and have parties with “friends” that were only visible to him. He was violent and had to be brought to hospital with the help of the police.
A more recent crystal meth user was a policeman who was brought to the hospital by his colleagues. Since he started using crystal meth he had also started frequently being physically violent towards his wife. He had sold most of their home property to finance his addiction. On the day he was brought to hospital he had beaten up his wife and she had called the police station where he used to work for help. He was not violent towards anyone else but he was hyperactive and very talkative. He explained how he was an undercover policeman in the mutoriro programme where he worked with drug-addicted youths. He knew he had “drug-induced psychosis” but to him this was a code for his undercover operation. He took the time to calmly explain all this to me and requested to be transferred to the officer in charge of this undercover operation, who happens to be a well-known psychiatrist. He was existing in his own fantasy held together by fragments of reality.
The last patient I will talk about is not a crystal meth addict but is a medical doctor who is addicted to a pain killer called pethidine. This is a drug that is very common in medical practice for controlling severe pain and is also highly addictive when misused. His relatives described him as a very good doctor who was now neglecting his duties. It was not clear how he became addicted to pethidine but for health workers, access is one of the contributing factors. The professional body for doctors had ordered that he should get treatment or risk being struck off the register. This is why his relatives had brought him to the hospital. This was a professional who was about to lose his career to drug addiction.
In all my experience with people with drug-related health problems, it is clear that there is no typical drug addict. Anyone can become addicted to drugs. It is however more prevalent in youths who find themselves idle, most of them due to circumstances beyond their control. It is not surprising then that Zimbabwe is experiencing an increase in illicit drug use and addiction. A lot of youths are finding themselves dropping out of school due to economic hardships. Those who manage to finish school and graduate from universities will soon join their peers on the streets due to the high levels of unemployment. Soon enough we will have a huge population of youths who are addicted to drugs and prone to committing violent, senseless crimes. A drug epidemic similar to that seen in some South American countries.
Our public health system does not have drug rehabilitation services. The best we can do is manage acute symptoms and send them back into the community with a high likelihood that they will end up back in the hospital, in prison, or worse. It is only a matter of time before the problem becomes too big to handle. The adage, a stitch in time saves nine has never been more apt. The emergence of crystal meth on the streets is not only a health problem, it is a social, economic and eventually a political problem.
The end
The Health Bonfire 🔥 