Unsupervised self-treatment of methamphetamine abuse leading to gastricperforation in the emergency department: The role of uncontrolledNSAID consumption

Abstract

This case report aims to investigate the complications arising from unsupervised self-treatment of methamphetamine
addiction and the subsequent role of nonsteroidal anti-inflammatory drugs (NSAIDs) in contributing
to severe gastrointestinal damage. The objective is to enhance awareness among emergency physicians regarding
the intricacies and challenges inherent in managing patients engaged in self-managed addiction treatment
processes. A 35-year-old male, attempting self-directed methamphetamine cessation, presented to the ED with
abdominal pain, fatigue, and recurrent ED visits. The patient’s reliance on NSAIDs for withdrawal symptoms
inadvertently led to severe gastric perforation, requiring emergency surgical intervention. Current literature
lacks specific guidelines for managing methamphetamine-related gastrointestinal injuries, often resulting in
NSAID administration for symptomatic relief. This case highlights the need for tailored protocols in emergency
settings, as methamphetamine-induced intestinal damage may amplify NSAID-related complications. Recent
studies indicate that methamphetamine exposure compromises the intestinal mucosal barrier, exacerbating the
risk of NSAID-induced damage. Pro-inflammatory cytokines play a role in mucosal damage, and methamphetamine’s
sympathomimetic effects further contribute to gastrointestinal motility disturbances. Emergency physicians
should be alert to the challenges of managing methamphetamine users who attempt unattended
withdrawal. Balancing patient confidentiality with recognizing methamphetamine’s impact on the gastrointestinal
system is crucial, especially when considering NSAID administration. This case report underscores the
importance of heightened awareness am.