METH PROBLEM WEIGHS HEAVILY ON MONTANA HEALTH CARE FACILITIES

At age 19, Steve's teeth were already chipping and falling out. By
the time he landed in the Shelby prison, he had the blood pressure of
a 78-year-old man. He'll take Prilosec to ease stomach pains for the
rest of his life.

"I was in the meth explosion," the 26-year-old said. "We didn't know
what it would do to you back then."

A hit of methamphetamine puts battery acid, farm fertilizer and Drano
into a user's body. What the billboards show -- tooth decay and skin
sores -- doesn't touch on what meth does to your insides.

No one knows how many meth users are in Montana, and no one knows
what will happen when their health problems catch up to them. But
jails, community clinics and hospitals are already feeling the strain
- -- and expect it to continue.

"Meth is the perfect storm of substance abuse. It just goes on and on
as far as it's effects on people and our health care system," said
state Director of Public Health and Human Services Joan Miles. "Even
if you can get people off of meth, the damage is enough that many
will have lifelong health problems.

"And unless they are really able to get their lives back together,
they will be looking at state assistance."

Montana's meth boom began roughly a decade ago -- long enough for
addicts' health issues to emerge.

Exhausted from lack of sleep and food, walking skeletons end up in
hospitals, city-county clinics, jails and treatment centers statewide.

"Looking at their teeth, I can't help but wonder what's going on with
their bones and livers," said Laurel Andrechak, the nurse
practitioner for the Cascade County regional jail. "The nursing homes
are going to be packed in 20 years, if people make it that long."

The heavier the habit, the harsher the health effects.

According to the National Institute on Drug Abuse, meth use can lead
to strokes, cardiac arrhythmia, stomach cramps, shaking, anxiety,
insomnia, paranoia, hallucinations and structural changes to the brain.

Injecting meth combined with unsafe sex practices make addicts at
risk of getting deadly, incurable diseases such as hepatitis C and AIDS.

Andrechak estimates that half of her inmate patients have hepatitis
C, which leads to liver failure and cancer.

In jail, most get the medications they need. The Department of
Corrections spends more than $10 million a year on inmates' medical
expenses; the Cascade County regional jail pays roughly $500,000 annually.

"Quite frankly, it puts a huge stress on the jail budget," said
Cascade County Sheriff Capt. Dan O'Fallon. "A lot of these people are
very ill when they come in here."

Outside of jail, few get care for any of their physical ailments.

"They're not taking care of their chronic health issues," said Julie
Wood, the medical director of the local Community Health Care Center.
"They don't care about those things. They care about chasing the
high. What we see is people who come in to deal with the aftermath."

Deep in their addiction, few have jobs, fewer have insurance. Many
are paranoid and avoid doctors, fearing they'll report their meth use
to law enforcement.

"They come in here and they want us to fix everything," Andrechak
said. "We try, but we can't. It kind of breaks your heart."

Those who inhale or eat the drug find black pits on their teeth.

The Mayo Clinic medical journal describes how the drug makes saliva
more acidic, which eats the enamel coating and causes the teeth to
chip, rot and fall out.

The problem is made worse by poor hygiene -- Steve was homeless and
didn't own a toothbrush for years.

Known as crank bugs, the combination of dehydration and meth enzymes
evaporating through sweat glands causes addicts to feel like
something is crawling on, or under their skin. Scratching causes
sores that often become seriously infected and can scar.

Lithium from battery acid used to "cook" meth sucks calcium from a
user's body, making their bones brittle and fractures common.

People who cook meth take the biggest health risks, including cancer,
short-term and permanent brain damage and respiratory problems.

And it's no exaggeration to say meth kills.

Mother and activist Mary Haydal makes sure people know that meth took
the life of her daughter Cassie, an 18-year-old honor student and
basketball player at Custer County High. The powerful and addictive
stimulant triggered seizures and heart failure. Cassie collapsed into
a coma in 2000.

Other addicts die with less notice. Their bodies go into cardiac
arrest and they sometimes don't make it when they're either dumped
off or brought by ambulance to the nearest emergency room.

"We've had people that died," said Ricki Handstede, registered nurse
and emergency room, intensive care and behavioral health unit
director at the Northern Montana Hospital in Havre. "It poisons them.
It eats their body from the inside out."

John Flink, spokesman for the Montana Hospital Association, said
getting data quantifying meth's impact on hospitals and home health
agencies is difficult as it's hard to distinguish between meth
addicts and people with mental illnesses.

"It's certainly a problem, and I'm certain it's having an impact on
emergency rooms and hospitals as patients come in for help," he said.

Administrator of the Montana Chemical Dependency Center Dave Peshek
estimates that every year between 150 and 200 of his patients seeking
treatment are primarily meth users. Others use meth, but choose other
drugs or alcohol more often.

While the center's job is to help users come out of addiction, the
staff frequently has to address addicts' health problems. Hepatitis C
and diabetes are among the most common.

"Dermatology to internal medicine, psychiatrists to dentists -- all
areas of medicine have had to deal with the ravages of meth," Peshek said.

Many of the problems are treatable -- skin infections can clear up
and rotting teeth can be replaced with dentures.

Others, including brain damage that causes depression, anxiousness
and mood swings, will follow the addict for the rest of their lives.

Peshek said a quarter of the meth addicts he sees have long-term
damage and half will battle their health problems for the next five
to 10 years.

"There's going to be a wide-ranging and long-ranging impact," he
said. "There are some people who have likely inflicted some long-term
damage on themselves. We treat what we can, but we can't treat everything."

And as meth users surface from their addiction and begin to take care
of themselves, the pressure on the health care system could grow.

"We are clearly the safety net in the county," said Wood of the
City-County Health Department clinic. "So when people have exhausted
their resources for whatever reason, they turn to us."

While the meth boom began in the mid 90s, Miles points out that it
took generations before the health implications of tobacco and
alcohol came to light.

"There will be many lifelong problems with their addictions and it
will take years to see," she said. "If you look at tobacco and
alcohol use and its impact on state health care, it's enormous. Meth,
I think, has much more far-reaching effects when you put all the
pieces together."

That's because meth is so powerfully addictive and destructive.

Anna Whiting Sorrell The governor's health policy advisor said meth
touches nearly every department in the state. And regardless of
whether anyone can quantify the problem, taxpayers will take on the
burden of caring for addicts.

"As government, we are responsible to provide a safety net for the
people of our state," she said. "Whether it's meth or something else,
it's still our responsibility. We just know that our system is under
extreme pressure."

With several people secluded in detox daily, Andrechak is relieved
that someone is helping ailing meth addicts -- even if it is the jail.

At the jail, someone can watch to make sure the speeding heart beat
isn't a heart attack and can keep pregnant women from continuing to
use and make sure they get the prenatal care they need.

"People are a mess when they come in here," she said. "When they're
in jail, they are relatively safe. We can get them to care right
away. It's just a sad state of affairs."