How much does a meth habit cost per year?

The average methamphetamine user uses 1 -2 grams of meth per day at $100 per gram.

Therefore the average user spends $36,500 –  $73,000 per year on their habit

Other costs include:

  • $687M – Workplace productivity loss
  • $545M – Drug treatment
  • $351M – Additional health care costs among meth users

13 million people in the United States use meth.  The death rate is difficult to calculate as most users die of various complications such as cardiac infections or strokes, but is now estimated to be over 5000 deaths per year.



How much does a heroin habit cost per year?

The street cost of heroin is between $10 and $25 per dose.  Street heroin is often “cut” with other substances such as flour, talcum powder or chalk so the cost can vary depending on purity.

The average addict uses heroin between 4-6 times a day.

Therefore, the average heroin user spends:

$150 a day

$4500 a month

$54,000 a year

on their heroin habit.

Approximately 13,000 people died from heroin last year, or 35 deaths per day in the United States.


Can you make the diagnosis?

Frank is at a cocktail party, and is enjoying a martini and the hors d’oeuvres.  As he is talking with clients, he begins to notice a swelling feeling of his lips, and then of his tongue.

He tries to continue with the conversation, but starts feeling like the room is very hot, and also his skin starts feeling itchy.  He decides to go to the restroom.  Once there, he sees in the mirror that his upper lip looks swollen.  He lifts his shirt, and sees a rash:


What does Frank have?

  1.  An allergic reaction
  2.  The measles
  3.  A reaction to alcohol
  4.  A heat rash



If you guessed 1.  An allergic reaction, you are correct!

Frank is likely having a reaction to something in the hors d’oeuvres.  More than 3 million people have an allergic reaction per year. Symptoms can include itchy, raised red welts called “hives” on the skin’s surface, lip or tongue swelling, and shortness of breath.  The most common food allergy is from seafood.

Treatment for an allergic reaction includes medications such as anti-histamines (Benadryl) and steroids.  In some cases breathing treatments such as albuterol and epinephrine may be necessary.  If a patient is having lip or tongue swelling, or any difficulty breathing, they must be seen in the Emergency Department.  Severe allergic reactions can progress to a condition called “anaphylaxis” which can be fatal.


The measles rash would typically start with gradual onset of cold-like symptoms, cough, and watery eyes.  It is more common in un-immunized children.  Some people do react to alcohol, but that would be rare especially if they have had alcohol before and have never had a problem.  A heat rash more often affects infants though it can affect adults.  Heat rash causes red bumps on the skin and can occur during hot, humid weather.

Is drinking cocoa good for you?

We all love drinking a warm cup of cocoa, but is it good for you?


Cocoa contains chemicals called polyphenols, which are antioxidants also found in fruits and vegetables.  Polyphenols improve blood flow, lower blood pressure, and improve blood cholesterol and glucose levels.


Cocoa is abundant in flavanols, which are also antioxidants and  have an anti-inflammatory effect on our cells.


A recent study by the American Heart Association in patients with peripheral arterial disease found that patients who drank cocoa daily had improved blood flow to their legs with improved muscle function.  The patients who drank cocoa were able to walk further in a 6-minute walking test compared to patients who did not drink cocoa.


Cocoa also increases blood flow to the brain, improving brain function and reducing risk of neurodegenerative disease.


Another study found that patients who drank cocoa regularly had a small but significant reduction in their blood pressure.


Cocoa also reduces “bad” LDL cholesterol.  Cocoa consumption is linked to lower risk of heart disease, stroke, and death.



Can you make the diagnosis?

Nancy is working at her computer when she begins to notice it is hard to use her left hand.   Thinking it was because she was resting her elbow on the desk for too long, she tries to change the position, and continues working.

Her coworker approaches and asks Nancy a question.  When Nancy answers, her coworker notices that Nancy’s speech is slurred, and one side of her face appears to be drooping.

What is Nancy’s diagnosis?

  1.  Meningitis
  2.  Carpal tunnel syndrome
  3.  Migraine
  4.  Stroke



If you guessed 4.  Stroke, you are correct.

A stroke, or Cerebrovascular Accident (CVA), is caused when the circulation to a part of the brain is decreased.  Strokes can cause symptoms such as weakness, slurred speech, facial droop, and difficulty walking.

A stroke is a true emergency and Nancy’s coworker should call 911.  A pneumonic to remember about the warning signs of stroke is FAST (facial droop, arm weakness, speech difficulty, time to call 911).

Risk factors for stroke include high blood pressure, irregular heart rate such as atrial fibrillation, tobacco smoking, high cholesterol, and diabetes.

Treatment can include very strong blood thinners such as tPA (tissue plasminogen activator) but the patient must present within 3 hours of onset of their symptoms to receive these medications.

Meningitis can cause fever and confusion, but would not typically cause weakness worse on one side than the other.  Carpal tunnel syndrome causes pain and tingling in the hand.  The pain is often worse at night.  Carpal tunnel would not be expected to cause speech changes or facial droop.  A migraine can cause neurologic symptoms but is usually associated with a severe headache and vomiting.

Left facial droop:


How does salt affect blood pressure?

Our bodies have to have salt to live.  The currently dietary guidelines recommend about 2300 mg a day for most people.
Does eating salt (sodium) cause high blood pressure?
A worldwide medical study was performed in 1988 about salt.  It involved people from all around the world and tested over 10,000 people.  It measured their blood pressure,  their sodium intake, monitored their urine samples, and looked at their height, weight, and alcohol intake.   The researchers could find no significant link between salt and hypertension!
There are, however some people who are more sensitive to salt than others.  About 8 percent of the population appears to be more sensitive to salt. When a patient has high blood pressure, they can find out if they are salt-sensitive by decreasing the sodium in their diet to see if their blood pressure improves.
However, at this time there is no evidence that salt affects the  blood pressure for the other 92% of the population.

Can you make the diagnosis?

Greg sees that his neighbors are trying to move a new dresser into their apartment, and he offers to help them.  Together, they hoist the dresser up the stairway and get it set up.

That night, Greg wakes up with severe back pain.  When he tries to get up to go to the bathroom, he notices the pain is shooting down his left leg.

What does Greg have?

  1.  He has torn a muscle in his back.
  2.  A ruptured disc.
  3.  A urinary tract infection
  4.  A kidney stone


If you guessed 2.  A ruptured disc, you are correct!

A disc is a rubbery cushion that is between the spinal vertebra:


The disc is like a jelly donut.  The outer portion of the disc is thick and tougher.  The inside portion is soft material like jelly.

When a person has a back injury, such as from lifting a heavy object or twisting the back while lifting, the outer portion of the disc can rupture, and the “jelly” can be forced out of the disc.  That is a ruptured disc.  Then the ruptured disc and “jelly” can irritate the nerves coming out of the spine.

Sometimes a rupture disc can heal by itself over time.  But if a ruptured disc is accompanied by severe pain, pain down an arm or leg, is accompanied by weakness or numbness or loss of urinary or bowel control, then surgical intervention may be required.

A sprained or torn muscle in the back is a possibility.  There are many muscles in the back that can be injured, and these will typically heal with time.  A urinary tract infection is a possibility and can cause back pain over the kidney, but would usually be associated with a fever and burning with urination.  Kidney stones can cause severe back pain, but would be unlikely to radiate down the leg.