Unsupervised self-treatment of methamphetamine abuse leading to gastric perforation in the emergency department: The role of uncontrolled NSAID consumption

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.