Symptoms experienced by law enforcement personnel during methamphetamine lab investigations

Strategies to detect trace methamphetamine contamination on hard surfaces: Assessing realistic performance of commercially available presumptive tests and a laboratory-based LC-MS/MS method

Recreational methamphetamine production and heavy use can result in dwelling contamination that is difficult to detect. First responders and public health officials may use commercially available trace methamphetamine detection (presumptive) test kits to understand apparent and hidden dangers in impacted dwellings. Here, we assessed the limit of detection (LOD) of several commercially available presumptive test kits using simulated contaminated hard surfaces. Pyrex petri dishes were spiked with aliquots of methanolic methamphetamine solutions to reach desired simulated contamination levels. Commercially available presumptive tests were conducted according to manufacturer instructions and using included sample preparation materials, when available. Additionally, a laboratory-based liquid chromatography-triple quadrupole mass spectrometer (LC-MS/MS) trace methamphetamine quantification method was developed and validated using the EZSTATSG2 tool. For the LC-MS/MS method, samples were collected using 2-ply alcohol prep pads and methamphetamine was extracted using a 1:1 (v:v) methanol: water solution. Most presumptive tests considered were able to detect trace levels of methamphetamine extracted from hard surfaces, with LOD ranging from 0.10-15.00 μg/sample. Comparatively, the laboratory-based LC-MS/MS LOD was 0.05 μg/sample and limit of quantitation was 0.10 μg/sample. The LC-MS/MS method may be useful when the presence of dust or other contaminants interferes with presumptive test interpretation or reliability. Costs of presumptive tests varied from several dollars to tens of dollars, which is included alongside LOD results to aid stakeholders in identifying which test(s) are the best fit for purpose. Therefore, first responders, public health officials, and other stakeholders have several options for assessing trace methamphetamine contamination.

A Review of Methods Used to Detect Methamphetamine from Indoor Air and Textiles in Confined Spaces

Methamphetamine manufacture, use, and the resulting contamination is a significant issue that affects public health, the environment, and the economy. Third-hand exposure to methamphetamine can result in adverse health risks for individuals and first responders. Such exposures can result from the inhalation of airborne residues or from contact with contaminated objects. This review was conducted to determine the current methods used for methamphetamine extraction from indoor air and porous fabric materials. Dynamic solid phase microextraction (SPME) and sorbent sampling tubes have been applied to extract airborne methamphetamine residues from contaminated properties. SPME and solvent extraction have been applied to sample clothing and textiles for methamphetamine detection. This review demonstrates that there is limited literature on the detection of methamphetamine from indoor air and clothing. Supplementary and consistent methods to detect methamphetamine from air and porous surfaces should be developed and published to allow better assessment of the environmental risk to public health caused by third-hand exposure to methamphetamine.

Clinical toxicology of exposures to chemicals from clandestine drug laboratories: a literature review

INTRODUCTION

The synthesis of clandestine drugs is a widespread worldwide phenomenon, with clandestine drug laboratories occurring both in rural and urban areas. There is considerable unfamiliarity among medical professionals about the health risks that are associated with chemicals used in clandestine drug laboratories.

OBJECTIVE

To evaluate the adverse health effects resulting from exposure to chemicals involved in the production of clandestine drugs.

METHODS

The US National Library of Medicine PubMed database and the Excerpta Medica database (EMBASE) were searched from their date of inception to October 26, 2021 using combinations of relevant search terms. This yielded 1,558 unique articles, which were subjected to two eligibility criteria: (i) exposure to clandestine drug laboratory chemicals resulting in adverse health effects; (ii) subjects were human. A total of 22 unique articles were retrieved, consisting of 10 reviews, eight case reports/series and four retrospective studies. Further searches among the references cited in these publications yielded another seven case reports/series and six retrospective studies.

RESULTS

Inhalation: Surveillance studies reported respiratory symptoms (including cough, throat irritation, nasal irritation, and dyspnea) in 59% (n = 1,657 of 2,803) of those exposed. The case reports/series described respiratory symptoms in 43% of the cases (n = 36 of 84). Lung edema was reported occasionally (n = 2). Eye exposure: Surveillance studies reported eye irritation and burns in 23% (n = 647 of 2,803) of those exposed. The case reports/series described ocular adverse events in 36% of the cases (n = 30 of 84). More severe ocular effects, such as corneal damage and conjunctival necrosis, were reported after direct eye contact with caustic fluids. Skin exposure: Surveillance studies reported dermal effects, ranging from skin irritation to severe burns, in 6% of those exposed (n = 174 of 2,803). The case reports/series described dermal effects in 30% of the cases (n = 25 of 84). Ingestion: Gastrointestinal burns were observed after ingestion of caustic substances in 5% of the patients reported in the case reports/series (n = 4 of 84). Systemic effects: Surveillance studies reported headache and dizziness in 31% (n = 882 of 2,803) and 7% (n = 187 of 2,803) of those exposed, respectively. The case reports/series described sympathomimetic effects, including mydriasis, hypertension, tachycardia, in 4% of the cases (n = 3 of 84). Fatalities: Surveillance studies reported death in 1% of those exposed (n = 29 of 2803). Ten percent of the people reported in the cases report/series died (n = 8 of 84). Death was reported after inhalation of phosphine (n = 5), hydrogen sulfide (n = 1), methanol (n = 1), and after ingestion of sulfuric acid (n = 1).

CONCLUSIONS

Exposure to chemicals involved in the production of clandestine drugs mostly resulted in mild to moderate respiratory, ocular or dermal effects, usually caused by caustic chemicals or solvents. Systemic effects were generally mild, but severe symptoms and eight deaths were reported after exposure to phosphine, hydrogen sulfide, methanol and sulfuric acid.

Environmental Methamphetamine Exposures and Health Effects in 25 Case Studies

The clandestine manufacture and use of methamphetamine can result in contamination of residential properties. It is understood that this contamination remains in homes for a significant period, however there are a lack of data available to understand the health effects of exposure to environmental methamphetamine contamination (third-hand exposure). Our study collected information from 63 individuals in 25 separate case studies where the subjects had unwittingly suffered third-hand exposure to methamphetamine from former manufacture, use, or both. Data included environmental contamination data, information on subjects' health effects, and evidence of exposure using hair analysis. This study identified a range of health effects that occur from residing in these properties, including behavioural effects or issues, sleep issues, respiratory effects, skin and eye effects, and headaches. Methamphetamine was detected in hair samples from some individuals, including children. The exposures and concomitant reported health effects covered a wide range of environmental methamphetamine levels in the properties, including low levels close to the current Australian guideline of 0.5 µg methamphetamine/100 cm². There were no discernible differences between health effects from living in properties contaminated from former manufacture or use. This study demonstrates that residing in these properties can represent a serious public health risk.

Health effects from unintentional occupational exposure to opioids among law enforcement officers: Two case investigations

Recent increases in the rate of drug overdose-related deaths, the emergence of potent opioids such as carfentanil, and media reports of incidents have raised concerns about the potential for work-related exposure to a variety of illicit drugs among law enforcement officers (LEOs), other emergency responders, and other workers in the United States. To characterize the risk associated with unintentional occupational exposure to drugs, we retrospectively investigated two incidents that occurred in 2017 and 2018 where LEOs were exposed to opioid and stimulant drugs and experienced health effects. We interviewed five affected LEOs and others. We reviewed records, including emergency department documentation, incident reports, forensic laboratory results, and when available, body camera footage. Multiple drug types, including opioids and nonopioids, were present at each incident. Potential routes of exposure varied among LEOs and were difficult to characterize with certainty. Health effects were not consistent with severe, life-threatening opioid toxicity, but temporarily precluded affected LEOs from performing their essential job duties. While health risks from occupational exposure to drugs during law enforcement activities cannot currently be fully characterized with certainty, steps to prevent such exposures should be implemented now. The creation and implementation of appropriate controls plus education and training are both important to protecting first responders from these hazardous agents. To more fully characterize potential exposures, timely prospective toxicological evaluation of affected responders is recommended.

Exposures associated with clandestine methamphetamine drug laboratories in Australia

The clandestine manufacture of methamphetamine in residential homes may represent significant hazards and exposures not only to those involved in the manufacture of the drugs but also to others living in the home (including children), neighbours and first responders to the premises. These hazards are associated with the nature and improper storage and use of precursor chemicals, intermediate chemicals and wastes, gases and methamphetamine residues generated during manufacture and the drugs themselves. Many of these compounds are persistent and result in exposures inside a home not only during manufacture but after the laboratory has been seized or removed. Hence new occupants of buildings formerly used to manufacture methamphetamine may be unknowingly exposed to these hazards. Children are most susceptible to these hazards and evidence is available in the literature to indicate that these exposures may result in immediate and long-term adverse health effects. The assessment of exposure within the home can be undertaken by measuring contaminant levels or collecting appropriate biological data from individuals exposed. To gain a better understanding of the available data and key issues associated with these approaches to the characterisation of exposure, a review of the published literature has been undertaken.

Management of clandestine drug laboratories: need for evidence-based environmental health policies

Clandestine drug laboratories (CDLs) have been emerging and increasing as a public health problem in Australia, with methamphetamine being the dominant illegally manufactured drug. However, management and remediation of contaminated properties are still limited in terms of regulation and direction, especially in relation to public and environmental health practice. Therefore, this review provides an update on the hazards and health effects associated with CDLs, with a specific look at the management of these labs from an Australian perspective. Particularly, the paper attempts to describe the policy landscape for management of CDLs, and identifies current gaps and how further research may be utilised to advance understanding and management of CDLs and inform public health policies. The paper highlights a significant lack of evidence-based policies and guidelines to guide regulatory authority including environmental health officers in Australia. Only recently, the national Clandestine Drug Laboratory Guidelines were developed to assist relevant authority and specialists manage and carry out investigations and remediation of contaminated sites. However, only three states have developed state-based guidelines, some of which are inadequate to meet environmental health requirements. The review recommends well-needed inter-sectoral collaborations and further research to provide an evidence base for the development of robust policies and standard operating procedures for safe and effective environmental health management and remediation of CDLs.

Decontamination of clothing and building materials associated with the clandestine production of methamphetamine

This study was designed to determine how easily methamphetamine can be removed from clothing and building materials, utilizing different cleaning materials and methods. The study also addressed the penetration of methamphetamine into drywall and the ability of paints to encapsulate the methamphetamine on drywall. Clothing and building materials were contaminated in a stainless steel chamber by aerosolizing methamphetamine in a beaker heater. The amount of methamphetamine surface contamination was determined by sampling a grid pattern on the material prior to attempting to clean the materials. After cleaning, the materials were again sampled, and the degree of decontamination noted. We found that household clothing and response gear worn by first responders was easily decontaminated using a household detergent in a household washing machine. A single wash removed over 95% of the methamphetamine from these materials. The study also indicated that methamphetamine-contaminated, smooth non-porous surfaces can be easily cleaned to below detectable levels using only mild cleaners. More porous surfaces such as plywood and drywall were unlikely to be decontaminated to below regulatory levels even with three washes using a mild cleaner. This may be due to methamphetamine penetration into the paint on these surfaces. Evaluation of methamphetamine contamination on drywall indicated that approximately 40% of the methamphetamine was removed using a wipe, while another 60% remained in the paint layer. Stronger cleaners such as those with active ingredients including sodium hypochlorite or quaternary ammonia and commercial decontamination agents were more effective than mild detergent-based cleaners and may reduce methamphetamine contamination to below regulatory levels. Results from the encapsulation studies indicate that sprayed on oil-based paint will encapsulate methamphetamine on drywall and plywood surfaces up to 4.5 months, while latex paints were less effective.

Respiratory protective equipment, mask use, and respiratory outcomes among World Trade Center rescue and recovery workers

BACKGROUND

Serious respiratory illnesses have been reported among rescue/recovery workers (RRW) following the World Trade Center (WTC) attacks.

METHODS

We studied RRW enrolled in the WTC Health Registry to assess the effects of different respiratory protection equipment (RPE) types on respiratory outcomes, such as recurrent respiratory symptoms and diseases possibly associated with 9/11 exposures. We performed descriptive and multivariate analyses adjusting for demographics and exposure variables.

RESULTS

A total of 9,296 RRW met inclusion criteria. The strongest predictors of using adequate RPE were being affiliated with construction, utilities or environmental remediation organizations and having received RPE training. Workers who used respirators were less likely to report adverse respiratory outcomes compared to those who reported no/lower levels of respiratory protection.

CONCLUSIONS

Level of respiratory protection was associated with the odds of reporting respiratory symptoms and diseases. Training, selection, fit testing, and consistent use of RPE should be emphasized among emergency responders.

Methamphetamine exposure and chronic illness in police officers: significant improvement with sauna-based detoxification therapy

Background: The medical literature reports health hazards for law enforcement personnel from repeated exposure to methamphetamine and related chemical compounds. Most effects appear transitory, but some Utah police officers with employment-related methamphetamine exposures developed chronic symptoms, some leading to disability. This report is of an uncontrolled retrospective medical chart evaluation of symptomatic officers treated with a sauna detoxification protocol designed to reduce the chronic symptoms and improve the quality of life. Methods: Sixty-nine officers consecutively entering the Utah Meth Cops Project were assessed before and after a treatment program involving gradual exercise, comprehensive nutritional support and physical sauna therapy. Evaluations included pre- and post-treatment scores of the Research and Development Corporation (RAND) 36-item Short Form Health Survey (SF-36) in comparison with RAND population norms, pre- and post-treatment symptom score intensities, neurotoxicity scores, Mini-Mental Status Examination, presenting symptom frequencies and a structured evaluation of treatment program safety. Results: Statistically significant health improvements were seen in the SF-36 evaluations, symptom scores and neurotoxicity scores. The detoxification protocol was well tolerated, with a 92.8% completion rate. Conclusions: This investigation strongly suggests that utilizing sauna and nutritional therapy may alleviate chronic symptoms appearing after chemical exposures associated with methamphetamine-related law enforcement activities. This report also has relevance to addressing the apparent ill effects of other complex chemical exposures. In view of the positive clinical outcomes in this group, broader investigation of this sauna-based treatment regimen appears warranted.

Hazards of illicit methamphetamine production and efforts at reduction: data from the hazardous substances emergency events surveillance system

OBJECTIVES

Methamphetamine (meth) is a highly addictive drug of abuse that can easily be made in small illegal laboratories from household chemicals that are highly toxic and dangerous. Meth labs have been found in locations such as homes, outbuildings, motels, and cars. Its production endangers the "cook," neighbors, responders, and the environment. This article describes surveillance data used to examine the emergence and public health impacts of illicit clandestine meth labs, as well as two states' efforts to thwart lab operations and prevent responder injuries.

METHODS

We analyzed data collected from 2001 to 2008 by 18 states participating in the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance (HSEES) Program to examine the occurrence and public health impacts of clandestine meth production.

RESULTS

HSEES data indicate that the majority of clandestine meth lab events occurred in residential areas. About 15% of meth lab events required evacuation. Nearly one-fourth of these events resulted in injuries, with 902 reported victims. Most victims (61%) were official responders, and one-third were members of the general public. Since 2004, with the implementation of local and federal laws and prevention activities, the number of meth lab events has declined. Increased education and training of first responders has led to decreased injuries among police officers, firefighters, and emergency medical personnel.

CONCLUSIONS

HSEES data provided a good data source for monitoring the emergence of domestic clandestine meth production, the associated public health effects, and the results of state and federal efforts to promote actions to address the problem.

Health effects from reported exposure to methamphetamine labs: a poison center-based study

INTRODUCTION

Illicit methamphetamine laboratories pose a health hazard. However, information on symptoms from exposure is limited, particularly for setup or former laboratories.

METHODS

A descriptive study was done using case reports provided by the Washington State Poison Control Center for the years 1999 through 2004.

RESULTS

Reported exposures occurred mainly in residences, predominantly in setup and suspected former lab sites. For all lab types combined, the most frequent reported symptoms were headache (17%), nausea/vomiting (14%), respiratory (8%), and eye irritation (7%). Healthcare facility utilization was highest for law enforcement personnel (93%) and persons involved in methamphetamine production, or "cooks" (90%). It was lowest for other adults (29%) and children (46%). Hospitalization was most common for cooks (43%), followed by children (8%), law enforcement officers (3%), and other adults (3%).

CONCLUSION

Poison control center data help characterize health outcomes from exposure to suspected illicit methamphetamine labs. Many of the reported symptoms in suspected former labs are consistent with exposure to persistent irritants.

A 24-hour study to investigate persistent chemical exposures associated with clandestine methamphetamine laboratories

The clandestine manufacture of methamphetamine continues to be a concern across the United States. Although the exposures associated with the actual production process have been evaluated, the persistence of those exposures in a residential setting have not been investigated. This study was designed to document the contamination associated with two red phosphorous methamphetamine "cooks" conducted in a residence and the associated exposures up to 24 hours after the cook. The two cooks were conducted on the first day of the study, and exposures associated with different occupant activity levels were measured the following day. Airborne methamphetamine levels during the cook ranged from 520 microg/m(3) to 760 microg/m(3). On Day 2, airborne levels of methamphetamine ranged from 70 microg/m(3) to 210 microg/m(3) and increased with moderate to high activity levels within the residence. The majority of the methamphetamine measured during both days had a particle size of less than 1 mum, suggesting that the methamphetamine is formed as a condensation aerosol and is readily resuspended from contaminated surfaces. Significant methamphetamine contamination was found in the carpeting and likely was associated with the elevated levels of methamphetamine during activity. Levels of hydrogen chloride and iodine were also detected on Day 2 of the project although at very low levels. The study concluded that exposures may still present a significant inhalation exposure well after the actual cook.