DIVISION OF OCCUPATIONAL HEALTH, SAFETY AND MEDICINE
The Methamphetamine Problem:
A Health & Safety Overview for Fire Fighters
Methamphetamine and amphetamine-like compounds date back nearly 100 years. In 1919, a Japanese pharmacologist first synthesized methamphetamines. However, the abuse of methamphetamine became apparent during the 1930’s due to the stimulant, euphoric, and anorexic properties of the drug. During World War II, the drug was commonly used to increase wakefulness and attention. In fact, the Nazi’s developed a method of methamphetamine production called the Nazi Method that is still commonly used today in clandestine labs.
Until recently, most of the methamphetamine production occurred in Hawaii and other western states, such as California. Within the last decade there has been a rapid expansion of clandestine laboratories toward the east, but more prominent in the mid-west and especially in rural areas. For example, in Colorado, there were 31 clandestine lab seizures in 1998 and 455 seizures in 2001. Rural areas provide an ideal site for methamphetamine labs given the wide, open spaces, easy accessibility to ingredients such as anhydrous ammonia, and the small and usually understaffed law enforcement in these areas.
This movement towards the east and in rural areas has created some problems for all first responders. Many of these small clandestine labs are run by inexperienced individuals who do not have any knowledge of the safety hazards associated with the chemicals being used in the production of methamphetamines. The end result is a number of injuries, fires, and uncontrolled dumping of waste materials. To make matters worse, many times fire fighters responding to fires or accidents are unaware that the site is a clandestine laboratory and structural fire fighting gear is not designed to provide adequate protection. Thus, these individuals are exposed to a number of chemical, physical, biological, and environmental hazards.
The purpose of this document is to give an overview of some of the health and safety issues associated with clandestine drug labs. This is accomplished by discussing a number of different topics: the various methamphetamine production methods; the chemicals used, their sources, and some of their individual hazards; physical and biological hazards; acute and chronic health effects; and finally a review of controlled clandestine laboratory experiment by the Colorado Springs Police Department.
Methamphetamine Production Laboratories2-3, 5-10
There are two types of methamphetamine production laboratories: "super labs" and "mom and pop" labs. Super labs are typically found in California and Mexico and have the capability to produce 10 to 20 pounds of methamphetamine at a time. The product is usually sold in large metropolitan areas such as Los Angeles, San Diego, Phoenix, and San Francisco. "Beavis and Butthead" is an alternative name given to "mom and pop" labs since the term best describes the individuals operating in these methamphetamine laboratories. All jokes aside, these labs are the most problematic. Operators of these small clandestine labs often obtain methamphetamine recipes from the Internet or even fellow-inmates while incarcerated. The labs are constructed with everyday household items such as mason jars, stove burners, plastic tubing, tape, etc. Furthermore, chemicals used in the production process are often stored in inappropriate containers that can lead to accidents. It is not uncommon to have acid stored in two-liter soda bottles or anhydrous ammonia stored in propane or butane tanks which are not appropriate storage containers for these chemicals and therefore pose hazards to anyone in the area.
Methamphetamines can be produced by three different methods, each with their own inherent hazards: P2P, Ammonia lab, and Red Phosphorus lab
Also known as Phenyl-2-Propanone (P2P) or "Biker" lab
P2P is reduced in a chemical process using methylamine and mercuric chloride to form a mixture of d- and l-methamphetamine
Hazards: Severe eye and skin irritation can occur from the methylamine, which can lead to blindness. Mercuric chloride is highly toxic
This production method is less common today due to the restriction of phenyl acetic acid and because the end product is not as pure as the other methods and there are significant side-effects that can result from consumption of the methamphetamine that is produced using this method
Also known as "Nazi" or "Sodium Metal" lab
Ephedrine or Pseudoephedrine is reduced in a chemical process using anhydrous ammonia and lithium or sodium metal to form d-methamphetamine
Hazards: Anhydrous ammonia is stored as a compressed liquid, but it will rapidly expand upon release creating a toxic environment, which can be fatal at high concentration. Often, anhydrous ammonia is stolen from farms and stored in containers, such as propane tanks, that are not approved for storage of this agent. As a result, there have been a number of accidents where anhydrous ammonia is released into the atmosphere causing severe respiratory problems to both methamphetamine lab workers and first responders. Ammonia can also cause eye/nose/throat irritation, shortness of breath, wheezing, chest pain, pulmonary edema, pink frothy sputum, skin burns, and frost bite. Lithium reacts violently with water creating a fire and explosion hazard. Lithium is caustic to body tissue.
Also known as "Red P", "Tweeker" or "Mexican National" lab
Ephedrine or Pseudoephedrine is reduced in a chemical process using red phosphorus and hydriodic acid to form d-methamphetamine
Hazards: Red phosphorus is highly unstable: slight friction will cause ignition and deadly phosphine gas can be produced if overheated. Symptoms can include: shortness of breath, headache, double vision, tremor, jaundice, and pulmonary edema. Lung toxicity can occur immediately or can even be delayed for 18 hours or more.
There are a number of other chemicals used in the production of methamphetamines, but these items cannot be purchased in their natural form. Thus, many automotive and/or household chemicals are used as sources of substitution:
Acetone: fingernail polish remover
Methanol: brake cleaner fluid
Benzene: varnishes, lacquers
Ether: starter fluid
Hydriodic acid: driveway cleaner
Iodine crystals: antiseptics
Lithium metal: lithium batteries
Muriatic acid: swimming pool cleaner
Sodium hydroxide: drain cleaners, lye
Sulfuric acid: battery acid
Toluene: paint thinners
Note: It is not important to know each of the individual chemicals or the different types of methamphetamine production process used, but understand that the process has a number of dangerous hazards. The chemicals used, whether alone or in combination, can cause serious health problems and are considered fire and explosion hazards. In addition, clandestine labs are considered hazardous waste sites and should be managed by hazmat trained individuals to clear the site according to appropriate safety standards such as OSHA’s 29 CFR 1910.120.
Physical & Biological Hazards5, 11-12
In the early stages of methamphetamine abuse, users quickly become addicted to the euphoric feeling and from the vast amount of energy they have from using the drug. However, chronic use leads to multiple medical problems including paranoia. It is not uncommon for a user in a paranoid state to create a number of physical hazards, such as booby traps, that are potentially lethal to unsuspecting individuals including fire fighters. The purpose of these traps is to destroy evidence and discourage entry by injury or killing. Common traps include: animal traps, trip wires, grenades in lamp sockets, C-4 plastic explosives in VCR’s, light-bulbs filled with gasoline, or buried planks with protruding nails or spikes. Another hazard is "Mini-bombs", which consist of explosives wrapped in foil. They are very sensitive to heat, shock, and friction and people have been known to lose fingers or have been seriously injured while trying to dismantle these bombs.
Clandestine labs can also pose a biological hazard to fire fighters and other first responders. A commonly used route of ingestion of methamphetamine is through injection, especially in major metropolitan areas. In fact, injection of methamphetamine has led to lowered inhibition and the resurgence of HIV/AIDS in San Francisco. Clandestine lab cooks frequently operate in squalid living conditions, which can include leaving needles lying around the lab. This can increase the risk of needle sticks to fire fighters, thus exposing them to infectious diseases such as HIV or Hepatitis C. EMT’s also risk exposure to these infectious agents via accidental needle stick or though blood exposure while trying to tend to an injured lab cook.
Acute & Chronic Health Effects10, 13-14
Whether a clandestine methamphetamine lab is encountered incidentally or a planned lab invasion occurs, the health effects from these events are usually acute in nature. Some of the health effects from chemical exposure are described earlier in the "Methamphetamine Laboratory Production" methods section of this document. These chemicals most commonly affect the upper and lower airways. Symptoms can include coughing, throat irritation, or difficulty breathing. However, exposure can be much more serious, causing pulmonary edema or chemical pneumonitis. As mentioned earlier, lung injury may present early after exposure or maybe delayed for 18 hours or more. Other symptoms of acute exposure can include eye irritation, nausea or vomiting, or dizziness or lack of coordination.
Since the rapid spread of methamphetamines across the U.S. is a relatively recent event, not much is known about the long-term health effects fire fighters may develop from dealing with these methamphetamine laboratories. However, an article titled "Medical Surveillance of Clandestine Drug Laboratory Investigators" was published in the Journal of Occupational & Environmental Medicine that describes some long-term health effects from exposures from these labs. The authors of the study found, during spirometry evaluations, there was a significant reduction in the forced expiratory volume (FEV1) in those study participants who had longer duration of exposure without respiratory protection. Furthermore, there was a less rapid rate of decline in FEV1 with the use of respiratory protection.
Colorado Springs Police Department Clandestine Drug Experiment3
To better understand the potential level of exposure that fire fighters may encounter in clandestine methamphetamine laboratories, we will discuss the findings of a study conducted by the Colorado Springs Police Department. In their study, they established methamphetamine labs and produced methamphetamine under controlled conditions in the following settings: the police department laboratory and in abandoned house and motel. Furthermore, they analyzed 16 actual clandestine laboratories.
Departmental Lab Results:
Methamphetamine production occurred under lab hoods and air and wipe samples were taken to represent a worst case scenario under these controlled conditions
Air sample findings revealed hydrogen chloride and iodine levels were much higher than the American Conference of Government Industrial Hygienists (ACGIH) threshold limit values (TLV)
Wipe sample findings revealed methamphetamine levels on surfaces were much higher than the state standard.
The main point of this study is that despite controlled conditions under a laboratory hood with adequate ventilation, the levels of hydrogen chloride, iodine, and methamphetamine were much higher than threshold limit values and state standards.
Abandoned House Results:
This experiment was established to determine the likely exposures during the cook itself. The same equipment that would normally be used by a clandestine lab cook was utilized, but less than normal amounts of methamphetamine were produced
Air and wipe samples were taken in close proximity of the cook, away from the cook (10-15 feet), and in the cook’s breathing zone
When using the "Red P" method, phosphine, iodine, and hydrogen chloride levels were particularly high
Wipe samples revealed levels of methamphetamine on surfaces were much higher than TLV’s
The main point of this study was that despite the small amount of methamphetamine produced in this experiment, high levels were detected in the areas surrounding the cook. It is believed that these agents are spread through aerosolization
Abandoned Motel Results:
In this experiment, a chemist from the U.S. DEA conducted the cook. The production process was closely monitored and more water was used in the experiment. With this controlled environment, exposures were expected to be much lower than previous controlled cooks.
Air samples revealed phosphine and hydrochloric acid levels exceeded ACGIH TLV’s. On a more serious note, samples taken close to the cook revealed that hydrochloric acid levels were well above the NIOSH IDLH (Immediately Dangerous to Life & Health) levels
Wipe samples revealed methamphetamine levels were above TLV’s as far away as 20 feet from the cook. Items, such as a child’s toy, contained high pH levels, which is due to the presence of acid and/or methamphetamine. Interestingly, methamphetamine levels were still detectible on wipe samples taken from the hands of personnel and their PPE after decontamination
The main point of this experiment is that even with a full scale methamphetamine production (unlike the previous two experiments) under controlled conditions and with additional water incorporated into the cook, exposure levels were significantly elevated.
Actual Clandestine Drug Lab Results:
Part of the experiment conducted by the Colorado Springs Police Department included air and wipe samples of 16 clandestine drug labs.
Although none of the labs were actively producing methamphetamine at the time of analysis, methamphetamine residue was present throughout the structures in high levels including areas such as tables, air return grates, ceiling fans, refrigerators, and kitchen appliances. In fact, methamphetamine levels were at extremely high levels throughout a hotel room in which a clandestine lab exploded
The main point of this analysis was to illustrate that in uncontrolled conditions, unlike the controlled environment in the previous three experiments, exposures to various chemicals and methamphetamine is widespread and can be at much higher levels
Colorado Springs Police Department Experiments—Take Home Points:
Anyone encountering a clandestine methamphetamine laboratory can have multiple exposures at varying levels. In this series of experiments, levels of phosphine, hydrogen chloride, iodine, and methamphetamine levels were often well above threshold limit values.
Exposure is dependent upon whether the laboratory is active at the time of encounter and the type of production process being used. Unfortunately, fire fighters will not likely know if the lab is active at the time, nor the production process being used.
The recommended protection against the potential exposures in clandestine drug labs includes total skin protection and the highest respiratory protection available. This includes chemical resistant clothing, boots, and gloves and SCBA.
Derlet, R. et al. "Toxicity, Methamphetamines". April 29, 2005. Retrieved from www.emedicine.com/emerg/topic859.htm on 10/13/05
Kraman, Pilar. "Drug Abuse in America—Rural Meth". Trends Alert. The Council of State Governments. Retrieved from www.csg.org on 9/21/2005.
Martyny, JW, et al. "Chemical Exposures Associated with Clandestine Methamphetamine Laboratories". Retrieved from www.nationaljewish.org/pdf/chemical_exposures.pdf on 9/21/2005.
"Anhydrous Ammonia Theft". U.S. Environmental Protection Agency. Office of Solid Waste and Emergency Response. Retrieved from www.epa.gov/ceppo on 9/21/2005.
"Clandestine Drug Operations: Awareness and Safety". Alberta Municipal Affairs. Retrieved from www.municipalaffairs.gov.ab.ca/mahome/fco/pdf/AB-clan6-1.pdf on 9/28/2005
"Houston Fire Department Continuing Education: Clandestine Drug Labs". Retrieved from www.houstontx.gov/fire/firefighterinfo/ce/2001/February/Feb01CE.htm on 9/14/2005
Scott, M. "COPS: Clandestine Drug Labs". Community Oriented Policing Service: Problem-Oriented Guides for Police Series. No. 16. U.S. Department of Justice. Retrieved from www.cops.usdoj.gov/mime/open.pdf?Item=274 on 9/21/2005
"Hazards of Methamphetamine Production". Washington State Department of Health. Division of Environmental Health. Retrieved from www.doh.wa.gov/ehp/ts/CDL/methhazards.htm on 9/14/2005
"Anhydrous Ammonia Thefts and Releases Associated with Illicit Methamphetamine Productions—16 States, January 2000-June2004". MMWR Weekly. April 15, 2005. Retrieved from www.cdc.gov/mmwr/preview/mmwrhtml/mm5414a4.htm on 9/14/2005
"Methamphetamine Laboratory Identification and Hazards". National Drug Intelligence Center. Retrieved from www.usdoj.gov/ndic/pubs7/7341/index.htm on 9/14/2005
"Methamphetamine: A Growing Domestic Threat". DEA Publications. U.S. Department of Justice. Retrieved from www.fas.org/irp/agency/doj/dea/product/meth/threat.htm on 9/14/2005
"Environmental Impacts of Methamphetamine". Retrieved from www.dea.gov/concern/meth_environment.html on 9/14/2005
"Public Health Consequences Among First Responders to Emergency Events Associated with Illicit Methamphetamine Laboratories—Selected States, 1996--1999". MMWR Weekly. November 17, 2000. Retrieved from www.cdc.gov/mmwr/preview/mmwrhtml/mm4945a1.htm on 9/14/2005
Burgess. JL, et al. "Medical Surveillance of Clandestine Drug Laboratory Investigators". Journal of Occupational & Environmental Medicine. Vol. 44, No. 2. February 2002.
The International Association of Fire Fighters recognizes Rashad Saeed, DO MPH, Post-Doctoral Fellow in Occupational & Environmental Medicine at the Johns Hopkins Bloomberg School of Public Health who authored this report. Dr. Saeed served as a Medical Resident with the International Association of Fire Fighters in 2005. Through IAFF convention action in 1986, the occupational medicine residency program was established. The IAFF, in conjunction with the Johns Hopkins University, supports full-time medical residents each for a multiple month rotation in the IAFF Division of Occupational Health, Safety and Medicine.