Firefighters respond to an explosion in a motel parking lot. Police officers make a routine traffic stop for erratic driving. Emergency medical technicians (EMTs) respond to a call for a man lying unconscious on the front lawn of a suburban home.
At face value, these scenarios are little more than the stuff of the everyday lives of first responders. But a closer look reveals a far more insidious reality; namely, the ever-increasing likelihood that firefighters, police officers, EMTs and others will stumble unwittingly upon a methamphetamine lab, and into very real danger.
As of August 2005, at least 12 million people in the United States had tried methamphetamine (meth, ice, crystal, speed, tina), according to the National Survey on Drug Use and Health. The highly addictive stimulant can be smoked, snorted, injected or taken orally, and is manufactured in the form of a crystal-like powder or rocklike chunks.
Meth is both cheap and easy to manufacture in labs that are easily assembled, dissembled and established in nearly any type of setting. The B-movie depiction of the meth addict desperately cooking up batches of the drug has expanded far beyond the setting of the seedy motel room or run-down, back-woods shack. Today, manufacture of the drug (known as cooking) knows no geographic or socioeconomic boundaries. Methamphetamine labs can, and do, surface in virtually every kind of neighborhood across the country. Cooking takes place in everything from the house in suburbia, to high-priced hotel rooms, upscale apartments and condos, public storage facilities, abandoned buildings, wooded areas, alongside highways and even in vehicles such as campers, vans and recreational vehicles (mobile labs).
Despite the fact that more than 50,000 clandestine meth labs have been dismantled by authorities since 2001, the manufacture, use and distribution of the drug is more mainstream than ever before. In a 2006 survey by the National Association of Counties, nearly half of county law enforcement officers cited methamphetamine as their primary drug problem, more than heroin, cocaine and marijuana combined.
Immediate Danger, Lasting Threat
Every aspect of the use and manufacture of methamphetamine poses extreme dangers to first responders, from confrontations with combative, agitated and unpredictable users, to the explosive potential of the cooking process, to the possible long-term health effects of chemical exposure.
The precursors for the manufacturing process are the ephedrine or psuedoephedrine found readily in many cold and allergy products. A trip to the local hardware store is all that’s required to obtain needed chemicals, such as acetone, hydrogen peroxide, salt iodine and sulfuric acid. The drug is then cooked using the most common of household equipment – stoves, camp stoves, hot plates, electric skillets, blow torches, pots, pans, coffee grinders, hand blenders, kitty litter, trash bags, plastic bottles, jars and plastic hoses and tubing. Easily obtained chemistry equipment completes the picture: beakers, graduated cylinders, funnels, condensers, flasks and disposable plastic ware.
The immediate result is a highly flammable and explosive setting. A methamphetamine cooking session gone wrong can engulf a home or other structure in flames in a matter of seconds, putting everyone in the vicinity at risk.
But the danger doesn’t end there, cautions John E. Snawder, PhD, DABT, Leader, Biomonitoring Research Team, National Institute for Occupational Safety and Health (NIOSH). “During the cook, toxic substances fill the atmosphere and residue settles throughout the area, creating the potential for injury through direct contact and through inhalation.”
The byproducts of methamphetamine processing are toxic and can be lethal, creating an insidious threat of hazardous waste sites in communities across the country. Every pound of methamphetamine that’s manufactured generates 5 to 6 pounds of hazardous waste. That waste turns affected areas into toxic dumping grounds, ending up in trash cans next to neighbors’ homes, and in alleys, along highways, in the back of vehicles, in parks and forests, and the list goes on.
Dangers to Responders
Exposure has the potential to put everyone who enters contaminated sites – often without personal protective equipment (PPE) – at risk for long-term health effects.
The danger to children, other family members and neighbors of methamphetamine “cookers” has been well-documented in the media. But far less attention has been devoted to the risk incurred by first responders and by others who might stumble upon the scene in the course of their jobs, or enter the area after a lab has been dismantled (social workers, building inspectors, code enforcement officers and others).
When a site has been under surveillance, it’s approached as a hazardous materials event. This, says Snawder, is the ideal situation; law enforcement personnel and other first responders know what they’re up against and take appropriate precautions and, after the lab is dismantled, bulk contaminants are methodically removed.
“But an EMT who responds to a call for a “meth cooker” overcome by fumes, or a police officer who responds to what’s described as an ammonia leak in a parking lot, may have no idea of the dangers that await,” Snawder explains.
Changing Hazards, New Means of Detection
The hazards of meth labs change – from the immediate dangers of fire and explosion, to those of airborne contaminants and, finally, surface contaminants (residue). “Everyone who enters the scene, from first responders to those collecting evidence to social workers, should operate on the assumption that everything in the area is contaminated,” says Snawder.
Fortunately, once a lab is dismantled, those who need to enter the structure can be protected from the remaining residue relatively easily. “Residue is likely to be found on surfaces that aren’t normally cleaned,” Snawder explains, “such as the top-side of a ceiling fan or in the ‘dust bunnies’ behind a refrigerator.”
But knowing when an area is truly safe to enter and what types of PPE-related decisions need to be made is critical. “The key is to approach the problem by sampling the dirtiest areas in an attempt to prove that they’re actually clean,” Snawder says.
To this end, Meth-Chek Kits, developed by NIOSH and sold by SKC, enable sampling of everything from clothing to counter tops to trash bags (see “Sampling for Safety”). And the benefits extend beyond the actual cook site. Snawder cites the example of the methamphetamine cook being taken into custody, and the ability to test his clothing and other personal belongings before exposing those with whom he’ll come into contact.
The Meth-Chek Kits, which are licensed by the Centers for Disease Control and Prevention, are currently commercially available, and NIOSH continues to recruit personnel for additional testing of the kits as research continues.
Heed the Signs
Awareness of the dangers associated with methamphetamine and its manufacture are on the rise. But a proactive approach is needed. The increasing popularity of meth, the ease with which it’s made and the continued appearance of labs in a wide range of unexpected locations across the country underscore this need on the part of every first responder.
An encounter with a meth lab should be viewed as a very real – and likely – possibility, regardless of the area of patrol or response. The people and the environment encountered by first responders can, and should, put first responders on high alert to that possibility, as outlined below. (See http://wwww.policeone.com/writers/columnists/ScottBuhrmaster/articles/80897 for more information).
Identifying a user: The behavior and appearance of the people initially encountered at a suspected site can be reliable indicators that a first responder has happened upon a meth lab. Specifically, methamphetamine users typically display the following:
- Agitation, extreme anxiety, paranoia, confusion, irritability/nervousness
- Excited speech, inability to remain still, pounding heart, dry mouth, dilated pupils
- Gaunt appearance, signs of insomnia
- Signs of chemical burns (from contact with precursor chemicals) and signs of burns on fingers (from covering a vent hole on a meth pipe)
Approaching the scene: Whether during a traffic stop or approaching a structure, the first responder should interpret these signs as a strong indication of a possible meth-production environment:
- Strong chemical odors (cat urine, ammonia, nail polish remover)
- Windows that are heavily covered/blacked out and/or barred; doors that are well-protected against entry; and devices (such as trip wires) to alert people of others approaching
- Chemical containers and chemical waste (or signs of their presence), including anhydrous ammonia, red phosphorus, denatured alcohol, hydrogen chloride, muriatic/hydrochloric acid, toluene, ether or paint thinner (look for container labels)
- Propane tanks, especially with bent or tampered valves
- Abnormally large number of antifreeze containers, drain cleaner bottles, lithium batteries and car starter fluid containers
- A noticeable build-up of cigarette butts outside a residence or other structure (indicating the need to exit the building to smoke because of the explosive potential of chemical fumes)
- Signs that electricity has been run to an apparently abandoned building
- Trash that includes items such as large numbers of cold/allergy medicine packages, empty chemical containers, buckets of sludge, charred or broken glassware and chemistry equipment, pipes, hoses, hot plates, large trash bags and burned pots and pans
Inside a structure: Once entry into a structure has been made, the following signs should be viewed as indicators of a meth lab:
- Signs of the chemicals listed above
- Chemical odors and chemical staining (on bathroom and kitchen fixtures)
- Red, chemically stained coffee filters
- Glass lab ware
- Police scanners and other signs of counter-surveillance
- Breathing apparatus, protective goggles and lab-type clothing
- Plastic tubing and glass jars
- Cooking bowls with white powder or residue
Remaining alert to seemingly small indicators of a meth lab can be life-saving. First responders who encounter any of the indicators discussed above should treat the situation as if a meth lab were on site, even if the actual lab has yet to be found. Once a meth lab encounter is suspected, it is critical that all in the vicinity take the following precautions (http://www.policeone.com/writers/columnists/ScottBuhrmaster/articles/80897):
- Do not smoke (or allow others in the vicinity to smoke).
- Do not open or move any chemical containers.
- Do not touch any unknown substances with bare skin or smell the contents of any container.
- Do not plug in or unplug electrical devices or flip light switches.
- Do not use a firearm inside (if at all possible). Instead, should the need arise, look for opportunities to safely exit the area before any gunfire can erupt, and then establish an appropriate exterior perimeter.
Do not use flashbulbs to photograph evidence. Instead, use only photographic strobe equipment (that will not generate a spark).
- Refrain from actions that could generate friction (for example, use of friction-producing tools).
- Leave the area immediately and seek prompt medical care if you feel any of the following: difficulty breathing, dizziness, confusion, or burning of the skin, lungs or other mucous membranes.
Law, Order and Awareness: The Battle Wages On
In August 2005, more than 400 people were arrested in the first nationally coordinated operation aimed at methamphetamine producers and sellers. In Operation Wildfire, 56 labs and more than 200 pounds of meth were seized by the Drug Enforcement Agency and police in more than 200 cities nationwide. But Snawder cautions that while there’s a downward trend for larger labs, the smaller, mobile and “mom-and-pop” labs still are flourishing.
The fight against methamphetamine and its associated dangers has been taken up and joined by several states. In some of those states, such as Kentucky, Missouri, California and Michigan, strides are being made with respect to awareness training, outreach and community health. At the forefront of such efforts is Colorado, with a long-standing and comprehensive law enforcement, awareness and training effort (see “Colorado Fights Back”). But despite the proactive approaches on the part of some states, required awareness training remains the exception rather than the rule.
From the legislative angle comes another approach. The Combat Methamphetamine Epidemic Act of 2005 (Title VII of Public Law 109-177) approaches the problem via rules and restrictions regarding the import, production quotas and sale of products containing the precursors of methamphetamine production (ephedrine, pseudoephedrine and phenylpropanolamine). A dozen states have passed laws forcing stores to remove medicines containing these precursors from their shelves. Others have passed laws limiting the quantity of such items that may be purchased and placing them behind the pharmacy counter.
“The goal,” says, Snawder, “is to prevent the purchase of sufficient amounts of these products to manufacture meth for distribution. But people are still able to obtain enough of these substances to make meth for personal use, leaving the smaller labs up and running.”
Like a brush fire, which is put out in one area only to crop up in another, the meth problem is a difficult one to contain, and calls for flexibility in the development and implementation of the means with which to fight it. Oklahoma’s meth lab seizures have fallen 90 percent since April 2004, when it became the first state to ban over-the-counter sales of these types of cold and allergy medications. But, at the same time, seizures of crystal ice (smokable Mexican meth) rose nearly five-fold, from 384 cases in the 15 months before passage of the law to 1,875 since. Other states have followed Oklahoma’s lead, and expect a similar trade-off. In Tennessee, meth lab seizures have fallen 50 percent since a psuedoephedrine ban. Tennessee has not yet seen an increase in ice trafficking, but agents are preparing for the likelihood.
While a portion of the battle continues to be waged on the legislation front, awareness remains critical to the health and safety of first responders – and to all others who may encounter meth labs or the hazards left behind. And, as in all such cases, a proactive approach initiated “from the top down” is likely the most effective way to ensure the short- and long-term safety of the personnel who find themselves waging the battle against a dangerous and insidious enemy.
Sidebar: Colorado Fights Back
For 13 years, Colorado’s North Metro Task Force (focal point for drug investigations within Adams and Broomfield Counties) has been at the forefront of the fight against meth. Seizure of clandestine labs is only one component of the Task Force’s multifaceted battle plan, which serves as a model for those attempting to heighten community and first responder awareness.
During the late 1990s, most of the clandestine drug labs recovered were from proactive enforcement. But beginning in 1999, the task force noticed that police officers were finding obvious drug labs while responding to other calls (complaints of a loud party, domestic violence, possible child abuse, etc).
This, in turn, prompted concerns about first responders who might happen upon unidentified labs, and risk exposure to a laundry list of hazards.
What arose from these concerns was an educational initiative called the “First Responders Operations Course,” which is aimed at patrol officers, fire fighters, building inspectors and other at-risk employees in each of the cities within Adams and Broomfield counties.
The task force took on the responsibility of providing an 8-hour first responders safety course to all participating agencies. In 2001, more than 700 people participated in the training (police officers, fire fighters, probation officers, social workers, building inspectors, city attorneys, victim advocates, environmentalists, emergency medical technicians, paramedics, code enforcement officers and animal control officers).
The task force since has been asked to provide the training to other agencies across the state and, over the last 4 years, has trained more than 11,500 city and county employees, as well as citizens within the community and around the state. The training casts a wide net, hoping to include all those who might come into contact with meth labs and their associated hazards, and includes realtors, judges and lawyers, educators, foster parents, treatment providers, probation officers and parole officers and parks maintenance employees as well as more traditional first responders.
The task force also has taken on the challenge of raising public awareness with the goal of passing new laws and assisting with the prosecution of those who manufacture meth. To that end, in conjunction with the Greater Metro Telecommunications Consortium, the task force assisted in the production of a 30-minute videotape created to educate citizens about the hazards of meth labs. “The Hidden Threat: The Rapid Rise in Methamphetamine Labs” aired simultaneously on all local cable-8 programming channels on Dec. 5, 2001.
The task force reported a reduction in safety concerns after initiation of their awareness training program. But the number of labs located by first responders doubled during the next 2 years, and that number continues to increase, underscoring the critical need for continued efforts to heighten awareness among first responders and all others at risk.
Sidebar: Sampling for Safety
Once the hazardous bulk materials are removed from a meth lab, surface contamination is the predominant exposure risk.
During the cooking process, depending on the method, methamphetamine base is released and airborne contamination settles out. During the salting-out process, a great deal of fine aerosol methamphetamine is released, settling virtually everywhere, and often at a considerable distance from the cook location. Additional release of contaminants comes from smoking the meth, and from the transfer of product throughout the location by both users and cookers.
Treating a newly discovered lab is usually a law enforcement (or in worst cases, a fire department or emergency medical technician [EMT]) event, and then a hazardous materials (HAZMAT) event.
Based on Health Hazard Evaluation requests from law enforcement, fire/EMT service and, originally, public health and remediation workers who were involved with some labs on reservation lands (Indian Health Service folks), a rapid test was developed for on-site testing. The goal was primarily to enable, with minimal training, rapid assessment of contamination levels, and to provide a safe way of wiping skin and clothing to avoid transfer of contamination and estimate decontamination efficiency.
In light of this, the National Institute for Occupational Safety and Health (NIOSH) initially looked at some colorimetric disclosure methods, ultimately validated a method, and subsequently worked with SKC on marketing and selling a product (Meth-Alert).
The Meth-Chek Kits, sold by SKC, are built around a lateral flow immunochemical assay (LFIA). The goal was to develop a simple, accurate test that was cost-effective, enabling its use to over-sample a suspect lab and do a limited number of analytical chemistry confirmation tests.
Sidebar: Laboratory Validation: Some Results
Results of laboratory validation of immunochemical tests were as follows:
- Diagnostic Sensitivity = (259/259+21)*100 = 97 percent when methamphetamine is present +/- 25 percent stated cut-off
- Diagnostic Specificity = (18/0+18)*100 = 100 percent
- Method Accuracy > 95 percent to identify presence/absence of methamphetamine (460/480 correct)
- Method Sensitivity > 96 percent when methamphetamine present +/- 25 percent stated cut-off
Field evaluation is on-going, with the device put to the test in several meth labs in Ohio, Kentucky and Indiana, and in a small number of mobile labs. In all these field trials NIOSH has seen greater than 95 percent agreement between the LFIA and laboratory-based, liquid chromatography mass spectroscopy (LC-MS) methods. In some cases, the LFIA detects methamphetamine below the level of the analytical method. At other times, particularly when looking at transfer or smoking residues, large differences can be seen when samples are taken from adjacent areas.
The caveat with these results is that they are from a specific team with expertise at finding residues (knowing where to look, and for what surfaces the sampling materials are most efficient). – John E. Snawder, PhD, DABT, Leader, Biomonitoring Research Team, National Institute for Occupational Safety and Health (NIOSH)
Laura Bruck has been a medical writer and editor since 1987.