History & Epidemiology of Exposure to Methamphetamine Contamination in Homes and Clandestine Labs

Transcription

1 History & Epidemiology of Exposure to Methamphetamine Contamination in Homes and Clandestine Labs Evan Schwarz, MD Washington University School of Medicine ACMT / BIA Meth Lab Working Group Clandestine Meth Labs V.. PDX Aug 2015

2 Objectives! Know the trends involving clandestine methamphetamine laboratories in the US and Montana! Understand the current demographic trends in meth use! Be aware of the most common injuries resulting from meth labs

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5 53% of children in foster care due to meth 50% of adults in prison are there for meth-related crime 20% of adults in treatment are there for meth addiction

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10 History of Amphetamines 1887 Amphetamine first Synthesized by the Romanian chemist Lazăr Edelean in Berlin, Germany 1918 Methamphetamine synthesized from ephedrine in Japan by chemist Akira Ogata, via reduction of ephedrine using red phosphorus and iodine Marketed as Benzedrine inhaler 1935 Abuse reported 1940 s WW II combat fatigue

11 Amphetamine History 1944 Treatment for Narcolepsy (d-amphetamine) 1950s Popular as anti-sleep med in college, weight loss pill among women, Methamphetamine bennies among the Beat generation 1959 First Restrictions by FDA 1960s West Coast motorcycle gangs crank 1970 Restricted to Class II drug by Controlled Substances Act (CSA) Amphetamine MDA abuse declines PMA

12 Bikers and Crank! Home-brew! By 1970, control majority of trade! Expand to international market! P2P! Pre-cursor laws

13 Amphetamine History 1980 Enantiomeric pure drug 1990s Large scale operations 2000s Pseudoephedrine restrictions 2000s Portable meth labs 2000s Synthetic cathinones Cathinone Pseudophed

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15 Drug Abuse Warning Network (DAWN) ED Visits Involving Meth from

16 In 2006 Who is Using Meth?! ~ 730,000 current Meth users (0.3%) Peak age range for Meth use yrs (2.8%) Decreases with age (0.7% by age 30)! ~ 259,000 tried Meth for the first time Average age at 1 st use = 22 yrs old Average age in 2005, only 18.6 yrs

17 U.S. Poison Center Data! D ), ) D ( D / )) 5 3 8

18 Other Sources of Use Data! Community Epidemiology Working Group (CEWG)! Jails Honolulu (40.3%), Phoenix (38.3%) San Diego (36.2%) Los Angeles (28.7%) Seattle (10.9%)

19 Monitoring the Future: School Age Users! MTF Project at the University of Michigan! Assesses extent of drug use across the US in 8 th, 10 th and 12 th graders! In 2008 " Good News!!!! Drop in use and Increase in disapproval! Use is down by about 2/3 among teens since 1999

20 School-Age Meth Users Annual Prevalence 8 th 10 th 12 th Graders 8 th 1.2% 10 th 1.6% 12 th 1.0%

21 Adapted by CESAR from National Institute of Drug Abuse, Monitoring the Future: National Results on Adolescent Drug Use, , Volume I: Secondary School Students,

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23 National Drug Threat Assessment! Availability increasing! Mainly from Mexico Mexican lab seizures Drug busts at the border! Purity increased since 2012

24 National Drug Threat Survey : Greatest Drug Threat by OCDETF Region RED = METHAMPHETAMINE

25 National Forensic Laboratory Mid-Year 2014 Report

26 DEA Statistics

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28 US Meth Use, ,

29 Hazardous Substances Emergency Events Surveillance (HSEES) System! 53,142 hazmat events from ,568 victims! Meth related hazmat events Classified as personal services! Subclassified as household events! 81% of personal services events occur in households 70% of personal services victims occur in households Horton, et al. Am J Ind Med 45: , 2004

30 Hazardous Substances Emergency Events Surveillance (HSEES) System! 883 households with known hazmat releases! 24% (208 of 883) of household events were meth-related 140 events involved 234 victims! More than one victim per event Most frequent victims were! Police Officers (65.0%; n = 152)! General Public (25.2%; n = 59) Horton, et al. Am J Ind Med 47: , 2005

31 Hazardous Substances Emergency Events Surveillance (HSEES) System! Most common meth lab toxicants Ammonia (NH 3 ) Ethyl ether Hydrochloric acid (HCl)! Most common meth lab symptoms Respiratory irritation Headache! 24.8% (n = 58) treated at hospital & released! 2 deaths (not police officers) Horton, et al. Am J Ind Med 47: , 2005

32 Medical Consequences of Meth Labs

33 Medical Effects from Meth Labs! Data from ATSDR Hazardous Substances Emergency Events Surveillance (HSEES).! 40,349 events reported to HSEES between Jan 1, 2000 and June 30, ,791 (4%) involved meth labs. Events reported in 15 of 16 reported states! WA 399; NJ 0 Number of meth-related events increased over time of study MMWR 2005; 54:

34 Medical Effects from Meth Labs! 186 of 1,791 meth events (10%) involved fires or explosions! Most common substances were NH 3 (16%), meth chemicals NOS (13%) and HCl (8%)! Meth events had a higher percentage of casualties than did non-meth events 558 of 1,791 (31%) resulted in 947 injuries Police officers most frequently injured (n=531; 56%) Respiratory irritation, headache, eye irritation and burns MMWR 2005; 54:

35 Medical Effects from Meth Labs! Of the 947 injuries: 274 were seen at hospitals &released 68 were treated at hospitals & admitted 62 were treated at the scene 9 died MMWR 2005; 54:

36 Methamphetamine Control Act: 1996! Broadened restrictions! Increased penalties for production and trafficking! Established controls relating to the distribution, importation, and exportation of pseudoephedrine, phenylpropanolamine, and combination ephedrine drug products. Reportable at 24 gms/transaction.

37 Combat Methamphetamine Epidemic Act of 2005! A retrievable record of all purchases of ephedrine identifying the name and address of each party to be kept for two years! Required verification of proof of identity of all purchasers! Non-liquid dose form of regulated product may only be sold in unit dose blister packs! Restricted access: behind the counter! Daily sales restriction! Monthly sales not to exceed 9 grams of pseudoephedrine base in regulated products

38 US Meth Lab Seizures,

39 Oregon Meth Laws Different Than Most! NOV. 15, 2004: Oregon Board of Pharmacy requires pseudofed be kept behind the counter, and picture ID required! JULY 1, 2006: A Prescription required! Note: Mississippi has a similar law. Other states adopted similar measures

40 Oregon Pseudofed (PSE) Restrictions: Before and After 84 months: ! 3220 meth lab incidents 84 months since! 103 meth lab incidents! ! ! ! ! ! ! ! ! !

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45 What were the unintended consequences? Meth Lab Seizures in Mexico

46 Meth Sources! $100-$120/gram, $1100-$1300/ounce Price has doubled in past 3 years (per Lt. D. Evans, Reno, NV Police Dept, 2009)! Coming from super labs in Mexico and central California 900 metric tons/year! Manufacturers and high-level dealers are primarily Mexican nationals

47 From 2007 to 2010, the price per pure gram decreased 60% while the purity increased 114%

48 Meth and Crime Source: Lt. D. Evans, Reno, NV PD

49 Meth and Crime! Meth addiction has devastating effects on families! The addict s ability to effectively parent children diminishes tremendously Child neglect/abuse Exposure to sexual and/or violent environment at a young age Exposure to the drug, paraphernalia, and possibly lab materials Source: Lt. D. Evans, Reno, NV PD

50 Safety Tips for Approaching Agitated Drug Users! Keep a social distance > 7 to 10 foot radius.! Detaining a patient alone is not recommended.! Do not shine bright lights at him or use mirrors.! Slow your movements - he is paranoid.! Keep your hands visible, move them slowly.! Speak slowly and softly - the user hears sounds at a high pitch and at a fast pace! Give/Ask short specific instructions Source: US Dept of Justice (1999)

51 Summary! The distribution of meth use & labs are very region-dependent! # of clandestine labs in the US was declining but now increasing in some areas Labs are still a problem in many parts of the country Likely due, at least in part, to restrictions on precursor sales! The declining number of labs does not represent a decrease in meth use Production shifts, not declines in use! Most meth lab injuries are burns or respiratory/skin/membrane irritation

52 Questions QUESTIONS