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Clandestine Meth Labs V. April, 2011

Clandestine Meth Lab Issues

ACMT / ATSDR Meth Lab Working Group

Rob Palmer Toxicology Associates, PLLC Rocky Mountain Poison & Drug Center University of Colorado Denver

Acknowledgements

This material is supported by a cooperative agreement between the American College of Medical Toxicology (ACMT) and the Agency for Toxic Substances and Disease Registry (ATSDR) of the Centers for Disease Control

Objectives

  Be familiar with the most common synthetic methods used in illicit methamphetamine manufacture

  Understand the impact and consequences of precursor regulation

  Be aware of the most common injuries resulting from meth labs

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Methamphetamine History   1887 Amphetamine first synthesized in Germany   1919 Methamphetamine synthesized in Japan   1930s Amphetamine in Benzedrine inhaler   1960’s West Coast motorcycle gangs

–  Known as “crank”   1970’s Becomes a DEA Schedule II drug

–  Caused its use to decrease   1980’s Simpler recipes

–  Enantiomerically pure drug   1990’s Large scale operations

–  Legal maneuvers

National Drug Threat Survey 2007: Greatest Drug Threat by OCDETF Region

US - 2009 Data

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US Meth Lab Seizures, 2001- 2008

US Meth Use, 2000 – 2005   Number of primary methamphetamine treatment

admissions to publicly funded treatment facilities

•  Red Phosphorus / Hydroiodic Acid Reduction of Ephedrine or Pseudoephedrine

•  Liquid Ammonia / Alkali Metal Reduction of Ephedrine or Pseudoephedrine

•  “One Pot Method” using cold pack

•  Phenyl-2-Propanone (P2P) condensation with N-methylformamide and treatment with HCl

Common Synthetic Methods

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•  Extraction of ephedrine / pseudoephedrine •  The “cook” •  Extraction of free base •  Salting out •  Drying •  Packaging & distribution

General Synthetic Phases

+ +

The Extraction

Red P / HI Method

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Ephedrine Bronchodilator / Stimulant Pseudoephedrine Decongestant Red Phosphorus Matchbook Strikers / Flares Iodine Crystals Water Purification Sodium Hydroxide Drain Cleaner Acetone Hardware Solvent Ether Starting Fluid Toluene Hardware Solvent

Chemical Use

Red P / HI Method

Red Phosphorus Isolation

RED WHITE BLUE

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Cold Cook

 A variation of the Red P / HI method  Chemicals are mixed in plastic

container where meth oil drips into another plastic container through a tube attached to each cup

 Mixture is heated by sunlight or by burying containers in hot sand

 Only produces very small quantities (chemically very inefficient)

The “Death Bag”

Photo: North Metro Task Force

Liquid NH3 / Metal Method

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Chemical Use Ephedrine Bronchodilator/Stimulant Pseudoephedrine Decongestant Liquid Ammonia Fertilizer Sodium Hydroxide Drain Cleaner Acetone Hardware Solvent Ether Starting Fluid THF Plumbing Solvent

Liquid NH3 / Metal Method

The ‘Nazi Method’

The ‘One Pot Method’

  Ammonium nitrate (cold pack)   Pseudoephedrine / Li metal   Eliminates need to heat reaction   Aka “Shake-N-Bake” method   Methamphetamine is reportedly

extracted from mixture   Yields are extremely low and

product is impure   Not suited for large-scale

production

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And this was a Meth Lab…

And this was a Meth Lab…

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And this was a Meth Lab…

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And this was a Meth Lab…

25% of known Meth-labs were discovered because of explosion or fire

MMWR 2005; 54: 356 – 359.

And this WAS a Meth Lab!

Methamphetamine & Precursors

Ephedrine Pseudoephedrine Phenylpropanolamine

Methamphetamine Amphetamine

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Precursor Laws

  Virtually all states have some form of methamphetamine precursor law as of 2005-2006

  Substances may only be sold by a pharmacist/pharmacy tech and a log must be signed

  Pseudoephedrine placed behind counter, sold by and to someone ≥18 years of age

  Maximum allowed purchase amounts –  Package sizes of not more than 3 grams (1,440 mg of PE

base) per day or 9 grams per month –  Responsibility to remain under the limit is on the BUYER not

the retailer   Regulation has led to ‘smurfing’

Precursor Restriction

Basic Hazard Types

  Chemical –  Hazardous chemicals –  Uncontrolled reactions –  Spills

  Environmental –  Suspects, bullets –  Explosions and Fires –  Booby Traps and IEDs –  Ambient Oxygen

Concentration –  Heat Stress –  Waste Dumping Pits –  Rerouting of Electricity

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Environmental: Suspects

  May be armed.   May be uncooperative.   May be psychotic.   May be contaminated.

  May be … coming to your ED via your EMS system.

Weapons Cache at a Meth Lab

On-Site Chemicals

  Depends on methods being used

  Quantities vary based on size and activity of lab

  Not everything present is necessarily used for meth production

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Chemicals

  Over 350 chemicals have been associated with meth labs

  50 – 60 chemicals are commonly found   By volume/quantity

Solvents Most Caustics Precursors Catalysts Least

Chemicals   Precursors

–  phenyl-2-propanone –  ephedrine –  pseudoephedrine

  Solvents –  methanol –  diethyl ether –  freon

  Reagents (catalysts & caustics) Catalysts –  mercuric chloride –  sodium acetate –  hydrogen sulfide –  hydriodic acid (HI) –  iodine –  red phosphorus Caustics –  hydrochloric acid –  phosphoric acid –  sodium hydroxide

Specific Acute Chemical Hazards

  Recent studies have attempted to quantify the chemical exposures during meth production

  Five chemicals of concern were assessed –  Methamphetamine –  Phosphine –  Iodine –  Ammonia –  Hydrochloric Acid

Martyny JW et al. Chem Health & Safety 2007; 17: 40-52

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Why Do We Care? Medical Consequences of Meth Labs

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, 2004. –  1,791 (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: 356 – 359.

Medical Effects from Meth Labs

  186 of 1,791 meth events (10%) involved fires or explosions

  Most common substances were NH3 (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: 356 – 359.

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First Responders

  Washington state meth lab cook injured and causes hospital ED evacuation for 6 hrs

  Oregon firefighter suffered chemical burns after exposure to HCl and ephedrine during a fire in a home where meth manufacturing material was found

  Of first responders, police (n=79) had greatest number of injuries followed by EMS (n=17) and firefighters (n=8)

–  Most complaints were of respiratory & eye irritation –  PPE used by firefighters was most important factor

Burgess Am J Emerg Med 1999; 17: 50-52 Horton Am J Emerg Med 2003; 21: 199-204 Cooper MMWR, 2000; 49(17): 1021-1024.

CLIC: Lab Status

  Active: active chemical process or synthesis (26.2%)

  Set-up: lab & chemical ready no active process (16.5%)

  In-transit: lab/chemicals boxed or being shipped (42.5%)

  Former: structure that used to be lab (13.0%)

  Other: (1.8%)

Burgess, et al. Am J Ind Med 1996; 30: 488-494

CLIC: Exposures

  Most labs were making meth (81.1%) –  Other labs were PCP, MDMA, LSD and unknown

  Exposures (CLIC & Washington State Combined) –  inhalation 16/20 (80%) –  dermal 7/20 (35%) –  dermal and inhalation 4/20 (20%) –  not specified 1/20 ( 5%)

Burgess, et al. Am J Ind Med 1996; 30: 488-494

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CLIC: Symptoms

Headache 60% Sore throat 60% Nose irritation 40% Cough 35% Breathing diff. 20% Eye irritation 15% Skin burn 15%

Dizziness 15% Chest pain 10% Abd. pain 10% Nausea 5% Lung damage 5% Other 15%

Burgess, et al. Am J Ind Med 1996; 30: 488-494

Entry •  Suspects are apprehended & lab secured •  Short (5 – 30 minutes)

Assessment •  Physical hazards are evaluated & contents of lab

determined •  Variable time periods

Processing •  Lab contents are removed and representative

chemicals cataloged and sampled •  Longest phase (often >8 hours)

Disposal •  Chemicals and associated apparatus are transported

away from laboratory for destruction

CLIC: Investigation Phases

CLIC: Illness Episodes

Entry Assess. Process. Disposal Investigators 6 10 20 4 Illnesses 0 1 18 0 Tot. time (hrs) 2.5 6.5 85.8 3.3 Illnesses/hr 0 0.15 0.21 0

  Fire/explosion, leak/spill, or uncontrolled reaction present in majority of illness episodes

  Most injuries occurred in cases where respiratory protection was not used

Burgess, et al. Am J Ind Med 1996; 30: 488-494

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Health Effects

  Most commonly reported adverse effects are headache and airway irritant symptoms

  Most associated with “processing phase”   7 to 15 fold risk of becoming ill during a

seizure of active lab compared to setup and in-transit

Burgess, et al. Am J Ind Med 1996; 30: 488-494

Drug Endangered Child (DEC)

  Definition: –  A child under 18 years allowed to be present

  Where methamphetamine is being sold, offered for sale (or possessed with intent to sell), delivered, distributed, prescribed, administered, dispensed, manufactured, or manufacture is attempted

  Around drug paraphernalia or toxic or flammable chemicals stored for the purpose of manufacturing or attempted manufacture of methamphetamine

Drug Endangered Child (DEC)

  35 states + DC have legislation to assist DEC

  Some states mandate the presence of a child is an aggravating circumstance in sentencing

–  Up to 5 years + fine up to $25,000   Many states now have DEC

units/response guidelines

www.colodec.org

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Summary

 Most current synthetic methods involve the conversion of ephedrine or pseudoephedrine to methamphetamine

 Precursor regulation has had an impact on the number of meth labs in the US

 Most meth lab injuries are burns or respiratory/skin/membrane irritation

 Prevention of exposure is the most effective approach

Questions