Morbidity and Mortality Weekly Report
Adverse Health Effects Associated with Living in a Former Methamphetamine
Drug Laboratory — Victoria, Australia, 2015
Jackie Wright, PhD1; Michaela E. Kenneally2; John W. Edwards, PhD1; G. Stewart Walker, PhD3
The manufacture of methamphetamine in clandestine drug
amphetamine-based medications. Data concerning health
laboratories occurs in various locations, including residential
effects were obtained from documentation of medical assess-
houses and apartments. Unlike the controlled manufacture of
ments from the family doctor, school medical information,
chemicals and drugs, clandestine manufacture results in the
self-reported observations by the family members in response
uncontrolled storage, use, generation, and disposal of a wide
to a questionnaire, and evaluation of behavioral issues, based on
range of chemicals and the deposit of methamphetamine drug
the completion of the
Behavior Assessment System for Children,
residues on indoor surfaces (
1). These residues have been found
Second Edition (BASC-2)* Parent Rating Scales (PRS).
at high levels on porous and nonporous surfaces and have been
Assessment of drug exposure levels was based on the collec-
shown to persist for months to years (
1). Persons exposed to
tion and analysis of hair samples from all members of the family
these environments often have poorly defined exposures and
1 week after leaving the home, and from the children, approxi-
health effects. It is commonly assumed that these levels of
mately 3 months later. Because none of the family members used
exposure are low compared with those related to illicit drug use
amphetamines, through either prescription or illicit drug use, the
or therapeutic use of amphetamine-based drugs for managing
testing of hair to determine environmental exposure was consid-
behavioral issues such as attention deficit hyperactivity disor-
ered suitable. Hair samples measuring 3–4 cm in length (from
der (
2). In 2015, a family that was unknowingly exposed to
the scalp) were collected, which was considered representative
methamphetamine residues in a house in Australia was found
of exposure over the 3–4 months preceding sampling. Testing of
to have adverse health effects and elevated methamphetamine
the hair was conducted at Forensic Science, South Australia by
levels in hair samples, highlighting the potential for public
methanolic extraction and analysis of the extract by liquid chro-
health risks for persons who might live in methamphetamine-
matography with tandem mass spectrometry using electrospray
contaminated dwellings. This case study highlights the impor-
ionization. The hair was subjected to a methanol wash before
tance of the identification and effective decontamination of
extraction to remove any recent external contamination. The
former clandestine drug laboratories.
washes also were analyzed for the presence of amphetamines.
In May 2013, police seized chemicals and manufacturing
The lower limit of detection for this analysis was 5 pg/mg for
equipment from a property in rural Victoria, Australia, and
methamphetamine and amphetamine.
arrested the owner. After completing investigation of the prop-
All family members experienced adverse health effects
erty, police issued a notice to the local council indicating that the
while living in the home. The most serious health effects were
property was a former clandestine drug laboratory and posed a
reported in the youngest child (a boy aged 7 years) and included
potential health risk. The council issued a notice to clean up the
development of asthma-like symptoms, trouble sleeping, and
property; however, the cleanup was not performed. The property
behavior changes (Table 1). Of note, a parent-requested cogni-
was sold in August 2013, and normal prepurchase checks did not
tive behavioral assessment to evaluate potential gifted traits,
identify the property as a former methamphetamine laboratory
undertaken for this child 3 months before moving into the
or reveal that a notice to clean up the house had been issued.
home identified no at-risk or clinically significant behavioral
In October 2013, the new owners, a family of five, moved into
issues. From the BASC-2 PRS evaluation conducted 1 week
the house. Seven months later, in May 2014, the local council
after moving out of the home, anxiety, attention issues, and
contacted the owners to advise them that their home was a
somatization were scored as at-risk or clinically significant and
former drug laboratory. Environmental testing of the home
were consistent with observations provided by the mother and
was carried out during late May–October 2014 and revealed
school personnel. Most of the health problems identified in all
elevated levels of methamphetamine on surfaces inside the home,
family members, including the youngest child, were observed
ranging from 11.7–26.0
µg/100 cm2, well above the Australian
to resolve over time (6–12 months) after they were moved
limit of 0.5
µg/100 cm2 (
3) for safe levels in a residential home.
from the contaminated premises (Table 1).
The family was required to vacate the property in March 2015.
Methamphetamine was detected in the hair of all family
The family included two adults and three children aged
members at concentrations ranging from 5 to 460 pg/mg
7, 8, and 11 years. None of the family members had ever
used methamphetamine or had been taking any prescribed
*
http://www.pearsonclinical.com/education/products/100000658/behavior-
assessment-system-for-children-second-edition-basc-2.html.
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US Department of Health and Human Services/Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report
(Table 2). Amphetamine was also detected in the hair of the
members. Methamphetamine (60 pg/mg) was reported in the
two youngest children, ranging from 16 to 20 pg/mg (Table 2).
hair sample of the boy aged 8 years and was thought to be related
The highest methamphetamine levels in the hair samples col-
to differences in hair growth rate and hair sample collection.
lected were found in the two youngest children (boys aged 7
and 8 years), with a lower level (50 pg/mg) found in the hair
Discussion
of the older child, a girl aged 11 years.
The data from this case study of a single family present
Lower levels of methamphetamine were reported in the hair
evidence of adverse health effects and reflect exposure to
of the children’s mother (17 pg/mg) and father (5 pg/mg). The
methamphetamine that occurred while living in a home with
only detection of methamphetamine in the hair wash was from
environmental methamphetamine surface contamination levels
the mother (8 pg/mg).
in the range of 11.7–26.0
µg/100 cm2.
Retesting for drugs in hair samples 3 months after moving
The highest levels of methamphetamine detected in the
out of the home (June 2015), indicated clearance of the drug,
hair samples analyzed were from the two younger children.
with no detection of amphetamines in the hair for most family
These children had the lowest body weights in the family
TABLE 1. Adverse health effects reported by family members while living in and after vacating a methamphetamine-contaminated house —
Victoria, Australia, 2015
Age (yrs)
Sex
Respiratory
Cognitive/Behavioral
Other adverse health effects
7
Male
Persistent cough, asthma-
Trouble sleeping, fearfulness, vivid/scary dreams, irritability,
Skin rashes; sore, watery eyes
like symptoms
aloof, easily distracted. BASC-2 testing: anxiety, somatization,
ADHD (at-risk or clinically significant; not present before living
in home)
8
Male
Asthma
BASC-2 testing: no issues identified 1 week after vacating
Sore, watery eyes
home; anxiety and somatization reported 3 months after
vacating home, while living in rented accommodation without
access to personal possessions
11
Female
Persistent cough
Trouble sleeping, irritability. BASC-2 testing: no significant
Sore, watery eyes
issues identified
40
Female
Persistent cough
Excess energy
Sore, watery eyes; weight loss;
improved distance vision
38
Male
none
Trouble sleeping, decreased memory function (self-reported)
Sore, watery eyes; dizziness and
blurry vision while cleaning
contaminated areas
Abbreviations: BASC-2 =
Behavior Assessment System for Children, Second Edition; ADHD = attention deficit hyperactivity disorder.
TABLE 2. Concentrations of methamphetamine and amphetamine in hair samples collected from members of a family exposed to a
methamphetamine-contaminated residence 1 week and 3 months after vacating the home — Victoria, Australia, 2015
Concentrations at 1 week after
Concentrations at 3 months after
vacating the home (pg/mg)
vacating the home (pg/mg)
Factors that might increase or decrease
Age (yrs)
Sex
Methamphetamine
Amphetamine
Methamphetamine
Amphetamine
exposure in the home
7
Male
460
20
Not detected
Not detected
Regularly played games that involved rolling
on the floor, touching all surfaces and
running hands along the walls. Infrequent
8
Male
330
16
60
Not detected
washing of hands.
11
Female
50
Not detected
Not detected
Not detected
Spent a lot of time on electronic media and
limited active play with brothers.
40
Female
17*
Not detected
Not tested
Not tested
Regularly cleaned the home, including just
before hair samples were collected. Has
colored hair.
38
Male
5
Not detected
Not tested
Not tested
Works out of the home most of the day,
including weekends.
* Methamphetamine (8 pg/mg) also was detected in the methanol wash of this hair sample.
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MMWR / January 6, 2017 / Vol. 65 / No. 52
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Morbidity and Mortality Weekly Report
and, according to their parents, had multiple opportunities for
regular close contact with indoor surfaces, including engag-
Summary
ing in activities that involved rolling on the floor, running
What is already known about this topic?
around the house, rubbing their hands on walls, and touching
The clandestine manufacture of methamphetamine is known to
items throughout the home. In addition, these children were
result in various levels of contamination of all surfaces in homes.
Information is available on drug exposures and health effects
reported by their parents to wash their hands less frequently
for drug users as well as persons exposed during manufacture.
than other members of the family. The oldest child reportedly
What is added by this report?
spent more time using electronic media and was involved in
limited physical play; her hair methamphetamine level was
A family of five, including three children aged 7–11 years, lived
in a home in rural Victoria, Australia, that was previously a
substantially lower than those of her two brothers.
clandestine methamphetamine drug laboratory with docu-
The lower levels of methamphetamine reported in the hair of
mented environmental contamination. The family members
the mother potentially reflect lower levels of methamphetamine
developed adverse health effects, and there was evidence of
exposure in the home. In addition, the mother reported that
systemic absorption of methamphetamine from the environ-
she colored her hair, which has been reported to result in some
ment, based on hair samples collected after they had vacated
the premises. Health effects were most pronounced in the
loss of amphetamine in tested hair samples (
4,
5). The children’s
youngest child, who also had the highest methamphetamine
mother reported regularly cleaning the house, including just
levels in hair, possibly related to a combination of repeated
before hair sampling after moving out of the home. This might
contact with surfaces during play activities and less frequent
account for a measured level of methamphetamine identified
hand washing.
in the extract from the external hair wash. The children’s father
What are the implications for public health practice?
worked away from the home most of the day; his hair had the
If properties formerly used for the clandestine manufacture of
lowest level of methamphetamine contamination.
methamphetamine are not properly cleaned the public might be
Methamphetamine levels in the hair samples of the two younger
unknowingly exposed to drug residues. Appropriate identifica-
children (460 pg/mg and 330 pg/mg) are consistent with the lower
tion and management of these properties, including measures by
authorities to prevent the sale of unremediated homes, are
end of the range reported in children removed from clandestine
important to prevent exposures and adverse health effects.
drug laboratories (range = 100 pg/mg–131,000 pg/mg) (
6,
7) and
chronic adult drug users (range = 100 pg/mg–128,000 pg/mg)
(
6,
8). The levels reported were similar to those reported in stud-
is significant variation among persons who might have had the
ies conducted on low-level methamphetamine use by adults
same level of exposure and the measured levels in hair, although
smoking doses of approximately 500–1,000 mg/day (
8). The
for an individual, correlation between dose and the concentration
detection of amphetamine in the hair of the younger children
of amphetamines in hair has been reported (
8,
10). However, the
might reflect environmental exposures in the home, where low
data reported for the family members support the association
levels of amphetamine also were detected in the surface samples
of higher levels of methamphetamine and amphetamine in hair
analyzed (but not quantified by the laboratory), or the presence
with higher levels of exposure (based on reported activities, body
of metabolites, supporting the systemic absorption of metham-
weight, and time in the contaminated home). The fact that hair
phetamine. The ratio of methamphetamine to amphetamine
concentrations declined precipitously after the exposure was
in the hair was found to be consistent with the mean reported
removed is consistent with an association between exposure and
in hair samples from children removed from clandestine drug
elevated hair levels. Second, the presence of methamphetamine
laboratories and from drug-exposed children (
6,
7).
and amphetamine in the hair samples collected reflect exposures
The most substantial health effects were in the youngest
that might have occurred during the preceding 3–4 months (
10)
child, who also had the highest measured levels of metham-
with the environmental data (surface residue sampling) reflecting
phetamine in hair. The health effects reported in this study also
contamination levels at the time of sampling only (approximately
have been reported in children removed from active metham-
3–6 months before the collection of hair samples). Levels of envi-
phetamine drug laboratories (
9). Follow-up with the family
ronmental contamination and exposures that might have occurred
has identified that the respiratory effects, trouble sleeping, and
before this time are not known and might have been higher.
behavioral changes mostly resolved during the 12 months after
Residual environmental methamphetamine contamination can
the family vacated the contaminated home.
result in adverse health effects in exposed persons, particularly in
The findings in this report are subject to at least two limitations.
young children. Appropriate identification and management of
First, there is no established quantitative relationship between
former clandestine drug laboratories, including appropriate reme-
the dose of methamphetamine to which a person is exposed and
diation and measures to prevent the sale of contaminated homes, is
the measured methamphetamine level in hair. In addition, there
important to prevent exposures and adverse health effects.
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Morbidity and Mortality Weekly Report
1Health and Environment, School of the Environment, Flinders University,
5. Tsanaclis L, Wicks JF. Patterns in drug use in the United Kingdom as
Adelaide, South Australia, Australia; 2Toxicology, Forensic Science SA,
revealed through analysis of hair in a large population sample. Forensic
Government of South Australia, Adelaide; 3School of Chemical & Physical
Sci I
nt 2007;170:121–8. http://dx.doi.org/10.1016/j.forsciint.2007.03.033
Sciences, Flinders University, Adelaide, South Australia, Australia.
6. Bassindale T. Quantitative analysis of methamphetamine in hair of
children removed from clandestine laboratories—evidence of passive
Corresponding author: Jackie Wright,
[email address].
exposure? Forensic Sci Int 2012;219:179–82.
http://dx.doi.
org/10.1016/j.forsciint.2012.01.003
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