PRESENTED BY

Kary Environmental Services Inc

N. Weiss Associates Inc

White Mountain Apache Housing

Exposures To Methamphetamine For

Housing Employees

PRESENTED BY

George Schweidereick

Project Manager

Kary Environmental Services Inc

Office: (480) 945-0009

Cell: (480) 330-6587

Email: georges@karyenvironmental.com

The Affects of Methamphetamine

Acute versus Chronic Exposure

Mission Statement

Kary Environmental Services Inc.’s (KES) Drug Remediation Team’s mission is to protect life, health, property, and the environment by isolating, containing, and mitigating toxins; performing remedial activities and minimizing the dangers associated with them. Utilizing our over 37 years of experience, KES provides a core team for our clients that helps develop, train, and implement policies and procedures proven to combat the drug related issues facing our Tribal Nations.

Who Is Kary Environmental Services? Kary Environmental services, Inc. is a licensed environmental contractor that is certified to perform pre testing, remediation and reporting required by law. We can complete the decontamination of the structure containing and impacted by the manufacturing or use of illicit drugs. As a State certified decontamination contractor, KES uses safe and innovative techniques to assess and remediate properties at an affordable cost.

Drug labs or more commonly, drug use homes, are found everywhere – homes, apartments, trailers, storage facilities, hotel/motel rooms, restaurants, vehicles. The chemicals and by-products used in the manufacturing and drug use will contaminate the structure, contents, carpets, drywall, HVAC system, and septic systems. KES performs drug impacted clean ups with a high regard for safety and the environment and follows all State and local guidelines to perform assessments and/or decontamination of structures.

Kary Environmental Services Inc.’s inherent understanding of the dire need for Tribal entities to create and adopt Policies and Procedures that not only address the drug epidemic facing our Tribal communities but enforce and eliminate the hazards associated with them. KES’s proven track record helps us to quickly navigate the Tribal Laws and Policies to assist in developing a set of Policies and Procedures regarding drug awareness and remediation specific to your Tribal Nation. KES’s partnership shall reduce the liabilities for Tribal Housing Authorities by providing defensible analytical and reports for every sampling and remediation occurrence.

KES’s Proven Track Record

Kary Environmental Services, Inc. has successfully partnered for assessing and remediating illicit drug use homes within Tribal Communities. KES brings our over thirty-seven years of experience in the environmental industry. Our strong background and experience in Assessments, Remediation, Environmental, Health and Safety Training, Hazardous and Non-Hazardous Waste Management, and our expertise on the Testing and Remediation of Methamphetamine impacted structures and properties have been pivotal for the program. Over the course of the last 15 years KES and Tribal Communities have established and implemented Policies and Procedures for the assessment and remediation of methamphetamine. We have assisted in creating Community Outreach programs to better educate the community members on the health risks associated with illicit drug use. We have established training programs for Tribal personnel who partake in the assessment and remedial activities.

KES’s Contracts• State of Arizona (ADEQ) - HAZMAT ER/ROUTINE• State of Arizona (ADEQ) - Asbestos Abatement• State of Arizona (ADEQ) - Air Quality Specialized Technical Srv.• State of Arizona (ADEQ) - Clandestine Lab and Meth Impacted Cleanup• Maricopa County - HAZMAT ER/ROUTINE• Maricopa County - Asbestos Lead Abatement• Maricopa County - Safety Training• Maricopa County - Laboratory Service thru ESC• Mohave Cooperative - HAZMAT Routine T&D• Town of Prescott - HHW• Town of Gilbert - HAZMAT and HHW Support• City of Mesa - HAZMAT ER/ROUTINE• City of Mesa - Asbestos / Lead Abatement• City of Mesa - HHW Support Contract• City of Phoenix - Decontamination Contract PD• City of Phoenix- Confined Space Rescue Standby• City of Phoenix- Decontamination Contract FD• City of Phoenix- HAZMAT ER/Routine/HHW• City of Chandler - HAZMAT / ER• City of Tempe - HAZMAT / ER / HHW• City of Tempe - Trade Services - Mold• City of Tempe - Asbestos and Mold Abatement

KES’s Contracts (cont’d)

• ASU - Environmental Services Asbestos Abatement Contractor• City of Scottsdale - HAZMAT and Bio• City of Scottsdale - HHW Curbside and Stationary Event• City of Goodyear - HAZMAT with PD• City of Yuma - Emergency Environmental Services• Tempe Union HSD - HAZMAT ER / Routine/ minor asbestos• City of Glendale - Curbside HHW 2016• City of Glendale - Emergency Response – Facilities Statewide• City of Peoria - Curbside HHW • City of El Mirage - Curbside HHW • City of Surprise - PO for ER and Services• United Parcel Service - Emergency Response – Facilities Statewide• ADEMA - ER / Routine Response• Inter Tribal Council of Arizona – HHW Event and Training• Western Area Power - Liberty Substation Cleaning• White Mountain Apache Tribe – UST Remediation• White Mountain Apache Tribe – Soil Sampling and Characterization• White Mountain Apache Tribe – Housing Authority Brownsfield Clean-Up Grant• White Mountain Apache Tribe – Housing Authority Meth Remediation• San Carlos Apache Tribe – Meth Remediation• San Carlos Apache Tribe – HHW

THE POTENTIAL HEALTH EFFECTS DEPEND ON THE SPECIFIC CHEMICALS TO WHICH A PERSON IS EXPOSED, HOW MUCH OF EACH CHEMICAL TO WHICH A PERSON IS EXPOSED, HOW LONG A PERSON IS EXPOSED, AND THE HEALTH CONDITION OF THE PERSON BEING EXPOSED.

EXPOSURE TO METH RESIDUES MAY CAUSE SYMPTOMS SIMILAR TO THOSE EXPERIENCED BY METH USERS. EXPOSURE TO VOCS MAY CAUSE SYMPTOMS SUCH AS NOSE AND THROAT IRRITATION, HEADACHES, DIZZINESS, NAUSEA, VOMITING, CONFUSION AND BREATHING DIFFICULTIES.

SOME VOCS MAY CAUSE CANCER. ACIDS OR BASES WILL CAUSE A BURNING SENSATION ON THE SKIN AND IN MUCOUS MEMBRANES, AND CAN CAUSE SEVERE EYE DAMAGE. EXPOSURE TO METALS AND SALTS CAN CAUSE A WIDE RANGE OF HEALTH EFFECTS INCLUDING RESPIRATORY IRRITATION, DECREASED MENTAL FUNCTION, ANEMIA, KIDNEY DAMAGE AND BIRTH DEFECTS. METALS SUCH AS LEAD AND MERCURY ARE PARTICULARLY HAZARDOUS.

What are the Potential Health Effects of Exposure to

Chemicals in Meth Use and Manufacturing?

Studies have shown when 40 mg of smoked

methamphetamine is ingested:

67-90% of the meth smoked is taken into the body

That means: 26-36mg of the meth is inhaled.

What happens to the 4-14 mg of meth that is exhaled?

Meth residues are displaced throughout the area.

Residue from the smoke has been found in multiple

studies to uniformly go throughout the living space.

Typical cleanup standards seen throughout the United

States range between 1.5 and 0.05, the most common

cleanup standard utilized is 0.01 mg/100cm.

What happens when Meth is vaporized and ingested?

Exposure

Smoking meth releases a mist of meth-laden, chemical droplets/particulates.Like cigarette smoke, leaves a meth residue coating surfaces, in porous materials, and in forced-air heating/cooling (HVAC) systems.

Possible Exposure Pathways from Meth Use Residue: - Inhalation- Dermal/Trans-Dermal (skin absorption)- Ingestion through hand to mouth contamination particularly applicable to young children

At Risk Populations to Meth Use Residue: - Law Enforcement and other First Responders- Maintenance Crews - Counselors- Children- Individuals with certain medical conditions- Pregnant women- Seniors

*Young children are a high risk population because they spend approximately 80%-90% of their time indoors. Infants and young children have greater exposure to air pollutants because they are rapidly growing. Children also have a higher rate of oxygen consumption per unit body weight and narrower airways than adults.

Acute Effects: Meth is irritating to skin, eyes, mucous membranes, and the upper respiratory tract. Eye contact may cause pupil dilation and retraction of the upper lid. Acute intoxication can cause dizziness, headache, dry mouth, a metallic taste, anorexia, insomnia, tremor, rash, chest pain, difficulty breathing, fainting, blurred vision, dilated pupils, impotence, bluish skin color, lung congestion, convulsions, and coma. Overdose may cause exaggeration of reflexes, rapid breathing, confusion, panic states, aggressiveness, hallucinations, brain oxygen loss, elevated body temperature, skeletal muscle wasting, fatigue, depression, acute paranoia, and a schizophrenic-like state. Other effects include nausea, vomiting, diarrhea, cramps, irregular heartbeat, high or low blood pressure, and circulatory collapse.

Chronic Effects: Long-term exposure may cause severe skin conditions, insomnia, irritability, poor concentration, hyperactivity, personality changes, weight loss, teeth grinding and tooth loss, ulcers of the lips and tongue, physical and psychological dependence, anxiety, fear, compulsive behavior, delirium, disorientation, hallucinations, or a psychotic schizophrenic-like condition with possible self-injury.

Meth Exposure in Children

• Young mobile children are at home for long hours, down on the floor exploring the environment, and putting everything in their mouths!

• Developing brain and organs may be more susceptible to damage.

• Children’s bodies are less able to process and eliminate chemicals.

• Children can develop acute or chronic diseases as well—such as cancer and organ damage. (eg. Leukemia, kidney or liver failure).

Meth Exposure in Children (cont’d)

How do children even get meth in their systems?

• 80-97% of total exposure for a child results from dermal contact with “soft” surfaces such as carpet and hard surfaces such as linoleum.

• Ingestion (hand-to-mouth activity), accounts for just 3% of total exposure.

• The efficiency of dermal absorption of methamphetamine is 57%.

Acute vs Chronic Effects in Children

Acute Effects Among Children• Altered mental state

– Agitation

– Hallucinations

– Confusion

• Tachycardia

• Hypertension

• Vomiting

• Uncontrolled Crying

• Seizures

• Rapid Eye Movements

Acute vs Chronic Effects in Children

Chronic Effects Among Children

These can be from lack of appropriate stimulation/ interaction and toxic insult to specific areas of the brain.

• Physical

– Failure to Thrive/ Poor Growth

• Developmental Delays

– Speech delays

– Sensory integration issues

– Cognitive Delays (learning issues)

• Behavioral problems

– Tantrums/ aggression

– Attention problems (ADHD)

– Social Maladjustment

Pregnancy and Meth Use• Methamphetamine can cross the placental walls as well

as the blood-brain barrier.

• Babies exposed to meth before they are born have a higher risk of:• Congenital defects such as cleft palate and limb defects• Learning disabilities• Preterm birth• Behavioral problems• Physical delays

Children exposed to meth are also at risk for inadvertent poisoning, trauma, neglect, abuse, and adverse psychological effects.

https://www.ncbi.nlm.nih.gov/pubmed/17990840

Recently in a presentation with a Community’s Indian Health Services showed an estimate of approximately 15-20% of babies born in 2019 within their Tribe have been exposed to meth.

That is about 1 in 6 babies born within this Community.

Quiz Time

NAME THE TOXIN??

Preventing Exposures

Steps for prevention fall into two main categories:

(1) Creation and implementation of appropriate controls into housing policies.

(2) Education and training.

Both are important to help protect first responders from exposure to hazardous agents and for first response work to be performed in a manner that minimizes the potential for health effects from illicit drug exposure.

A police officer (Officer 1) performed a traffic stop and vehicle search. Officer 1 found materials consistent with illicit drugs, including the contents of an unlabeled rubber container. When Officer 1 opened the rubber container outside of the vehicle, a gust of wind blew powder from inside the rubber container onto Officer 1, who reported that the powder was “all over me and my uniform.” Officer 1 was wearing a short‐sleeved uniform and no gloves. Officer 1 attempted to brush the powder off and used hand sanitizer to clean the hands and arms.

Within 5 minutes of opening the container, Officer 1 became disoriented and lightheaded, and had “blurry vision.” A second officer called for an ambulance, which arrived approximately 10 minutes after symptom onset.

How could this entire incident been avoided?

At the point of finding the unknown and unlabeled container, a Safety Program should have triggered a protocol for the officer.

The officer should have donned proper PPE which should be outlined in a Safety Program such as nitrile gloves, long sleeves, safety glasses, and a respirator.

Once the powder was upon the officer’s uniform the officer should have been properly trained to prevent cross contamination.

Properly established protocols would have trained the officer to uses soap and water only to wash the arm. Utilizing hand sanitizer only elevated the exposure. Hand sanitizer will open your pores and expedite the dermal absorption rate.

Once the officer began to show an adverse reaction, Officer 2 should have administered Narcan while awaiting the ambulance. Again, with proper and sufficient training, the actions would have taken place.

Emergency medical service (EMS) providers assisted with decontamination by washing Officer 1’s exposed skin with water. EMS providers noted that Officer 1 was alert and had elevated blood pressure, heart rate, and respiratory rate upon their arrival. EMS providers noted that Officer 1’s pupils were 4 mm (normal range is 2–4mm in diameter depending on ambient light) and reactive. During transport to the emergency department, Officer 1 noted intermittent symptoms of “trouble thinking and staying awake.” Officer 1 reported “mild blurry vision” in the emergency department, which resolved after several hours.

Physical examination in the emergency department noted that Officer 1 was alert and there were “no constricted pupils.” No laboratory tests were done on Officer 1. Symptoms resolved and the emergency department physician’s discharge assessment was “chemical exposure.”

The forensic laboratory identified fentanyl and methamphetamine in the powder remaining in the rubber container.

Policies and ProceduresKES recommends a Tribal wide creation of a new, or amending of current policies, targeting the following goals should be met:

• Creation of bylaws to eradicate illicit drug activity while protecting occupants and common property.

• Limiting liabilities for the governing body.

• Defensible standards for the assessment and remediation of illicit drug use and/or manufacturing within a residence.

• Community outreach, education, and recovery programs.

• Creation of or amending of a Safety Program that properly trains employees to limit their exposures to meth and other illicit drugs.

• Create protocols to be followed in the event an exposure to illicit drugs to prevent further exposure and/or death.

• TRAIN, TRAIN, TRAIN – conduct regular safety meetings.