Overall, 3.6% (n=2,373) of the total HSEES events (n=66,588) reported from 2001 to 2008 were meth related (). The highest percentage of meth lab events were reported in 2003 (n=524 events, 5.8% of all 2003 HSEES events) and 2004 (n=442 events, 5.7% of all 2004 HSEES events). The percentage of reported meth events decreased in 2005, when states began applying sales restrictions on ephedrine products. The percentage further decreased in 2006, the year the Federal Combat Methamphetamine Epidemic Act became effective nationwide.10
All HSEES events and clandestine meth lab events, by year: ATSDR HSEES database, 2001–2008
The majority of events (n=2,102, 88.6%) occurred at fixed facilities (e.g., hotels, apartments, or sheds) (). The remainder of the events (n=271, 11.4%) were related to transportation (e.g., mobile labs in cars or motor homes, or meth lab chemicals being transported). It is difficult to assign a meaning to the changing percentages over time, because the number of participating states varied from 11 to 18 during this period.
Proportion of fixed-facility and transportation-related methamphetamine lab events, by year: ATSDR HSEES database, 2001–2008
More than 85.6% (n=2,032) of illegal clandestine meth lab events occurred within one-fourth of a mile of a residence. The general land use immediately surrounding an event recorded in the HSEES system can be characterized by as many as two descriptors. The general land use immediately surrounding the reported meth lab locations was identified as residential in 68.3% of events (n=1,621), commercial in 28.9% of events (n=686), agricultural or undeveloped in 28.5% of events (n=676), industrial in 2.7% of events (n=64), recreational in 1.0% of events (n=24), and other in 2.7% of events (n=64). The total (n=3,135) is greater than the total number of events because more than one area could be reported per event. Meth labs have been most commonly found in residential areas, with an upward and progressive trend in the percentage of events in these areas from 2001 to 2008 (). In recent years, a decreasing percentage of meth labs have been discovered in agricultural or undeveloped areas and in commercial areas. Because residential areas can have higher population densities, and chemicals in meth labs can volatilize, explode, or catch fire, people in homes near the vicinity of a meth lab are potentially at risk.
Proportion of methamphetamine lab events by type of area in the vicinity of the event, by year: ATSDR HSEES database, 2001–2008
Meth lab events required evacuations more than twice as often as all HSEES events during the 2001–2008 surveillance period (14.5% [n=343] of meth lab events compared with 6.5% [n=4,339] of all HSEES events). In the HSEES data, the highest percentage of evacuations was ordered in response to meth events in 2008 (30.5%, n=32), and the lowest in 2005 (8.3%, n=25), but the actual number of events with an evacuation was relatively stable. The 2001–2008 clandestine meth lab events resulted in the evacuation of 3,596 people. The greatest number of people (n=1,210) evacuated was in 2004, which had the second-highest number of events (n=442). The lowest number of people (n=108) evacuated was in 2008, which had 105 events, the second-lowest number reported.
Analysis of all HSEES events, 2001–2008, showed that 9.0% of the events resulted in reported victims. Analysis of all meth events during the same interval showed that nearly one-fourth (22.8%, n=541, range from 37.0% in 2001 to 10.6% in 2006) resulted in victims. Victims were defined as people who suffered at least one adverse health effect or who died in association with the clandestine drug lab chemical incident. Of the 16,474 HSEES event victims reported from 2001 to 2008, 902 (5.5%) were related to clandestine meth lab events.
Most often, the victims were treated at the scene by emergency medical personnel (6.8%, n=61) or they were observed and reported by an official even though the victim did not seek medical treatment (42.9%, n=387). The percentage of all victims in the HSEES database who did not seek medical treatment when officials observed symptoms was 6.5%, which is significantly different (p=0.001) when compared with victims in meth events. In meth lab events, about one-third of victims (33.9%, n=306) were treated at the hospital and released; 10.8% of victims (n=97) were admitted to a hospital for further treatment; 2.3% of victims (n=21) received treatment from a private physician; and 2% of victims (n=18) died. Thirteen deaths occurred at the scene or upon arrival at the hospital, three deaths occurred after arrival at the hospital, and two deaths occurred at unknown times. When these data are compared with all victims recorded in the HSEES system, the more severe medical outcomes of being admitted to a hospital or dying are consistent: 11.2% of all victims were admitted to the hospital, and 2.5% of all victims died. The most frequently reported symptoms or health effects were respiratory irritation (53.8%), headache (34.0%), burns (15.4%), and eye irritation (10.5%) ().
Frequency of injury types reported by victims associated with methamphetamine lab events: ATSDR HSEES database, 2001–2008
Sixty-one percent (n=552) of victims were official responders to the incident, including police officers (55.1%, n=497), firefighters (5.9%, n=53), emergency medical services (EMS) personnel (0.2%, n=2), and unspecified responders (0.2%, n=2). One-third of victims (33.5%, n=302) were general public, and 5.1% (n=46) were employees.
The percentage of meth lab events with victims in the HSEES system consistently declined from 36.6% (n=110) in 2001 to 11.4% (n=12) in 2008, with no deaths reported in 2008. The percentage of police officers among victims decreased from 49.7% in 2001 to 35.3% in 2008, with a high of 70.9% in 2004 and a low of 24.2% in 2007 (). The percentage of firefighters and other official responders among victims declined slightly from 8.9% in 2001 to 5.9% in 2008, and peaked at 11.l% in 2005. During the same period, the percentage of general public among victims increased from 29.1% (n=52) to 47.1% (n=8), with a high of 72.3% (n=24) in 2007.
Proportion of responder and general-public victims associated with methamphetamine lab events, by year: ATSDR HSEES database, 2001–2008
HSEES Program states affected by the meth lab epidemic used their HSEES data to target public health interventions. The outreach activities included creating responder, public, and worker education and awareness; educating santitation workers and law -enforcement personnel about meth lab refuse dangers; and participating in state policy advisory groups. Examples of public health and legislative efforts to fight the meth lab epidemic in two states, Minnesota and New York, follow.
After observing emerging meth lab trends in the state from 1997 to 2000, the Minnesota HSEES Program conferred with HSEES programs in Iowa and Missouri. Data from these programs indicated that meth-related activity was moving north rapidly.12
Using HSEES data and non-HSEES data in support of action, the Minnesota Department of Health obtained state funds in 2001 for a Meth Lab Program (MLP). The priority focus of the MLP was on education related to public health and safety hazards. As the MLP endeavored to educate responders and the public on meth hazards, meth activity continued to increase, but the number of related victims, especially first responders, declined.
In January 2005, near the beginning of the legislative session, Meth Day at the Capitol was held at the Minnesota State Capitol. Many different groups, such as government agencies, law enforcement agencies, treatment providers, and community organizations, developed presentations, displays, posters, and videos aimed at informing Minnesota lawmakers and the general public about meth activity and the associated community hazards. In conjunction with data from other sources, HSEES data helped to show how meth activity had spread extensively in the state. The event assisted in further increasing public awareness of the issue. A bill that limited access to pseudoephedrine and ammonia was passed by the Minnesota Legislature, signed by Governor Pawlenty in May 2005, and enacted in July 2005.13
Data analyses showed that, after implementation of the meth lab laws in July 2005, the number of newly discovered meth labs declined almost threefold: from 95 in January–June 2005 to 33 in July–December 2005.
Clandestine drug labs, primarily meth labs, were first identified in New York State (NYS) in the 1980s and then virtually disappeared until 2001. As other states were already dealing with the problems of clandestine meth labs, NYS HSEES Program staff sought to learn from their experiences by conducting extensive research and contacting key personnel in those states. They learned that the response to clandestine meth labs needed to be multi-agency and that awareness training was needed by everyone who might respond to a clandestine meth lab. To address the immediate need and raise awareness about and recognition of clandestine meth labs and the associated hazards, NYS HSEES program staff helped facilitate awareness seminars that targeted all agencies and groups that could be involved in clandestine drug lab identification and response throughout NYS.
During development of the multi-agency presentations, law enforcement identified a need for an easy-to-read reference card. This need led to the development of a visor card with relevant technical (visual indicators of a lab, products commonly found, and potential hazards) and contact information that was distributed to all law enforcement personnel in NYS. To increase awareness among public health officials and decrease their chance of injury, NYS HSEES Program staff developed guidance in 2003 about the physical dangers of responding to odor complaints that may originate from a clandestine meth lab. This odor-guidance document was distributed to all county environmental health officials and to state environmental health staff in regional and district offices.
NYS HSEES Program staff made a presentation at the NYS Department of Health's Environmental Health Directors Fall Conference in 2003 and conducted a video-cast for state and local health department staff. NYS HSEES Program staff also participated in the preparation of a report that focused on the effectiveness of three chemical deterrents that could be added to agricultural anhydrous ammonia to prevent its subsequent use in the production of meth. NYS HSEES Program staff provided data and testimony to the New York State Commission of Investigations that wrote “Methamphetamine Use and Manufacture,” released in 2005.14
NYS HSEES Program staff also provided information to the New York City Attorney General's Office for the report, “New York State Law Enforcement Council—2005 Legislative Priorities.”15
Following release of the reports, a comprehensive bill to combat meth labs was drafted, passed, and enacted into law in 2005.16
This legislation restricted sales of pseudoephedrine and created and/or increased penalties for crimes associated with the clandestine manufacture of meth. After the law was passed in 2005, the number of identified clandestine meth labs in NYS decreased to fewer than 20 per year in 2007 and 2008.