Clandestine Lab FAQs (6)
All symptomatic persons, both children and adults, should be evaluated by medical personnel immediately upon decontamination. Victims in sites with fire, explosion or chemical exposures should be evaluated immediately. Asymptomatic adults may not require additional medical intervention. It is recommended that all children removed from clandestine labs be evaluated by a practitioner qualified to perform a complete pediatric evaluation within 24 to 72 hours of removal from the lab, if feasible.
There is no single, well-defined expected presentation for a child with a history of potential chemical exposure in a methamphetamine laboratory. Recent exposure to methamphetamine itself will likely cause a picture of sympathetic excess (tachycardia, hypertension, hyperthermia, and irritability/agitation). A child with a more distant serious exposure to methamphetamine may present with CNS depression, neurological deficit or coma due to catecholamine depletion. It is important, however, not to focus only on the toxicity of the finished drug product. In point of fact, there are an untold number of potentially harmful chemicals with which a child could come in contact in a clandestine laboratory. The most common complaints are irritation of the eyes, skin, mucous membranes, gastrointestinal (nausea and vomiting), and headache. Evidence of irritation such as caustic burns, redness, swelling, etc. may or may not be apparent. Respiratory compromise, ranging from wheezing due to irritation to pneumonitis from aspiration of hydrocarbon solvents to respiratory arrest from inhalation of gases such as phosphine or cyanide, is possible in a clandestine laboratory. Finally, the child should be evaluated for signs or symptoms of abuse, neglect and nutritional deficit and, if present, further evaluation as deemed necessary should be completed.
Pre-hospital care providers (EMT’s or paramedics) should evaluate all children removed from a clandestine laboratory immediately to determine if they are truly asymptomatic. A truly asymptomatic child will likely not require immediate evaluation in the ED, but should see a primary care provider within 24 to 72 hours of removal, if feasible, from the laboratory for a complete assessment of health and developmental status. All symptomatic children and children not evaluated on scene by emergency medical personnel who are removed from a clandestine laboratory should be evaluated in the closest appropriate hospital ED. All children should receive continuing care in a medical home within 1 month.
All symptomatic children should be managed supportively as there is no specific antidote for an unknown chemical exposure. Usual clinical laboratory assessments should be made in order to manage such a child. With appropriate clinical and historic situations, additional analyses such as carboxyhemoglobin or whole blood lead may be indicated.
It is important to understand that it seems highly unlikely a truly asymptomatic child will become ill at a later time as a result of a toxic exposure in a clandestine laboratory. However, since there are no closely controlled studies proving this each child must be closely examined for the presence of symptoms. There are two levels of clinical laboratory assessment in an asymptomatic child removed from a clandestine laboratory. These include (1), acute exposure assessment and (2) general assessment of health and developmental status, primarily secondary to the high probability of neglect. With respect to the acute exposure issue, some jurisdictions request urine drug testing be performed on children removed from clandestine laboratories in order to assist in prosecution of the case. The topic of urine drug screens is addressed in greater detail in the next question. Current clinical laboratory test recommendations for the general assessment of health and developmental status include a CBC and a chemistry panel, which has electrolytes, liver function tests, kidney function tests and total protein and albumin.
The window of collection for the urine sample for a drug screen should be as short as possible after exposure within 8 to 12 hours of removal. Cases exist in which children in clandestine labs have been exposed either deliberately or inadvertently to drugs and medications other than methamphetamine. A urine drug of abuse screen detects some classes of commonly abused drugs. However, many harmful chemicals with which a child may come in contact in a clandestine lab will not be detected by such a screening tool. Urine drug screening may be performed at the discretion of the treating medical providers who understand its strengths and limitations. However, in cases of unresolving tachycardia or signs of sympathetic excess of unclear etiology, a drug screen might be useful. In completely asymptomatic children, a urine drug screen may be beneficial for prosecutorial efforts. Given the fact that some studies have shown greater that 50% of these children test positive for methamphetamine, the current recommendation is for urine drug screening to be performed. False positive results for amphetamines on screening tests are common and any positive screening result should be confirmed prior to legal action being initiated. Medical care should not be delayed while waiting for confirmation of screening results as confirmatory testing may take several days.
It should be emphasized, however, that all children should be considered exposed to methamphetamine or other drugs of abuse if found in a clandestine laboratory regardless of the urine drug screen results. All urine drug screens must be followed by confirmatory testing using GCMS. If performed, hair and skin-patch testing should be performed in consultation with a knowledgeable authority who understands the methodology strengths and limitations. Legal chain of custody procedures must be followed at all times for specimens obtained for drug testing.
General FAQs (1)
The Oklahoma Drug Endangered Children (OKDEC) is a statewide collaboration of individuals and entities dedicated to helping children endangered by substance abuse. Based in Oklahoma City, Oklahoma, we are proud to work alongside law enforcement, prosecutors, social services, medical personnel, treatment providers, prevention experts, probation and corrections, first responders, and many more. We believe that all of the professionals who have the opportunity to save a child from neglect and abuse should be trained to work collaboratively. With support from individuals, corporate partners, foundations, and governmental agencies, OK DEC provides training and technical assistance to enhance collaborations, develops and promotes best practices, and establishes child-centered approaches to help children caught up in the destructive cycle inherent in the abuse, manufacture, and distribution of illicit drugs.