NEHA October 2023 Journal of Environmental Health

Given that research is limited, for the pur- pose of characterizing symptoms associated with thirdhand exposure, both the manufac- ture and smoking of methamphetamine have been included in Table 1. We recognize there could be other symptoms not mentioned; therefore, this list should not be considered comprehensive (Flannery et al., 2006; Mat- teucci et al., 2007; Smith et al., 2015). Dose-Response Relationship The term dose-response refers to a concen- tration or dose of a toxin that will cause an e ect of a particular measurable response (endpoint) in the subject of a particular mea- surable response (endpoint). Dose-response curves generally assume a sigmoidal shape with increasing doses resulting in increasing e ects (Vallero, 2010). There are di”culties in applying this model to methamphetamines. The first issue is the lack of data about expo- sure and e ect (or symptoms), and the sec- ond issue is the nonspecific nature of the symptoms. Both of these impediments will be addressed to a degree by naming the syn- drome and facilitating information collation. When establishing guidelines to protect public health, observational research stud- ies are used to identify the no-observed- adverse-e ect level (NOAEL) and/or the low- est-observed-adverse-e ect limit (LOAEL). While it is important to include both quan- titative and qualitative results, it can be chal- lenging to determine an exact threshold due to variation among individuals (Eaton & Gil- bert, 2008; Ochoa, 2018). The vulnerability of the population that might be exposed is considered in the use of uncertainty factors, which are applied to the threshold (NOAEL or LOAEL). Establishing an LOAEL from observational studies has been identified by a number of researchers; however, the pub- lished research available is limited (Fahmi et al., 2010; Mayer & Miskelly, 2022; Thrasher et al., 2009; Wright et al., 2020). Hair samples have long been used as evi- dence in courts of law for cases involving illicit substances; this technique provides valuable information about the time frame and levels of methamphetamine a person has been exposed to (Kintz, 2017). Recent research has shown that environmental contamination from illicit drugs can be established through hair analysis (Kintz et al., 2020, 2021). In general, increas- ing concentrations have been found in hair

TABLE 1

Summary of Symptoms Experienced by Residents After Thirdhand Exposure to a Methamphetamine-Contaminated Property and by Residents Living in a Former Clandestine Laboratory

Symptom

Individuals Reporting Symptoms (% of Total Individuals)

Children and Adolescents ( n = 29) (<21 years) # (%)

Adults ( n = 34) (>21 years) # (%)

Adults ( n = 27) (Residing in a Former Clandestine Laboratory) # (%)

Behavioral and cognitive issues

23 (79) 21 (72) 18 (62) 16 (55) 16 (55) 16 (55)

22 (65) 23 (68) 18 (53) 19 (56) 20 (59) 20 (59)

2 (8) *

Sleeping difficulty Respiratory issues

11 (39)

Skin problems Eye problems

2 (7)

Nausea or vomiting

5 (19)

* Dizziness was the reported symptom but could also be categorized as a cognitive issue. Source: Thrasher et al., 2009; Wright et al., 2020.

research has demonstrated that newly intro- duced furniture can also absorb existing meth- amphetamine contamination from within a property (Wright et al., 2019). Thus, residents might move into a property and be unwit- tingly exposed to methamphetamine residues that have resulted from prior manufacture or smoking; this transfer is considered thirdhand exposure. Thirdhand exposure can cause sig- nificant—but poorly defined—adverse health e ects (Wright et al., 2020). There is limited research on the extent of these health impacts; however, the research available currently has identified a range of symptoms associated with exposure. We consider that there needs to be a collective term to describe the symptoms of thirdhand exposure to methamphetamine. We propose “thirdhand exposure to methamphetamine (THEM) syndrome” as a collective term to describe the various nonspecific symptoms that are related to methamphetamine expo- sure. This term will enable better tracking and collation of future research, which will inform best practices in regulation and in understanding these adverse health e ects. Thirdhand Exposure Symptoms Wright et al. (2020) analyzed 63 individuals who had previously resided in a methamphet-

amine-contaminated property. The symptoms and housing situations were documented and characterized for the 25 case studies. The individuals consented to hair analysis and permitted the property to be tested for meth- amphetamine. None of the participants were using or manufacturing methamphetamine themselves. The adverse health e ects varied from short-term to chronic symptoms, and the time spent and/or lived at the property ranged from a few days to 10 years (Wright et al., 2020). Participants self-reported symp- toms that were verified by health profession- als, such as the family general practitioner or school nurse (Wright et al., 2020). For indi- viduals <21 years and for adults, behavioral and cognitive issues (79% and 65%, respec- tively) and sleeping di”culties (72% and 68%, respectively) were the most prevalent adverse health e ects recorded (Table 1). Thrasher et al. (2009) published the ad- verse health e ects experienced by people exposed to methamphetamine laboratories (i.e., where the cooking process of making methamphetamine had taken place), which included residents living in former clan- destine laboratories. The six most reported symptoms from adult residents in this study were headaches, respiratory issues, nausea, cough, eye problems, and dizziness.

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October 2023 • Journal of Environmental Health

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