NEHA October 2023 Journal of Environmental Health

that their decontamination process worked (Kuhn, Walker, Whiley, et al., 2021). The environmental health profession should advocate for these processes to be conducted by independent businesses to ensure no con- flict of interest and resulting bias. The methods being used for testing by indus- try members are also problematic. Often there are no standardized methodologies and the presumptive test kits or lateral flow assays com- monly used have lower limits of detection than reported by manufacturers (Kuhn et al., 2023). This lack of standardization can unnecessarily increase stress and anxiety for homeowners or residents. Presumptive test kits should be used as a screening tool, not as the basis of a remedia- tion plan or decontamination validation. Envi- ronmental health professionals should be aware of this limitation and advise that quantitative testing should be conducted for any positive results from presumptive testing. There are also several uncertainties that must be considered when assessing the pub- lic health risks associated with managing

methamphetamine contamination. Future research is needed to inform best practices. For example, exposure time is one of the essential factors that can a ect the health outcome of the individual; thus, contamina- tion within residential properties is a main concern. People, especially young children, spend a significant portion of their time every day in the home (Wright et al., 2020). Resi- dues in public places, such as shops or public restrooms, are less of a concern due to the relatively short exposure time in that space. A syndrome name will both facilitate the col- lation of information and raise awareness of thirdhand methamphetamine exposure, which will support the e orts of the environ- mental health profession to regulate this pub- lic health threat and protect public health. Conclusion There are many gaps in knowledge currently regarding environmental contamination with methamphetamine from use and manufac- ture, as well as unknowns of adverse health

e ects associated with methamphetamines. Future research is needed to further charac- terize the symptoms and potential long-term consequences of thirdhand methamphet- amine exposure to human health. Our pro- posed syndrome definition and acronym of THEM syndrome will focus future research; provide a searchable keyword; and enable rel- evant studies to be more easily identified and tracked by medical professionals, research- ers, and government ocials. Acknowledgements: The authors thank Dr. David Everett for his input. The first author was funded by the Australian Government Research Training Program Scholarship; oth- erwise, there was no external funding for this article. Furthermore, the authors declare no conflict of interest. Corresponding Author: Emma J. Kuhn, Col- lege of Science and Engineering, Flinders University, Adelaide, SA, 5001, Australia. Email: emma.kuhn@flinders.edu.au.

References

Bade, R., Tscharke, B.J., Longo, M., Cooke, R., White, J.M., & Ger- ber, C. (2018). Investigating the correlation between wastewa- ter analysis and roadside drug testing in South Australia. Drug and Alcohol Dependence , 187 , 123–126. https://doi.org/10.1016/j. drugalcdep.2018.02.030 Bijlsma, L., Picó, Y., Andreu, V., Celma, A., Estévez-Danta, A., González-Mariño, I., Hernández, F., López de Alda, M., López- García, E., Marcé, R.M., Miró, M., Montes, R., Pérez de San Román-Landa, U., Pitarch, E., Pocurull, E., Postigo, C., Prieto, A., Rico, A., Rodil, R., . . . Quintana, J.B. (2021). The embodiment of wastewater data for the estimation of illicit drug consumption in Spain. Science of the Total Environment , 772 , Article 144794. https://doi.org/10.1016/j.scitotenv.2020.144794 Bitter, J.L. (2017). The persistence of illicit drug smoke residues and their recovery from common household surfaces. Drug Testing and Analysis , 9 (4), 603–612. https://doi.org/10.1002/dta.1993 Brill, F., & Raco, M. (2021). Putting the crisis to work: The real estate sector and London’s housing crisis. Political Geography , 89 , Article 102433. https://doi.org/10.1016/j.polgeo.2021.102433 Brurberg, K.G., Fønhus, M.S., Larun, L., Flottorp, S., & Malterud, K. (2014). Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): A systematic review. BMJ Open , 4 , e003973. https://doi.org/10.1136/bmjopen-2013-003973 Burge, P.S. (2004). Sick building syndrome. Occupational and Environmental Medicine , 61 , 185–190. https://doi.org/10.1136/ oem.2003.008813

Buzby, D., Mohr, A.L.A., Logan, B.K., & Lothridge, K.L. (2021). Evaluation of on-site oral fluid drug screening technology (Report No. DOT HS 812 859). U.S. Department of Transportation, National Highway Trac Safety Administration. https://doi. org/10.21949/1525998 Calvo, F., Karras, B.T., Phillips, R., Kimball, A.M., & Wolf, F. (2003). Diagnoses, syndromes, and diseases: A knowledge representa- tion problem. AMIA Annual Symposium Proceedings. AMIA Sym- posium , 802. Castaneto, M.S., Barnes, A.J., Scheidweiler, K.B., Scha er, M., Rog- ers, K.K., Stewart, D., & Huestis, M.A. (2013). Identifying meth- amphetamine exposure in children. Therapeutic Drug Monitoring , 35 (6), 823–830. https://doi.org/10.1097/FTD.0b013e31829685b2 Cherney, A., O’Reilly, J., & Grabosky, P. (2006). Networks and meta-regulation: Strategies aimed at governing illicit syn- thetic drugs. Policing and Society , 16 (4), 370–385. https://doi. org/10.1080/10439460600973693 Chey, W.D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: A clinical review. JAMA , 313 (9), 949–958. https://doi. org/10.1001/jama.2015.0954 Chiu, V.M., & Schenk, J.O. (2012). Mechanism of action of metham- phetamine within the catecholamine and serotonin areas of the central nervous system. Current Drug Abuse Reviews , 5 (3), 227– 242. https://doi.org/10.2174/1874473711205030227

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October 2023 • Journal of Environmental Health