Why the recent increase in cases? Why is this happening here and now?
I'm not sure it's really an increase in cases. I think what happened is someone found other evidence that methamphetamine was being used in these public spaces and restrooms.
I think that’s why you're hearing it now is because Boulder took some samples, and they found meth that put them in a difficult situation. There's no real guidance in terms of cleaning public spaces or risk levels for public spaces. All we have is residential guidance, which is really not appropriate for public spaces.
What is the residential guidance for exposure levels of methamphetamine contamination?
These regulatory thresholds were determined in the early 2000s and were really based on homes where you had clandestine methamphetamine laboratories. Researchers and public health officials were concerned about not only the meth contamination, but the contamination from all the other chemicals that you would have that would be used in making meth. Nowadays, the market and production of meth has changed – most meth in the U.S. is coming in from other places, and there’s not as much clandestine methamphetamine cooking that happens in homes.
When we set these regulations, they were set at levels well below those that would be expected to cause effects to a child – extrapolated to if that child was in that environment 24 hours a day, seven days a week, crawling on contaminated carpets for example.
Residential limits are relatively similar across most states. They range from roughly 0.5 micrograms per 100 square centimeters to 1.5 micrograms per 100 square centimeters. Frankly, that's not a huge difference.
Has anywhere else set different methamphetamine exposure standards for public spaces?
The only countries that have really thought about it in any sort of detail that I'm aware of are Australia and New Zealand.
Australia has a limit that is several times higher for public spaces than for residential spaces. It’s around 20 micrograms per 100 square centimeters for public spaces.
So there are levels of exposure and contamination? Regular smoking in a residential space – such as a hotel room – would be the next step down from a former lab?
Correct. We’ve done experiments simulating the smoking of methamphetamine in spaces, such as abandoned hotels. What we found when meth is smoked in an environment like that, most of the hotel room surfaces are going to be contaminated with meth. They are at much lower levels than you would see from a former cook space, but still contaminated.
In these cases, you still have to protect children especially from spaces like hotel rooms where meth was smoked. You don't know how long people are going to spend in these spaces, and there are people that live in hotels. So it ends up really not that different in terms of what you would do in terms of remediation compared to a former cook lab.
As far as contamination in these public restrooms then, is the impact of contamination more limited?
Yes. Most of what we're worried about in these situations is smoking, not other forms of meth consumption. Smoking creates that aerosol which coats all the surfaces around it with methamphetamine. I would not be worried about people injecting meth, taking pills or snorting it. Those methods are not going to contaminate a very large space.
The good thing is that the way bathrooms are constructed is, you have an exhaust ventilation system that goes directly outside. You're not distributing this methamphetamine aerosol throughout the facility, and the surfaces that are most highly contaminated are those surfaces that you're not going to touch. So from my perspective, this is a really, really low potential for any sort of health effects.
What is involved in cleaning and remediation with these contaminated spaces?
Colorado regulations define a very detailed type of cleaning that has to happen in these environments with methamphetamine. You have to not only clean it, but also verify it's clean after you're done with additional samples that are below the 0.5 micrograms per 100 square centimeters.
It is systematic and thorough: identify, clean, verify. That’s what the local health agencies are doing now.
How does meth contamination work on different surfaces during the cleaning and remediation process?
We did some studies where we looked at how long methamphetamine contamination lasts on surfaces, and I think what we found, as well as most others who have studied it, is that it lasts as long as your research study. Once it's on a surface, it lasts a long time – but slowly dissipates over time.
Additionally, what research has shown is that methamphetamine is really water soluble. So it's pretty easy to clean off non-porous surfaces with normal cleaning chemicals. Now, when you talk about drywall, painted surfaces, carpets, drapes and upholstery, that's a different story. But for the kinds of surfaces you would see in a bathroom, it's relatively easily decontaminated.
What are the symptoms people would experience if they encountered significant enough meth contamination to cause a reaction?
The most commonly reported symptom is respiratory irritation – especially for those with pre-existing lung disease, people with asthma. At higher levels of exposure, beyond what you would see in these public space cases, central nervous system symptoms may occur – like you were using meth. But again, that would only be at heavily contaminated homes or former meth labs, which are rare.
I think the thing that I saw that might concern me more than anything, and this is low risk as well, is some of these bathrooms have changing tables. Let's say you laid your baby on that changing table without any clothes on. You could get a significant portion of their skin contaminated with meth. I think that's the only realistic scenario that I see where you are at any risk of health effects. Because in these spaces: We go to the bathroom, we wash our hands before we leave, and we're only in there for a few minutes. The opportunity for exposure is just really low in these library cases.
Is the Colorado School of Public Health involved in any way with cleanup or monitoring or education in these cases or related cases?
Not at the moment. The Colorado School of Public Health, through its affiliate, National Jewish Health, was very involved in doing the formative research to identify these exposures and to really think about what levels were safe and how to clean these contaminated spaces up.
With the change in methamphetamine production and distribution over the last 10 years or so, that work has decreased at the Colorado School of Public Health. But I do know that the state is thinking about this and considering the question: Do we need new regulations specific for public spaces? If so, what does that need to be? And I don't have a crystal ball, but I'm relatively certain that we’re going to get a phone call about that. If that call does come, we'll be involved in some way.