WELCOME TO METHAMPHETAMINE USE AND MANUFACTURE: SAFETY ISSUES

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WELCOME TO METHAMPHETAMINE USE AND
MANUFACTURESAFETY ISSUES

• Randall Webber, M.P.H.
• Lighthouse Institute
• Chestnut Health Systems
• Bloomington, IL
• www.chestnut.org/li
• rwebber_at_chestnut.org

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 Risks associated with the manufacture
(cooking) of methamphetamine

• Explosion
• Fire
• Respiratory problems, up to and including
  permanent damage
• Chemical burns
• Contact with potentially violent
  chemist(s)/illegal subculture

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Risks associated with the manufacture (cooking)
of methamphetamine

• Stimulant psychosis associated with chemists use
  of methamphetamine

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SIGNS THAT METHAMPHETAMINE IS BEING MANUFACTURED
IN THE CLIENTS HOME

• Laboratory equipment
• Large quantity of pills containing ephedrine or
  pseudoephedrine (e.g., Tedral?, Primatene?/
  Sudafed?)
• Chemical odor (may be similar to ammonia or cat
  urine)

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SIGNS THAT METHAMPHETAMINE IS BEING MANUFACTURED
IN THE CLIENTS HOME

• Chemicals not commonly found in a home
• Red phosphorus - Acetone
• Liquid ephedrine - Ether
• Iodine
• P2P (phenyl-2-propanone)

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SIGNS THAT METHAMPHETAMINE IS BEING MANUFACTURED
IN THE CLIENTS HOME

• Unusually high quantities of household chemicals
• Lye
• Drano?
• Paint thinner

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SIGNS THAT METHAMPHETAMINE IS BEING MANUFACTURED
IN THE CLIENTS HOME

• Plastic or metal containers with punctures on the
  bottom or side
• Chemicals usually found on a farm (e.g.,
  anhydrous ammonia)
• Residue from cooking of methamphetamine

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Signs of client methamphetamine use

• Increased breathing and pulse rate
• Sweating
• Rapid/pressured speech
• Euphoria
• Hyperactivity
• Dry mouth
• Tremor (shaking hands)

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Signs of client methamphetamine use

• Dilated pupils
• Lack of appetite
• Insomnia/lack of sleep
• Bruxism (teeth-grinding)
• Depression (the crash-occurs when drug wears
  off)
• Irritability, suspiciousness, paranoia

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THE CRASH No PARACHUTE

• Severe depression
• Sadness
• Despair

• Anguish
• Anxiety
• Panic
• Suicidal ideation.

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Signs of client methamphetamine use

• Visual and auditory hallucinations
• Formication (coke bugs)
• Presence of white powder, straws, glass pipes or
  injection equipment
• Track marks other signs of intravenous drug use

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Tracks and Abscesses
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Tracks and Abscesses
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AMPHETAMINE PSYCHOSIS

• Onset appears as a result of acute intoxication.
  
• While psychosis may appear during the withdrawal
  period, it is not a true withdrawal sign.
• Generally associated with chronic, high dosage
  use.
• Can occur in snorters, but more likely to occur
  in IV users and smokers.

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AMPHETAMINE PSYCHOSIS

• Onset of methamphetamine psychosis can be from
  2-48 hours after the initial dose.

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AMPHETAMINE PSYCHOSIS SYMPTOMS

• Suspiciousness
• Irritability
• Delusions of persecution and/or grandeur
• Ideas of reference
• Visual, auditory and/or tactile hallucinations
  (latter formication)
• Hyperactivity

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AMPHETAMINE PSYCHOSIS SYMPTOMS

• Agitation
• Aggressiveness.
• Depression, sometimes severe, may also be
  present.
• Closely resembles paranoid schizophrenia.

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AMPHETAMINE PSYCHOSIS SYMPTOMS

• Differential diagnosis may be based on presence
  or lack of physical signs such as pupillary
  dilation, increased blood pressure, pulse, and
  rapid breathing rate, as well as sudden onset and
  remission

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AMPHETAMINE PSYCHOSIS

• Once an individual has suffered a CNS stimulant
  psychosis, s/he is more likely to experience the
  same outcome in the future.
• Psychotic symptoms generally disappear as
  abstinence continues, and rarely persist beyond
  24 hours after the cessation of drug use.

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AMPHETAMINE PSYCHOSIS

• If psychotic signs persist beyond 24-48 hours,
  additional psychiatric consultation is advised.

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AMPHETAMINE PSYCHOSIS PROGRESSION

• Irritability
• Hostility
• Suspicion
• Paranoia

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INDICATIONS OF POTENTIAL/IMPENDING
METHAMPHETAMINE-INDUCED CLIENT VIOLENCE

• Signs of methamphetamine use
• Client is extremely irritable and/or
  argumentative
• Escalation of client irritability, anger
• Regular client does not appear to know who you
  are

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INDICATIONS OF POTENTIAL/IMPENDING
METHAMPHETAMINE-INDUCED CLIENT VIOLENCE

• Evidence of client paranoid thinking, delusions
  (e.g., that mirrors are actually one-way windows)
• Client verbalizes implicit or explicit threat
• Presence of knife, firearm or other weapon in the
  immediate vicinity

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COMPONENTS OF A SAFETY PLAN

• Check with law enforcement if you believe the
  home/area you will be visiting is high risk for
  meth use/manufacture
• Inform supervisor/co-worker(s) that you will be
  visiting a client with a history of making/using
  methamphetamine
• If you feel unsure of your safety, leave
• Do not let client get between you and an exit

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COMPONENTS OF A SAFETY PLAN

• Do not argue with or antagonize client
• Do not avoid eye contact, but do not stare
• Do not position yourself in the clients
  peripheral vision area or where the client can
  not see you.
• Do not move suddenly

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COMPONENTS OF A SAFETY PLAN

• Do not speak quickly
• Tell the client what you are doing and why
• Ask permission if you want to go to another area
  of the clients dwelling or look in cabinets
  (e.g., to ensure food is in the house)

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COMPONENTS OF A SAFETY PLAN

• Watch for
• Symptoms of stimulant use
• Methamphetamine paraphernalia
• Signs that client is becoming upset, angry or
  suspicious
• Scratch marks or scabs, particularly on clients
  hands and arms (men) or face (women)

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COMPONENTS OF A SAFETY PLAN

• Watch for
• Evidence of hallucinations
• Responding or reacting to voices or visual
  stimuli that you can not hear/see
• Client has difficulty communicating because s/he
  is distracted by auditory hallucinations

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COMPONENTS OF A SAFETY PLAN

• Watch for
• Strong chemical odor (may indicate manufacturing
  of meth)
• Other indicators

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Getting Help

• Pre-dial 911 into your cell phone
• Yell FIRE! or 911!-More people will respond
• Stop traffic
• Make a scene
• Break a window