https://www.sandiegohealthdirectory.com/kb en-us Methamphetamine is an addictive stimulant drug that strongly activates certain systems in the brain. Methamphetamine is chemically related to amphetamine, but the central nervous system effects of methamphetamine are greater. Both drugs have some limited therapeutic uses, primarily in the treatment of obesity. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=164 Wed, 02 Aug 2006 08:30:45 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=164
Methamphetamine is made in illegal laboratories and has a high potential for abuse and addiction. Street methamphetamine is referred to by many names, such as "speed," "meth," and "chalk." Methamphetamine hydrochloride, clear chunky crystals resembling ice, which can be inhaled by smoking, is referred to as "ice," "crystal," "glass," and "tina."

According to the 2003 NSDUH, 12.3 million Americans age 12 and older had tried methamphetamine at least once in their lifetimes - 5.2 percent of the population, with the majority of past-year users between 18 and 34 years of age. Significant decreases in past year use were seen among 12- to 17-year-olds.

Methamphetamine releases high levels of the neurotransmitter dopamine, which stimulates brain cells, enhancing mood and body movement. It also appears to have a neurotoxic effect, damaging brain cells that contain dopamine as well as serotonin, another neurotransmitter. Over time, methamphetamine appears to cause reduced levels of dopamine, which can result in symptoms like those of Parkinson’s disease, a severe movement disorder.

Methamphetamine is taken orally or snorting the powder, by intravenous injection, and by smoking. Immediately after smoking or intravenous injection, the methamphetamine user experiences an intense sensation, called a “rush” or “flash,” that lasts only a few minutes and is described as extremely pleasurable. Oral or intranasal use produces euphoria—a high, but not a rush. Users may become addicted quickly, and use it with increasing frequency and in increasing doses.

Animal research going back more than 20 years shows that high doses of methamphetamine damage neuron cell endings. Dopamine- and serotonin-containing neurons do not die after methamphetamine use, but their nerve endings or terminals are cut back, and regrowth appears to be limited.

Methamphetamine is a highly addictive central nervous system stimulant that can be injected, snorted, smoked, or ingested orally. Methamphetamine users feel a short yet intense rush when the drug is initially administered. The effects of methamphetamine include increased activity, decreased appetite, and a sense of well-being that can last from 20 minutes to 12 hours. The drug has limited medical uses for the treatment of narcolepsy, attention deficit disorders, and obesity.

Methamphetamine can easily be manufactured in clandestine laboratories using store bought materials and is the most prevalent synthetic drug manufactured in the United States. The ease of manufacturing methamphetamine and its highly addictive potential has caused the use of the drug to increase throughout the Nation. The methamphetamine problem was originally concentrated in the West but has spread throughout almost every major metropolitan area in the U.S. with the exception of the Northeast.

The effects of methamphetamine use can include addiction, psychotic behavior, and brain damage. Methamphetamine is highly addictive and users trying to abstain from use may suffer withdrawal symptoms that include depression, anxiety, fatigue, paranoia, aggression, and intense cravings for the drug. Chronic methamphetamine use can cause violent behavior, anxiety, confusion, and insomnia. Users can also exhibit psychotic behavior including auditory hallucinations, mood disturbances, delusions, and paranoia, possibly resulting in homicidal or suicidal thoughts. Use of methamphetamine can cause damage to the brain that is detectable months after the use of the drug. The damage to the brain caused by methamphetamine use is similar to damage caused by Alzheimer's disease, stroke, and epilepsy.

The central nervous system (CNS) actions that result from taking even small amounts of methamphetamine include increased wakefulness, increased physical activity, decreased appetite, increased respiration, hyperthermia, and euphoria. Other CNS effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Hyperthermia and convulsions can result in death.

Methamphetamine causes increased heart rate and blood pressure and can cause irreversible damage to blood vessels in the brain, producing strokes. Other effects of methamphetamine include respiratory problems, irregular heartbeat, and extreme anorexia. Its use can result in cardiovascular collapse and death.

Results reported at the most recent CEWG meetings indicate that methamphetamine abuse and production continue at high levels in Hawaii, west coast areas, and some southwestern areas of the United States—but methamphetamine abuse also is continuing to spread eastward.

The percentage of adult male arrestees testing methamphetamine-positive in 2003 was highest in Honolulu (40.3 percent), Phoenix (38.3) San Diego (36.2), and Los Angeles (28.7).

Several other items of significance were reported, as follows:
The numbers of clandestine methamphetamine laboratory incidents reported to the National Clandestine Laboratory Database decreased from 1999 to 2004. During this same period, methamphetamine lab incidents increased in Midwestern States (Illinois, Michigan, and Ohio), and in Pennsylvania. In 2004, more lab incidents were reported in Illinois (926) than in California (673). In 2003, methamphetamine lab incidents reached new highs in Georgia (250), Minnesota (309), and Texas (677). There were only seven methamphetamine lab incidents reported in Hawaii in 2004.

In the first 6 months of 2004, nearly 59 percent of substance abuse treatment admissions (excluding alcohol) in Hawaii were for primary methamphetamine abuse. San Diego followed, with nearly 51 percent. Notable increases in methamphetamine treatment admissions occurred in Atlanta (10.6 percent in the first 6 months of 2004, as compared with 2.5 percent in 2001) and Minneapolis/St. Paul (18.7 percent in the first 6 months of 2004, as compared with 10.6 percent in 2001).

Some MDMA (ecstasy) and cocaine users are switching to methamphetamine, ignorant of its severe toxicity.

In many gay clubs found throughout New York City and elsewhere, methamphetamine is often used in an injectable form, placing users and their partners at risk for transmission of HIV, hepatitis C, and other STDs.

Methamphetamine is a highly addictive central nervous system stimulant that can be injected, snorted, smoked, or ingested orally. Methamphetamine users feel a short yet intense "rush" when the drug is initially administered. The effects of methamphetamine include increased activity, decreased appetite, and a sense of well-being that can last from 20 minutes to 12 hours. The drug has limited medical uses for the treatment of narcolepsy, attention deficit disorders, and obesity.

Methamphetamine can easily be manufactured in clandestine laboratories using store bought materials and is the most prevalent synthetic drug manufactured in the United States. The ease of manufacturing methamphetamine and its highly addictive potential has caused the use of the drug to increase throughout the Nation. The methamphetamine problem was originally concentrated in the West but has spread throughout almost every major metropolitan area in the U.S. with the exception of the Northeast.

Decreased domestic methamphetamine production is reducing wholesale supplies of domestically produced methamphetamine. The decreased production is a result of law enforcement pressure, public awareness campaigns, and increased regulation of the sale and use of precursor and essential chemicals used in methamphetamine production. However, decreases in domestic methamphetamine production have been offset by increased production in Mexico.

Methamphetamine is easily produced in clandestine laboratories or meth labs using a variety of ingredients available in stores. The manufacturing of methamphetamine is called "cooking". Cooking a batch of meth can be very dangerous due to the fact that the chemicals used are volatile and the by-products are very toxic. Meth labs present a danger to the meth cook, the community surrounding the lab, and the law enforcement personnel who discover the lab.

The Hazardous Substances Emergency Events Surveillance (HSEES) system collects and analyzes data about the public health consequences (e.g., morbidity, mortality, and evacuations) of acute hazardous substance—release events. Of the 40,349 events reported to the HSEES system during January 1, 2000—June 30, 2004, a total of 1,791 (4%) were associated with illicit meth production. Meth events consistently had a higher percentage of persons with injuries than did nonmeth events. Of the 1,791 meth events, 558 (31%) resulted in a total of 947 injured persons.

The methamphetamine trafficking situation has significantly changed within the last decade in the United States. Outlaw motorcycle gangs and other independent laboratory operators were once the primary traffickers of methamphetamine in the United States. However, Mexico-based trafficking groups entered the illicit methamphetamine market in 1994 and now dominate the trade leaving motorcycle gangs with a small share of the market. Mexico based trafficking groups dominate the market for many reasons, including their ability to obtain large quantities of the chemicals needed to produce the drug, their access to established smuggling and distribution networks, and their control over "super labs" which are capable of producing in excess of 10 pounds of methamphetamine in one 24-hour production cycle.

Law enforcement reporting indicates that methamphetamine laboratories have been discovered on federal lands throughout the United States. Methamphetamine laboratories often are discovered in or near caves, cabins, recreational areas, abandoned mines, and private vehicles located on or adjacent to federal lands.

Increased restrictions on cold preparations and other medicines containing methamphetamine precursor chemicals in many states have contributed to sharp declines in the number of labs in those states. Additionally, restricted importation of bulk pseudoephedrine from Canada since January 2003 has resulted in significant declines in the number of domestic methamphetamine super labs.]]> Smokeless tobacco use can lead to nicotine addiction and dependence. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=122 Tue, 27 Jun 2006 07:54:08 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=122
Chewing tobacco and snuff contain 28 cancer-causing agents. The most harmful carcinogens in smokeless tobacco are the tobacco-specific nitrosamines (called TSNAs). They are formed during the growing, curing, fermenting, and aging of tobacco. TSNAs have been detected in some smokeless tobacco products at levels many times higher than levels of other types of nitrosamines that are allowed in foods, such as bacon and beer.

Other cancer-causing substances in smokeless tobacco include N-nitrosamino acids, volatile N-nitrosamines, benzo(a)pyrene, volatile aldehydes, formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene, and polonium-210.

All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The amount of nicotine absorbed from smokeless tobacco is 3 to 4 times the amount delivered by a cigarette. Nicotine is absorbed more slowly from smokeless tobacco than from cigarettes, but more nicotine per dose is absorbed from smokeless tobacco than from cigarettes. Also, the nicotine stays in the bloodstream for a longer time.

Smokeless tobacco users increase their risk for cancer of the oral cavity. Oral cancer can include cancer of the lip, tongue, cheeks, gums, and the floor and roof of the mouth.

People who use oral snuff for a long time have a much greater risk for cancer of the cheek and gum than people who do not use smokeless tobacco.

The possible increased risk for other types of cancer from smokeless tobacco is being studied.

Some of the other effects of smokeless tobacco use include addiction to nicotine, oral leukoplakia - white mouth lesions that can become cancerous, gum disease, and gum recession when the gum pulls away from the teeth. Possible increased risks for heart disease, diabetes, and reproductive problems are being studied.

In 1986, the Surgeon General concluded that the use of smokeless tobacco is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence. Since 1991, NCI has officially recommended that the public avoid and discontinue the use of all tobacco products, including smokeless tobacco. NCI also recognizes that nitrosamines, found in tobacco products, are not safe at any level. The accumulated scientific evidence does not support changing this position.

Because all tobacco use causes disease and addiction, NCI recommends that tobacco use be avoided and discontinued. Several non-tobacco methods have been shown to be effective for quitting cigarettes. These methods include pharmacotherapies such as nicotine replacement therapy and bupropion SR, individual and group counseling, and telephone quit lines.

In the United States, the 2000 National Household Survey on Drug Abuse, which was conducted by the Substance Abuse and Mental Health Services Administration, reported the following statistics:
1. An estimated 7.6 million Americans age 12 and older (3.4 percent) had used smokeless tobacco in the past month.
2. Smokeless tobacco use was most common among young adults ages 18 to 25.
3. Men were 10 times more likely than women to report using smokeless tobacco (6.5 percent of men age 12 and older compared with 0.5 percent of women).
4. People in many other countries and regions, including India, parts of Africa, and some Central Asian countries, have a long history of using smokeless tobacco products.

High-Risk Populations and Current Estimates: Smokeless tobacco use in the United States is higher among young white males; American Indians/Alaska Natives; people living in southern and north central states; and people who are employed in blue collar occupations, service/laborer jobs, or who are unemployed.

An estimated 7 percent of high school students are current smokeless tobacco users. Smokeless tobacco is more common among males (11 percent) than female high school students (2 percent). Estimates by race/ethnicity are 8 percent for white, 5 percent for Hispanic, and 3 percent for African American high school students.

An estimated 3 percent of middle school students are current smokeless tobacco users. Smokeless tobacco is more common among male (4 percent) than female (2 percent) middle school students. Estimates by race/ethnicity are 3 percent for white, 1 percent for Asian, 2 percent for African American, and 4 percent for Hispanic middle school students.

Nationally, an estimated 3 percent of adults are current smokeless tobacco users. Smokeless tobacco use is much higher among men (6 percent) than women (0.3 percent).

Adolescents who use smokeless tobacco are more likely to become cigarette smokers.

Smokeless tobacco use can lead to nicotine addiction and dependence.

Several national organizations provide information about the health risks of smokeless tobacco and how to quit:

The National Institute of Dental and Craniofacial Research's National Oral Health Information Clearinghouse offers educational booklets that discuss spit tobacco use in a colorful and graphic format. These booklets are designed specifically for young men who have decided to quit or are thinking about it. ]]> Now, as more and more children are found living at home-based labs, law enforcement, medical, and social services professionals are showing growing awareness of the enormous physical, developmental, emotional, and psychosocial damage these children may incur. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=116 Mon, 26 Jun 2006 06:58:17 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=116
Now, as more and more children are found living at home-based labs, law enforcement, medical, and social services professionals are showing growing awareness of the enormous physical, developmental, emotional, and psychosocial damage these children may incur.

Children who live at or visit these sites or are present during drug production face acute health and safety risks, including physical, emotional, and sexual abuse and medical neglect. The manufacture of methamphetamine may involve hazards such as fires and explosions. The age-related behaviors of young children such as frequent hand-to-mouth contact and physical contact with their environment increase the likelihood that they will inhale, absorb, or ingest toxic chemicals, drugs, or contaminated food. Their physiological characteristics for example higher metabolic and respiratory rates and a developing central nervous system, leave them particularly vulnerable to the effects of toxic chemical exposures. Exposure to drugs and alcohol before birth places infants at increased risk for neurological abnormalities and respiratory problems, which may be compounded by ongoing environmental exposures.

Personnel involved in laboratory seizures should include or have ready access to qualified professionals who can respond to the immediate and potential health needs of the children present at these sites. Actions should include taking children into protective custody, arranging for toxicologic urinalysis for methamphetamine and other drugs, conducting comprehensive medical and mental health assessments, and ensuring short- and long-term care and follow-up with a pediatrician.

Sites that produce methamphetamine may be called laboratories, but they bear little resemblance to legitimate pharmacologic laboratories. The Drug Enforcement Administration (DEA) defines a clandestine laboratory as “an illicit operation consisting of a sufficient combination of apparatus and chemicals that either has been or could be used in the manufacture or synthesis of controlled substances.” In a methamphetamine laboratory, the “cook” often handles ignitable, corrosive, reactive, and toxic chemicals in the presence of an open flame or heat source. Some of these substances are extremely harmful or lethal when inhaled or touched; others react violently when they are heated, immersed in water, exposed to air, or combined. Although clandestine labs use a number of manufacturing methods, all produce volatile chemicals and toxic vapors that present significant health and safety hazards to the meth cook, children, and others who enter the site, including law enforcement personnel and other members of the response team.

People in the surrounding community also may be at risk. The long-term effects of exposure to some of these substances have not been established. However, many of these chemicals are known to damage vital body organs or to cause cancer and other adverse health conditions.

Illegal meth laboratories can be set up wherever activities may be hidden from view, often in locations that are especially dangerous to children, such as sleeping areas, eating areas where food is also stored and prepared, and garages. These makeshift labs and their dangerous components for instance, chemical containers and electrical wiring have been discovered in vehicles of all types, hotel and motel rooms, storage lockers and units, mobile homes and surrounding areas, apartments, ranches, houses, campgrounds, rural and urban rental properties with absentee landlords, abandoned dumps, restrooms, houseboats, and other locations. Meth can be produced in as few as 6 to 8 hours using apparatus and cookware that can be dismantled rapidly and stored or relocated to avoid detection.

Meth production and trafficking were originally concentrated in the West and Southwest, particularly in California, Arizona, Utah, and Texas. Suppliers were outlaw motorcycle gangs and independent trafficking groups. Although California produces 85 percent of the Nation’s methamphetamine, the expansion of Mexico-based meth traffickers and independent U.S.-based laboratories has increased meth availability and abuse in the Pacific Northwest, Midwest, portions of the Southeast including Georgia, Tennessee, and the surrounding states, and, more recently, the Mid-Atlantic states and New England. Increasingly, local entrepreneurs are producing smaller amounts of meth in less complex laboratories using homemade or Internet recipes of dubious origin.

A child living at a clandestine methamphetamine laboratory is exposed to immediate dangers and to the ongoing effects of chemical contamination. In addition, the child may be subjected to fires and explosions, abuse and neglect, a hazardous lifestyle as well as the presence of firearms, social problems, and other risks.

The chemicals used to cook meth and the toxic compounds and byproducts resulting from its manufacture produce toxic fumes, vapors, and spills. A child living at a meth lab may inhale or swallow toxic substances or inhale the secondhand smoke of adults who are using meth; receive an injection or an accidental skin prick from discarded needles or other drug paraphernalia; absorb methamphetamine and other toxic substances through the skin following contact with contaminated surfaces, clothing, or food; or become ill after directly ingesting chemicals or an intermediate product. Exposure to low levels of some meth ingredients may produce headache, nausea, dizziness, and fatigue; exposure to high levels can produce shortness of breath, coughing, chest pain, dizziness, lack of coordination, eye and tissue irritation, chemical burns to the skin, eyes, mouth, and nose, and even death.

Corrosive substances may cause injury through inhalation or contact with the skin. Solvents can irritate the skin, mucous membranes, and respiratory tract and affect the central nervous system. Chronic exposure to the chemicals typically used in meth manufacture may cause cancer; damage the brain, liver, kidney, spleen, and immunologic system; and result in birth defects. Normal cleaning will not remove methamphetamine and some of the chemicals used to produce it. They may remain on eating and cooking utensils, floors, countertops, and absorbent materials. Toxic byproducts of meth manufacturing are often improperly disposed outdoors, endangering children and others who live, eat, play, or walk at or near the site.

Approximately 15 percent of meth labs are discovered as a result of a fire or explosion. Careless handling and overheating of highly volatile hazardous chemicals and waste and unsafe manufacturing methods cause solvents and other materials to burst into flames or explode. Improperly labeled and incompatible chemicals are often stored together, compounding the likelihood of fire and explosion. A single spark or cigarette ember can easily ignite highly combustible materials left on stovetops, near ignition sources, or on surfaces accessible to children. Hydro-generators used in illegal drug production constitute bombs waiting to be ignited by a careless act. Safety equipment is typically nonexistent or inadequate to protect a child.

Children living at methamphetamine laboratories are at increased risk for severe neglect and are more likely to be physically and sexually abused by members of their own family and known individuals at the site. Parents and caregivers who are meth dependent typically become careless, irritable, and violent, often losing their capacity to nurture their children. In these situations, the failure of parents to protect their children’s safety and to provide for essential food, dental and medical care including immunizations, proper hygiene, and grooming, and appropriate sleeping conditions is the norm. Older siblings in these homes often assume the role of caretaker. Some addicted parents fall into a deep sleep for days and cannot be awakened, further increasing the likelihood that their children will be exposed to toxic chemicals in their environment and to abusive acts committed by the other drug-using individuals who are present. Children living at meth lab sites may experience the added trauma of witnessing violence, being forced to participate in violence, caring for an incapacitated or injured parent or sibling, or watching the police arrest and remove a parent.

Hazardous living conditions and filth are common in meth lab homes. Explosives and booby traps together with trip wires, hidden sticks with nails or spikes, and light switches or electrical appliances wired to explosive devices have been found at some meth lab sites. Loaded guns and other weapons are usually present and often found in easy-to-reach locations. Code violations and substandard housing structures may also endanger children. They may be shocked or electrocuted by exposed wires or as a result of unsafe electrical equipment or practices. Poor ventilation, sometimes the result of windows sealed or covered with aluminum foil to prevent telltale odors from escaping, increases the possibility of combustion and the dangers of inhaling toxic fumes.

Meth homes also often lack heating, cooling, legally provided electricity, running water, or refrigeration. Living and play areas may be infested with rodents and insects, including cockroaches, fleas, ticks, and lice. Individuals responding to some lab sites have found hazardous waste products and rotten food on the ground, used needles and condoms strewn about, and dirty clothes, dishes, and garbage piled on floors and countertops. Toilets and bathtubs may be backed up or unusable, sometimes because the cook has dumped corrosive byproducts into the plumbing.

The inability of meth-dependent and meth-manufacturing parents to function as competent caregivers increases the likelihood that a child will be accidentally injured or will ingest drugs and poisonous substances. Baby bottles may be stored among toxic chemicals. Hazardous meth components may be stored in 2-liter soft drink bottles, fruit juice bottles, and pitchers in food preparation areas or the refrigerator. Ashtrays and drug paraphernalia such as razor blades, syringes, and pipes are often found scattered within a child’s reach, sometimes even in cribs. Infants are found with meth powder on their clothes, bare feet, and toys. The health hazards in meth homes from unhygienic conditions, needle sharing, and unprotected sexual activity may include hepatitis A and C, E. coli, syphilis, and HIV.

Children developing within the chaos, neglect, and violence of a clandestine methamphetamine laboratory environment experience stress and trauma that significantly affect their overall safety and health, including their behavioral, emotional, and cognitive functioning. They often exhibit low self-esteem, a sense of shame, and poor social skills. Consequences may include emotional and mental health problems, delinquency, teen pregnancy, school absenteeism and failure, isolation, and poor peer relations. Without effective intervention, many will imitate their parents and caretakers when they themselves become adults, engaging in criminal or violent behavior, inappropriate conduct, and alcohol and drug abuse.

Many children who live in drug homes exhibit an attachment disorder, which occurs when parents or caretakers fail to respond to an infant’s basic needs or do so unpredictably. These children typically do not cry or show emotion when separated from their parents. Symptoms of attachment disorder include the inability to trust, form relationships, and adapt. Attachment disorders place children at greater risk for later criminal behavior and substance abuse. To minimize long-term damage, children from these environments require mental health interventions and stable, nurturing caregivers.

Children Found in Meth Lab Homes: The living areas and physical condition of children found in two meth lab homes are described below.

a. The five children ranged in age from 1 to 7 years old. The one-bedroom home had no electricity or heat other than a gas stove with the oven door opened. Used hypodermic needles and dog feces littered areas of the residence where the children were found playing. Because there were no beds for the children, they slept with blankets underneath a small card table in the front room. The bathroom had sewage backed up in the tub, leaving no place for the children to bathe. A subsequent hospital exam revealed that all the children were infected with hepatitis C. The youngest was very ill. His liver was enlarged to the size of an adult’s. The children had needle marks on their feet, legs, hands, and arms from accidental contact with syringes.

b. At another lab site, a 2-year-old child was discovered during a lab seizure. Her parents both abused and manufactured methamphetamine. She was found with open, seeping sores around her eyes and on her forehead that resembled a severe burn. The condition was diagnosed as repeated, untreated cockroach bites.

Dangerous animals trained to protect illegal meth labs pose added physical hazards, and their feces contribute to the filth in areas where children play, sleep, and eat. Many children who live in meth homes also are exposed to pornographic materials or overt sexual activity. Others may actually be involved in the manufacturing process but receive no safety gear to protect them from noxious chemical fumes.

A coordinated multidisciplinary response to children found at clandestine meth lab sites will help ensure that all the needs of each child are met and that evidence is gathered to support the management and prosecution of each case.

Personnel who respond to seizures of illegal drug laboratories and conduct investigations may be from any of the law enforcement, social services, prosecution, environmental health, and medical disciplines.

These personnel usually respond according to their own agency’s protocols and, in most instances where multidisciplinary teams have not been established, operate independently. When jurisdictions do not coordinate their responses to these complicated scenes, personnel often overlook children’s needs or assume another agency will address these needs, fail to remove children from conditions of endangerment, or fail to gather adequate evidence to substantiate appropriate endangerment and other legal charges. Coordinated multidisciplinary investigations enhance information gathering, evidence integrity, interventions, and comprehensive treatment services for children and their families.

A medical professional that has been trained in diagnosing and treating children exposed to neglect and abuse, possible chemical hazards, and trauma should be a member of the multidisciplinary team. Before any seizure of a meth lab, operational agreements should be established with appropriate medical professionals to ensure that personnel are included who can help identify the children who have been harmed, determine the extent of harm, and provide treatment, support services, and monitoring. Frequently, public health nurses assigned to child protective services agencies will respond to the scene of a meth lab seizure when children are present.

Toxicology testing and a physical examination should occur as soon as possible after a child is found living at or visiting a methamphetamine production site. A medical protocol should instruct that search warrants served at methamphetamine manufacturing sites require the collection of children’s urine within 12 hours. Medical personnel must document each child’s physical and mental condition, using photographs as appropriate. They also must document any relevant injuries or exposures that occurred before lab seizure and provide diagnosis and treatment for drug exposures resulting from the manufacturing process, ingestion of drugs and hazardous substances, and physical injuries and abuse. Results of these medical evaluations and testimony of the examining physician, toxicologist, or other specialists may be required in child endangerment cases.

To address the complex behavioral and emotional problems experienced by these children, a psychologist, clinical social worker, or other mental health professional should participate on the team. Crisis intervention may be needed when children are removed from their families. Referrals for therapeutic services are often necessary for children coping with the effects of long-term neglect and abuse. The mental health professional should be consulted throughout the prosecution of a case, working closely with child protective services, law enforcement, and prosecutors to consider the emotional state of the child.

Child protective services (CPS) typically operate under local county offices of social services, and, when necessary, intervene on behalf of children at the direction of the juvenile court. When parents who are illegally manufacturing or abusing drugs are suspected of child endangerment, child welfare workers determine the course of the child welfare investigation and share information with law enforcement officers, district attorneys’ offices, and health care and mental health agencies. Investigations by CPS and/or adult protective services who become involved when vulnerable adults are found at the scene may involve law enforcement assistance when necessary for the safety of children or other vulnerable family members.

The CPS worker participating on a multidisciplinary response team often coordinates medical examinations, including transportation to and from appointments, and coordinates communication between the criminal and dependency and/or family law courts. CPS workers interview children and parents, take children into emergency custody, assess the need for both short- and long-term protective custody, arrange for timely medical and mental health evaluations and follow up care, and gather information for the juvenile court. They coordinate these activities with law enforcement to ensure that child endangerment issues are adequately evaluated. CPS workers also must provide records of any relevant current and past investigations. The responding CPS worker also may be required to testify in child endangerment cases.

Law enforcement organizations that may be involved in both planned and unplanned seizures of illegal methamphetamine laboratories include city police departments, county sheriffs’ departments, state departments of justice or bureaus of narcotics enforcement, and federal law enforcement agencies. Law enforcement personnel at all levels of jurisdiction who find children living at illegal drug manufacturing sites must act to ensure the immediate safety of the children present, ensure that children are placed in a safe environment with a responsible caretaker not relatives with similar substance abuse problems, which commonly occurs, contact CPS at the local level, and file child endangerment charges against endangering adults when appropriate. Close coordination and communication with CPS can help the officer carry out these responsibilities.

To minimize trauma to children and ensure consistency between the CPS and criminal investigations, CPS workers and law enforcement officers should jointly interview children found living at clandestine meth lab sites and children known to have been present during meth lab operation. Neighbors and witnesses should also be interviewed. Officers must document any present or potential danger, assess the level of danger and the likelihood of harm, and assess any intentional aspects of endangerment. The clothing and other belongings of children found at meth labs may be saved as evidence and tested for chemical contamination.

State statutes vary with regard to the circumstances that warrant endangerment charges. To prove child endangerment, law enforcement officers must use photographs, diagrams, and careful descriptions to document children’s physical injuries or access to dangers.

Photographs, diagrams, and careful descriptions also are critical in documenting the proximity of the methamphetamine laboratory and its hazards (such as booby traps, weapons, exposed wiring, chemical contaminants, waste products, and other unsafe matter) to the areas where children live, play, and sleep. All materials must be filed in a timely manner for both the CPS and criminal proceedings to progress. The testimony of investigating officers and results from the forensic chemists’ findings will be required to prove child endangerment. Their descriptions must be specific to codified rules of evidence.

Fire department personnel and hazardous materials professionals, including toxics control specialists and cleanup personnel, also play a key role in documenting conditions of child endangerment, including the potential for fire or explosion, presence of hazardous materials, improper storage of chemicals, and poor ventilation. Their training should address policies, responsibilities, processes, documentation, and procedures related to the examination, transportation, immediate treatment, and referrals of drug-endangered children living at illegal meth labs. A specialist in hazardous materials involved in the investigation should list all the chemicals found at an illegal drug-manufacturing site to help medical personnel assess the physical condition of children found there. The reports or testimony of hazardous materials specialists who respond to the site and other experts will be required in court.

Criminal prosecutors are responsible for filing and supporting charges of child endangerment, and the short- and long-term interests of the child must be an important consideration in the criminal drug prosecution. By reviewing all the evidence gathered, charging the drug violations as appropriate, and filing child endangerment charges against the appropriate parties, the prosecutor strengthens the multidisciplinary team’s efforts to achieve favorable child protection outcomes. Communication between CPS workers, probation officers, health care personnel, police officers, and attorneys should continue throughout the period of prosecution. Communication between the criminal and dependency and/or family law courts is crucial to avoid creating conflicts or jeopardizing either case outcome. Based on the nature of the crime and the jurisdiction in which it occurred, prosecution may take place in local, state, or federal courts. At the sentencing phase, the court establishes sanctions and activities considered necessary for rehabilitation. Even if charges of child endangerment are dismissed, the prosecutor can ask that the court consider conditions relating to the child endangerment charge in sentencing.

In cases in which one parent or caregiver is not charged with endangerment but lesser charges are levied, the prosecutor can play an important role in safeguarding the child’s welfare by influencing the terms of probation. These terms often include drug treatment, parenting classes, and other rehabilitative measures such as parent-child counseling to help the parent change his or her lifestyle and focus on the child’s welfare. Compliance with all terms of family reunification care plans or other dependency/family court orders also should be included in probation terms.

Children who are living or present at clandestine methamphetamine laboratory sites require immediate attention and care. Interagency protocols should be established in every jurisdiction where clandestine meth labs are found. The teams involved in seizing clandestine methamphetamine laboratories should include, or should have immediate access to, qualified personnel who can respond immediately to the potential health needs of any children who are present or living at the site. Actions should include taking children into protective custody and arranging for child protective services, immediately testing them for methamphetamine exposure, conducting medical and mental health assessments, and ensuring short- and long-term care and follow-up. A coordinated multidisciplinary team approach is critical to ensure that the needs of meth’s youngest victims are met and that adequate information is available to prosecute child endangerment cases successfully.

Note:
Methamphetamine, or meth, is the fastest growing drug threat and the most prevalent synthetic drug manufactured in the United States. Refined manufacturing has significantly increased meth’s strength. Called crank, speed, go fast, ice, or crystal, methamphetamine can be injected, snorted, smoked, or ingested orally. Meth is usually a white, odorless, bitter-tasting powder that dissolves easily in water. Crystal meth is often clear; it is found in large chunky crystals that are smoked. Methamphetamine users initially experience a short, intense rush that is followed by a sense of euphoria lasting up to 8 hours.

Methamphetamine use increases heart rate, blood pressure, body temperature, and rate of breathing. It produces extra energy and stamina, an increased libido, a sense of invulnerability, and a decrease in appetite. Chronic, high-dose methamphetamine abusers may exhibit increased nervousness, paranoia, schizophrenia-like symptoms, irritability, confusion, and insomnia. Violent and erratic behaviors frequently occur in the last phase of meth bingeing. Withdrawal from high doses of meth invariably produces depression, which varies in severity and duration but may last for months or even years.

This highly addictive, synthetic central nervous system stimulant is produced using chemicals extracted from readily available products. These products include over-the-counter cold medicines and diet pills and household products like lithium camera batteries, matches, tincture of iodine, and hydrogen peroxide. Flammable household products, including charcoal lighter fluid, gasoline, kerosene, paint thinner, rubbing alcohol, and mineral spirits, may be used in the mix. Corrosive products, such as the muriatic acid used in pools and spas, sulfuric acid in battery acid, and sodium hydroxide from lye-based drain cleaners, also may be used in the manufacturing process. In rural areas where anhydrous ammonia is used as a fertilizer, farmers are increasingly finding “cooks” using this highly toxic chemical to produce meth have tapped their ammonia tanks. ]]> Gun violence represents a major threat to the health and safety of all Americans. Every day in the United States, 93 people die from gunshot wounds, and an additional 240 sustain gunshot injuries. The fatality rate is roughly equivalent to that associated with HIV infection -- a disease that the Centers for Disease Control and Prevention has recognized as an epidemic. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=105 Thu, 22 Jun 2006 07:56:30 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=105
In 1996 the most recent year for which data is available, 34,040 people died from gunfire in the United States. Of these deaths, approximately 54 percent resulted from suicide, 41 percent resulted from homicide, and 3 percent were unintentional. Firearm injuries are the eighth leading cause of death in the United States. In addition, for every fatal shooting, there are roughly three nonfatal shootings.

Gun-related crime peaked in the late 1980's and early 1990's. Since that time, the United States has made steady improvement in reducing gun-related violence. Gun-related homicides have declined by 33 percent since 1993, including a 35-percent drop in handgun homicides. Meanwhile, from 1992 to 1996, murder rates declined by 20 percent, aggravated assaults by 12 percent, and the overall violent crime rate by 16 percent. The Federal Bureau of Investigation's (FBI's) Uniform Crime Report data for 1997 show that these trends are continuing, with murder and robbery totals declining by 7 percent over the previous year and the total of all violent crimes declining by 3 percent. Nonetheless, gun violence remains a serious national problem.

The impact of gun violence is especially pronounced among juveniles and adolescents. The firearm homicide rate for children under 15 years of age is 16 times higher in the United States than in 25 other industrialized countries combined. Among those ages 15 to 24, the U.S. firearm homicide rate is 5times higher than in neighboring Canada and 30times higher than in Japan, and the firearm homicide rate for the 15- to 24-year-old age group increased 158 percent during the 10-year period from 1984 to 1993. This contrasts with a 19-percent decline in gun-related homicides for those 25 and older. A teenager in the United States today is more likely to die of a gunshot wound than from all the "natural" causes of death combined.

Young African-American males have the most elevated homicide victimization rate of any race or gender group. Homicides involving firearms have been the leading cause of death for African-American males ages 15 to 19 since 1969.

There are approximately 44 million gun owners in the United States. This means that 25 percent of all adults, and 40 percent of American households, own at least one firearm. These owners possess 192 million firearms, of which 65 million are handguns. Among legal gun owners, the reasons given for owning or carrying a weapon include hunting, sports-related activities, and home protection. Among those who own handguns, 75 percent reported in a national survey that self-protection is the primary reason for owning a firearm.

Approximately 37,500 gun sales, including 17,800 handgun sales, are completed every day in the United States. The increasing number of gun owners has elevated the danger of guns being acquired illegally through robberies and burglaries. In 1994, more than a quarter-million households experienced the theft of one or more firearms; nearly 600,000 guns were stolen during these burglaries.

The number of youth who report that they carry weapons is significant. In 1997, 14 percent, or 1 in 7 male juveniles, reported carrying a gun outside the home in the previous 30-day period. In the inner city, the problem is more severe. One study involving 800 inner-city high school students reported that 22 percent said they carried weapons. An even greater number of convicted juvenile offenders reported carrying guns -- 88 percent, according to another study.

Firearms are readily available on the illegal gun market, and those who are most likely to possess guns are drug sellers and gang members -- overwhelmingly young and male. More than two-thirds of the respondents in one study of urban arrestees stated that the primary reason for owning and carrying a weapon is self-protection --a small number also reported using the weapon for drug trafficking or other illegal activities. Among arrestees overall, 23 percent of those who owned a gun said they had used one to commit a crime. Among juvenile drug sellers who owned a firearm, 42 percent reported using a gun in a crime; among gang members, 50 percent reported using a gun.

Although no national database contains detailed information about all the guns used in crimes, police records and surveys of offenders provide some insights on the types of firearms used in criminal offenses. In 1994, the Bureau of Alcohol, Tobacco and Firearms received more than 85,000 requests from police departments for traces of guns used in crime. More than three-fourths of the guns traced were handguns, and almost one-third were less than 3 years old. In 1994, the most frequent types of guns used in homicides were large caliber revolvers, but the number of large caliber semiautomatic guns is increasing.

In an early survey of incarcerated felons, 32 percent reported that they had acquired their most recent handgun by theft. A more recent survey reported that 13 percent of all arrestees, 25 percent of all juvenile arrestees, 29 percent of the gang members, and 30 percent of the drug sellers had stolen guns.

During the 1997-98 school year, the public was riveted by extensive media coverage of school shootings in Jonesboro, AR; West Paducah, KY; Pearl, MS; Springfield, OR; and Edinboro, PA. This spate of multiple shootings increased parental concerns about school safety. However, the 40 school shooting deaths in the 1997-98 school year fall within the midrange of total annual incidents since 1992. According to the National School Safety Center, violent deaths in school settings (suicides and homicides) declined 27.3 percent between the 1992-93 school year and the 1997-98 school year.

The high profile multiple shootings also have fueled public perceptions that children are in danger while attending school. In fact, youth in particular those who live in high-crime neighborhoods are safest while in school. A 2-year study by the Centers for Disease Control and Prevention found that the incidence of school-associated violent death was less than one in a million.

Even if actual shootings at school are rare, the presence of guns in schools is not. One leading survey reveals that between 1994 and 1996, the percentage of 12th grade males that reported carrying a gun to school in the previous 4 weeks increased from 4.8 to 6.3, or roughly 1 in 17. Another survey tells us that 12.7 percent of student’s ages 12 to 19 reported knowing a student who brought a gun to school.

The drug market is a major contributor to the Nation's homicide rate. Indeed, the peak in homicides during the mid-1980's was directly related to the saturation of urban areas with the crack cocaine drug trade. Methamphetamine -- more powerful, more addictive, and easier to produce than crack cocaine -- is becoming a major drug of choice in urban, suburban, and rural communities. If the methamphetamine trade results in drug wars on the same scale as those of the 1980's, it is possible that homicide rates will begin to climb once more, as drug dealers are among those most likely to carry weapons.

Gangs have proliferated rapidly since 1980, when there were about 2,000 gangs with 100,000 members in 286 cities. By 1996, there were 31,000 gangs with 846,000 members in 4,800 cities and towns.

Gangs are more likely to recruit adolescents who own firearms, and gang members who are twice as likely to own guns for protection than non-gang members are more likely to carry guns outside their homes. The risk of being killed is 60 times greater among young gang members than in the general population and in some cities, far higher. For example, the St. Louis youth gang homicide rate is 1,000 times higher than the U.S. homicide rate.

Although not all gangs are drug organizations, gang membership appears to increase individual participation in drug use and trafficking, gun carrying, violence, and prolonged involvement in drug sales. Furthermore, gang activity is no longer a problem that is unique to urban communities. From 1989 to 1995, the percentage of students who reported that street gangs were present at school increased by 186 percent in suburban schools and 250 percent in rural schools. Gangs reportedly operate in 41 percent of urban schools, 26 percent of suburban schools, and 20 percent of rural schools. Long-term solutions to address the problem of gun violence must include a comprehensive approach to reducing the number of youth involved in gangs.

During the past decade, the epidemic of gun violence has led residents and law enforcement agencies in each of the communities to form a collaborative to find new solutions to this problem. In some cases, neighborhood residents determined to address the problem of gun violence and to take back their streets have driven these efforts.

In other communities, police, prosecutors, the courts, schools, health departments, public and private social service organizations, or members of the faith and business communities have spearheaded crime reduction efforts.

Regardless of who initiated the various crime prevention efforts, however, these communities have learned that each of these institutions contributes to the collaborative's ability to mobilize resources and implement strategies that produce desired outcomes. In particular, citizen participation in crime prevention efforts has been critical to their success and sustainability. Police can do their job more effectively when the community's priorities shape their actions. The subsequent development of trust enhances this partnership and results in greater police-community cooperation and mutual support.

These communities have also learned that their efforts must be long-term in order to be effective, and that capacity building in different sectors of the community is needed.
The comprehensive gun violence reduction programs is to incorporate multiple suppression and prevention strategies to address risk factors that are associated with violent criminal behavior, including aggressive behaviors at an early age, conflicts with authority, gun possession and carrying, gang membership, substance abuse, depression, exposure to violence, poor parental supervision, low academic achievement, truancy, delinquent peers, drug trafficking, and unemployment.

Rather than targeting one or two risk factors associated with gun violence, these collaboratives recognize that their efforts are likely to be more successful if they incorporate strategies that address both the supply and demand side of the illegal firearm market. They have therefore developed comprehensive, multiple-component programs that address the identified risk factors in multiple ways. Such program strategies include targeted police responses, surveillance of probationers, situational crime prevention using problem-solving strategies, parental supervision, peer mediation and conflict resolution, school-based interventions, community mobilization, legislation restricting youth access to guns, and tough sentences for crimes involving firearms.

Because gang membership is associated with violent behaviors, many of these comprehensive programs also include intervention strategies to reduce gang-related violence, including the development of geographically coded information systems to track gang violence, restricting gang members' access to firearms, enhancing prosecution of gang crimes, and punishing and monitoring offenders.

While these programs may vary in the degree to which the community is an integral part of their collaboratives, each of them has involved the community in assessing its gun violence problems or in implementing effective violence reduction strategies.]]> Heroin is an addictive drug, and its use is a serious problem in America. https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=104 Thu, 22 Jun 2006 05:56:13 GMT https://www.sandiegohealthdirectory.com/kb/link.php?action=detail&id=104
Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, collapsed veins, and, particularly in users who inject the drug, infectious diseases, including HIV/AIDS and hepatitis.

The short-term effects of heroin abuse appear soon after a single dose and disappear in a few hours. After an injection of heroin, the user reports feeling a surge of euphoria or "rush" accompanied by a warm flushing of the skin, a dry mouth, and heavy extremities.

Following this initial euphoria, the user goes "on the nod," an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Long-term effects of heroin appear after repeated use for some period of time.

Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, cellulitis, and liver disease. Pulmonary complications, including various types of pneumonia, may result from the poor health condition of the abuser, as well as from heroin’s depressing effects on respiration.

Heroin abuse during pregnancy and its many associated environmental factors e.g., lack of prenatal care, have been associated with adverse consequences including low birth weight, an important risk factor for later developmental delay.

In addition to the effects of the drug itself, street heroin may have additives that do not readily dissolve and result in clogging the blood vessels that lead to the lungs, liver, kidneys, or brain. This can cause infection or even death of small patches of cells in vital organs.

The Drug Abuse Warning Network reports that eight percent of drug-related emergency department visits in the third and fourth quarters of 2003 involved heroin abuse. Unspecified opiates—which could include heroin—were involved in an additional 4 percent of drug-related visits.

With regular heroin use, tolerance develops. This means the abuser must use more heroin to achieve the same intensity of effect. As higher doses are used over time, physical dependence and addiction develop. With physical dependence, the body has adapted to the presence of the drug and withdrawal symptoms may occur if use is reduced or stopped.

Withdrawal, which in regular abusers may occur as early as a few hours after the last administration, produces drug craving, restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps "cold turkey," kicking movements also known as "kicking the habit," and other symptoms. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and subside after about a week. Sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal, although heroin withdrawal is considered less dangerous than alcohol or barbiturate withdrawal.

There is a broad range of treatment options for heroin addiction, including medications as well as behavioral therapies. Science has taught us that when medication treatment is integrated with other supportive services, patients are often able to stop heroin use and return to more stable and productive lives.

In November 1997, the National Institutes of Health (NIH) convened a Consensus Panel on Effective Medical Treatment of Heroin Addiction. The panel of national experts concluded that opiate drug addictions are diseases of the brain and medical disorders that indeed can be treated effectively. The panel strongly recommended:
(1) Broader access to methadone maintenance treatment programs for people who are addicted to heroin or other opiate drugs; and
(2) The Federal and State regulations and other barriers impeding this access be eliminated. This panel also stressed the importance of providing substance abuse counseling, psychosocial therapies, and other supportive services to enhance retention and successful outcomes in methadone maintenance treatment programs.

Methadone, a synthetic opiate medication that blocks the effects of heroin for about 24 hours, has a proven record of success when prescribed at a high enough dosage level for people addicted to heroin. Other approved medications are naloxone, which is used to treat cases of overdose, and naltrexone, both of which block the effects of morphine, heroin, and other opiates.

Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor's office. Several other medications for use in heroin treatment programs are also under study.

For the pregnant heroin abuser, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. There is preliminary evidence that buprenorphine also is safe and effective in treating heroin dependence during pregnancy, although infants exposed to methadone or buprenorphine during pregnancy typically require treatment for withdrawal symptoms.

For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with relative safety, although the likelihood of relapse to heroin use should be considered.

There are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Several new behavioral therapies are showing particular promise for heroin addiction. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors.]]>