Clinical toxicology of exposures to chemicals from clandestine drug laboratories: a literature review

Abstract

INTRODUCTION: The synthesis of clandestine drugs is a widespread worldwide phenomenon, with clandestine drug laboratories occurring both in rural and urban areas. There is considerable unfamiliarity among medical professionals about the health risks that are associated with chemicals used in clandestine drug laboratories. OBJECTIVE: To evaluate the adverse health effects resulting from exposure to chemicals involved in the production of clandestine drugs. METHODS: The US National Library of Medicine PubMed database and the Excerpta Medica database (EMBASE) were searched from their date of inception to October 26, 2021 using combinations of relevant search terms. This yielded 1,558 unique articles, which were subjected to two eligibility criteria: (i) exposure to clandestine drug laboratory chemicals resulting in adverse health effects; (ii) subjects were human. A total of 22 unique articles were retrieved, consisting of 10 reviews, eight case reports/series and four retrospective studies. Further searches among the references cited in these publications yielded another seven case reports/series and six retrospective studies. RESULTS: Inhalation: Surveillance studies reported respiratory symptoms (including cough, throat irritation, nasal irritation, and dyspnea) in 59% (n = 1,657 of 2,803) of those exposed. The case reports/series described respiratory symptoms in 43% of the cases (n = 36 of 84). Lung edema was reported occasionally (n = 2). Eye exposure: Surveillance studies reported eye irritation and burns in 23% (n = 647 of 2,803) of those exposed. The case reports/series described ocular adverse events in 36% of the cases (n = 30 of 84). More severe ocular effects, such as corneal damage and conjunctival necrosis, were reported after direct eye contact with caustic fluids. Skin exposure: Surveillance studies reported dermal effects, ranging from skin irritation to severe burns, in 6% of those exposed (n = 174 of 2,803). The case reports/series described dermal effects in 30% of the cases (n = 25 of 84). Ingestion: Gastrointestinal burns were observed after ingestion of caustic substances in 5% of the patients reported in the case reports/series (n = 4 of 84). Systemic effects: Surveillance studies reported headache and dizziness in 31% (n = 882 of 2,803) and 7% (n = 187 of 2,803) of those exposed, respectively. The case reports/series described sympathomimetic effects, including mydriasis, hypertension, tachycardia, in 4% of the cases (n = 3 of 84). Fatalities: Surveillance studies reported death in 1% of those exposed (n = 29 of 2803). Ten percent of the people reported in the cases report/series died (n = 8 of 84). Death was reported after inhalation of phosphine (n = 5), hydrogen sulfide (n = 1), methanol (n = 1), and after ingestion of sulfuric acid (n = 1). CONCLUSIONS: Exposure to chemicals involved in the production of clandestine drugs mostly resulted in mild to moderate respiratory, ocular or dermal effects, usually caused by caustic chemicals or solvents. Systemic effects were generally mild, but severe symptoms and eight deaths were reported after exposure to phosphine, hydrogen sulfide, methanol and sulfuric acid.