May 23, 2011. Monday

11:47am, I contacted the Maine Poison Center at (800) 222-1222. I asked if someone there could

tell me what 56ng/ml of methamphetamine in a child’s urine would mean, what kind of dose

would give that result and if it could happen accidently or not. I was told that if is often not

possible to extrapolate the dose of a substance from a level in the system. I was asked for my

contact information, who I was working for, who the child had been with before the test was

given as well as Mila’s name and age. I provided that information. I was asked what type of test

was given but I was unable to provide that information. I was told to forward the lab results and

they would have a chemist get back to me. I sent the lab results as well as a brief synopsis on the

circumstances surrounding the test via e-mail to teetsl@mmc.org.

12:53pm, I was contacted by Dr Karen Simone, the Director of the Maine Poison Control. She

stated that the tests that are set up to determine substance levels and to check to see if they a

compliant do not check levels below 1000. She stated that the standard should give me some idea

that the 56 ng/ml is a very small amount. Dr. Simone agreed to give me information in general

based on the lab test results that I was providing to her. She stated that there is a d form and an l

form of a lot of drugs and it depends on which way the molecule spins and it is present in both

forms most of the time. She stated that in certain drugs the d part may be more active and other

drugs the l part may be more active.

Dr. Simone stated that years ago, when outlaw motorcycle gangs manufactured

methamphetamine, both the d and l were present. She stated now they have gotten better and the

methamphetamine is primarily in the d form. She stated that it still could be d and l in some cases

now. She explained that it is the d methamphetamine that gives you the desired drug reaction.

Dr. Simone went on to explain to me about the Vicks inhaler. She stated that there is a chemical

present in the Vicks inhaler that is not called l methamphetamine but is the same thing. She

stated that l methamphetamine does not give you a good high and anyone that knew what they

were doing would not manufacture l methamphetamine.

Dr. Simone stated that the test results I provided her are showing only a presence for l

methamphetamine. She stated that it was hard for her to imagine that this was the drug the child

was being exposed to if it were coming from a meth lab. She stated that exposure from a lab

should indicate d methamphetamine or at least a larger amount of d methamphetamine. She

stated that l methamphetamine only was not right for a meth lab situation. I asked Dr. Simone if

normal use of the Vicks inhaler would produce a 56 ng/ml level in a child's urine. She stated that

she was not sure if they knew that. I told Dr. Simone that the child's mother asked the father if a

Vicks inhaler had been used on the child. I told her that his response was that he does not use one

and told the mother not to use it on the child as it was not appropriate. I explained to Dr. Simone

that when the father found out why the mother wanted to know he changed his response to the

fact he uses a Vicks inhaler on the child all the time.

I asked Dr. Simone if applying Vicks vapor rub on the child's chest would come up with this

particular result. She stated that it would not. She added that the Vicks inhaler is the only product

that she knows about that could cause this result. She stated that there is a drug called Selegiline

that is used for Parkinsonism that would have l methamphetamine in it. She added that she could

not imagine any reason the child would've been exposed to that drug.

I asked Dr. Simone if the 56 ng/ml level of l methamphetamine would cause intoxication or

impairment in a three-year-old child. She stated there is no way to back extrapolate levels in

urine to actual dosage. She stated that is not a legitimate method and that I should be suspicious

of anyone that does make that extrapolation. She stated that the only thing anyone could say is

whether or not these levels are normal or not.

Dr. Simone referred to a methamphetamine study as it pertains to adults. (She stated that she just

happened to have this or otherwise she would have to charge me for a consult.) She added that

what she is doing for me now falls way outside the range of what they normally do at the Maine

Poison Control. She stated that she is looking at a study where they asked the person to use an

inhaler every three hours for five days or three days. She stated after the use period they

measured for l methamphetamine. She stated that the report indicated that one person had no l

methamphetamine in their system, one person had 72 ng/ml and one person had 1,500 ng/ml. She

stated that it appeared that most of the people tested had levels in the hundreds. I commented that

56 ng/ml is basically nothing. She agreed that it was not a high level.

She stated that she was not sure what we could do with this test level. She stated that she did not

believe you could prove exposure to methamphetamine with this test result. I told Dr. Simone

that the MDEA agent that initially worked on this case stated that no amount of

methamphetamine in child is appropriate. I told her that this agent eventually backed away from

the statement and stopped working on the case. Dr. Simone agreed that you should not have

methamphetamine in your system at all. She stated that it is two entirely different situations

between being exposed to a meth lab or using a Vicks inhaler.

Dr. Simone stated that the methamphetamine found in your system after being exposed to a meth

lab should not be l methamphetamine or if l is present it should be mostly d methamphetamine.

She confirmed that the methamphetamine in Sudafed would be just d or d and l. She stated that

there is no reason to make just l methamphetamine as no one would buy it. She agreed that

someone might buy it once but a dealer would not stay in business selling just l

methamphetamine. I asked Dr. Simone if Bath Salts had l methamphetamine in it. She

responded, “Not that I am aware of.” She stated that Bath Salts are primarily made up of MDPV

and mephedrone. She added that Bath Salts are a street drug and most any chemical could be in

them.

Dr. Simone stated that it sounded to her that I was trying to make something stretch to something

I don't understand. She stated what she meant was that I was trying to understand why there was

methamphetamine in the child's system and she added that she does not understand why it was

there either. She stated that she thought it was a stretch to think it was from Bath Salts and added

that Bath Salts has not been around that long. She stated that as far as she knows Bath Salts were

not on the scene in this area in March 2010. She said it is possible that was already other parts of

the country but she saw nothing in Maine at that time.

I told Dr. Simone one of the things I was trying to determine is if 56 ng/ml was a lot or a little to

be in someone's system. She described that amount as “teeny tiny”. She stated to even test them

out you would have to tell the person doing the test to go as low as they possibly could. Dr.

Simone added that if the child had been exposed to a meth lab, whatever got into their system by

whatever means would not stay in their system very long. Dr. Simone stated that in the situation

you would not expect to get high levels. She stated that her problem with this test was not the

level in the urine but the fact that it was just l methamphetamine.

Dr. Simone explained the reason you cannot extrapolate dosage from level in the urine is because

there are so many variables. She stated the variables range from how much water the person had

to drink to how much they weighed and several other possible factors. She stated that ten people

taking the same dosage would likely have different levels in the urine. I asked Dr. Simone what

the significance was of no methamphetamine been found in the child's hair sample. She stated

that that was hard to say. She stated that hair sample testing is not a matrix that has been around

very long and there are all kinds of problems with it. She stated basically to have it show up in

the hair you really needed a large dose or long-term use. She stated the reason that you would

check hair is so you could look back for a longer period of time. She stated that it is in the blood

the shortest period of time and in urine a little longer.

I asked Dr. Simone if this child were her patient and she was not expecting to find

methamphetamine in her urine, what kind of questions she would ask to determine where it came

from. She stated that she would not know where to begin. She said that she would start with a

Vicks inhaler and Selegiline and that would be as far as she would go. She stated that if it turned

out to be a Vicks inhaler she would ask which parent gave it to her or was there an outside party

that may have given it to her. She said that this finding is interesting, but without context she

does not know what she could do with it. She stated that she would feel differently about the

results if it were d methamphetamine.

I told Dr Simone that my reason for calling was to learn if I should pursue the methamphetamine

further or set it aside and concentrate on other aspects of the investigation. I told her I was

inclined to set it aside based on our conversation. She stated that I was probably on the right

track.