New Script for Sudafed?
By John Gramlich, Staff Writer
Oregon raised eyebrows in 2005 when it became the first state to require a doctor's prescription for tablets of Sudafed, Claritin D and several other common cold and allergy medicines. Intended to stop production of crystal meth — which is made with a decongestant found in those medicines — the law was panned by some as a huge hassle.
Oregonians, one blogger wrote on the liberal Daily Kos Web site, would be forced to take time off work, drive to the doctor, sit in a waiting room, open their wallets for a $15 or $20 co-pay and drive to the pharmacy — all for a $6 box of Sudafed "for your case of the sniffles."
Five years later, Oregon's law is raising eyebrows again. This time, it's because the number of meth labs found in the state has plummeted from 192 in 2005, the year before the prescription law went into effect, to just 10 last year — even as they've surged in other states. Combined with other anti-meth measures that all states have adopted, such as putting targeted cold medicines behind the counter instead of selling them off the shelf, monthly meth lab seizures have declined 96 percent in Oregon.
The decline is important not only because meth use in the United States has been linked to widespread crime and addiction, but because meth manufacturing is a dangerous chemical process that can result in explosions, toxic waste, injuries and death. But meth can't be made without pseudoephedrine, the decongestant that is found in several leading cold and allergy medicines, and states have sharply limited consumers' access to it in recent years. Pseudoephedrine was prescription-only in the United States until 1976.
Oregon's success is reverberating. Governor Haley Barbour last month signed a bill making Mississippi the second state to require prescriptions for drugs containing pseudoephedrine. At least nine localities in Missouri have passed their own laws, and legislators and law enforcers in capitols from Sacramento to Washington, D.C., are paying attention.
"It is fairly hard to argue with the success of the Oregon model," says Gary Boggs of the U.S. Drug Enforcement Agency.
But efforts to copy Oregon's law elsewhere are prompting deep concern on the part of major pharmaceutical makers such as Johnson and Johnson, Pfizer and Merck, which see a threat to their bottom line in the laws. If customers need a doctor's prescription for drugs containing pseudoephedrine, they may not buy the drugs at all. The U.S. pseudoephedrine market is estimated at more than $500 million a year.
Through their lobbying arm, the Consumer Healthcare Products Association, pharmaceutical makers have launched an aggressive and successful campaign against pseudoephedrine prescription laws like those in Oregon and Mississippi. And they have a powerful argument to make: There's a better way to stop domestic meth production, the association says, and we'll pick up the costs.
Pharmaceutical makers — and some law enforcers — want states to go after meth producers by setting up a computer tracking system that can instantly tell pharmacists whether they should or shouldn't sell those products to a given customer.
The system works like this: Customers who want to buy cold medicines containing pseudoephedrine must show identification to a store employee, who connects via the Internet to a statewide database to enter the transaction details. At the same time, the seller instantly finds out whether that customer has recently purchased pseudoephedrine somewhere else — and, if so, how much. If the customer has exceeded the legally proscribed amount set by the federal government, the pharmacist must refuse the sale, and police can be tipped off about any suspicious activity.
A TIGHTENING NET
Over the last six years, states have dramatically restricted access to cold and allergy medicines containing pseudoephedrine, a decongestant that is a key ingredient in making meth.
2004 : Governor Brad Henry signs a bill making Oklahoma the first state to move tablets containing pseudoephedrine behind the pharmacy counter. Under the new law, customers must ask for the tablets and show identification when buying it. Dozens of states follow Oklahoma.
2005 : Governor Ted Kulongoski signs legislation making Oregon the first state to ensure that some common cold and allergy medicines cannot be purchased without a doctor's prescription.
2006 : As part of the reauthorization of the Patriot Act, President George W. Bush signs the Combat Methamphetamine Epidemic Act , seizing on Oklahoma's law and requiring pills with pseudoephedrine to be placed behind the pharmacy counter at stores across the nation. The law also sets limits on how much pseudoephedrine customers can buy.
2006 : Oklahoma becomes the first state to create a statewide electronic tracking system for pseudoephedrine purchases. The new system instantly verifies whether those who want to purchase pseudoephedrine have exceeded the legal monthly or daily amount. Arkansas and Kentucky soon follow.
2010 : Governor Haley Barbour signs legislation making Mississippi the second state to require a doctor's prescription for medicines containing pseudoephedrine, while Alabama and Washington pass bills to authorize electronic tracking systems.
Arkansas, Kentucky and Oklahoma have launched such tracking systems, while Alabama, Illinois, Iowa, Kansas, Louisiana, Missouri and Washington are on their way, in most cases with the financial backing of the industry. Of those states, Oklahoma is considered a national leader. "Every pharmacy in Oklahoma that sells Sudafed is tied into this system," says Mark Woodward, a spokesman with the state Bureau of Narcotics and Dangerous Drugs Control.
More states are likely to go the electronic tracking route, particularly because the CHPA is paying for the systems — a huge selling point for cash-strapped state governments. Andrew Fish, the association's senior vice president, says he doesn't know exactly how much his member companies have spent to set up the systems so far, but "the initial investment by our industry is certainly seven figures."
The only cost for pharmacies and other stores where pseudoephedrine cold medicines are sold, Fish notes, is the price of an Internet connection, which most already have.
Requiring a prescription, meanwhile, is a tough sell politically. Many consumers and lawmakers see it as overly burdensome, even as they acknowledge Oregon's success against meth labs. "It surely does work, but it's a very difficult route," says Representative Tom Campbell, who has tested the legislative waters this year with both proposals in Washington. Campbell's prescription bill stalled, but the tracking measure is ready for Governor Chris Gregoire's signature.
So which way works best?
Both approaches have advantages and disadvantages.
Requiring a doctor's prescription certainly cuts down on meth makers' access to pseudoephedrine, and in Oregon, where the law has been enforced for nearly four years, the initial worries about its effects on consumers and pharmaceutical firms' profits were overblown, says Marcus Watt, a pharmacist and former member of the Oregon Board of Pharmacy.
"It wasn't the major catastrophe that some had claimed," Watt says, though he acknowledges some people now drive to neighboring Washington to buy pseudoephedrine products without a prescription.
Watt says he has heard few complaints from his customers, likely because pharmaceutical companies offer other cold and allergy medicines that do not contain pseudoephedrine and are fine replacements that can be sold in store aisles.
Ginny Burdick, the state senator who wrote the Oregon law, frames the debate this way: "What's more important to you: a little inconvenience or a child (living in a meth lab) who is going to have their whole life ruined by being exposed to these poisons?"
Even with a prescription requirement in place, however, there is no guarantee that those seeking pseudoephedrine can't get it from doctors anyway — especially since prescription drug abuse in its own right is a major national problem. One benefit that the pharmaceutical firms and some police officers see in the electronic tracking method is that law enforcement can be alerted quickly about who, exactly, is trying to buy more meth than is allowed. That can lead to arrests and prosecutions, getting more meth makers off the streets.
But the tracking method comes with its own complications, says Woodward, the spokesman for Oklahoma's drug enforcement agency. "Smurfers," or those who travel from store to store to buy pseudoephedrine in large quantities for meth production, often use multiple IDs that can fool the tracking systems, Woodward says. Another problem for both the prescription and tracking methods: Until similar laws are in place in neighboring states, customers can simply cross state lines to buy pseudoephedrine.
That could be the most powerful argument yet as more states look at both the Oregon and Oklahoma models to further restrict access to meth makers' key ingredient.