Prescriptions for cold meds won’t cut meth abuse

Debate in the General Assembly continues this year regarding the best approach to control the serious problem of illegal methamphetamine production. Many cold and allergy medications contain pseudoephedrine, which is a necessary ingredient in meth production by illegal “meth labs.”

These products are non-prescription but by law are behind the pharmacist’s counter. Federal and state efforts over the past decade have mainly centered on enacting legislation that limits the amount of PSE that an individual can purchase on a daily, monthly and yearly basis.

In 2011, Indiana further required retailers to use the electronic National Precursor Log Exchange before completing each PSE sale. Thirty states also use this system. This log is an Internet-based system that tracks sales and attempted sales, and instantly prevents purchases when persons have reached the legal limit. It also facilitates law enforcement identification of individuals who may be diverting these medications for the production of meth. The Indiana experience with NPLEx has been impressive, blocking tens of thousands of boxes of PSE-containing medications yearly.

Another approach has been enacted by two states, Mississippi and Oregon, that have made PSE products available only by prescription. The results of this prescription approach have been unclear, with contradictory sets of data (or interpretations of data) regarding their effectiveness. However, Oregon government-collected statistics reveal that 77 percent of the decline in meth labs occurred after the “behind the counter” law was enacted and before the prescription law went into effect. Prescription status makes little empiric sense. Highly regulated opioid prescription pain medications are now the easiest drugs to illegally obtain on the street. Why would it be any different for PSE?

Nationally, there has been a dramatic decline in meth-lab seizures, peaking at nearly 24,000 in 2004 and dropping to 11,573 by 2013. In high-meth states such as Tennessee and Missouri, meth-lab seizures are down about 40 percent in the past year alone.

The declines are due to laws limiting sales but also from home-cooked meth being largely replaced by much cheaper Mexican meth of much higher purity. The Drug Enforcement Agency reports that 90 percent of meth in the U.S. is now from Mexico. According to the Oregon Department of Justice, methamphetamine is currently on the rise and widely available from Mexican traffickers.

Fifteen million Americans (450,000 Hoosiers) use PSE products legitimately for medical conditions. Prescription-only PSE would increase the cost of medical care for these individuals by burdening them with the cost of a doctor’s visit, time away from work, child care, transportation, and the increased cost of a prescription drug. Physicians cannot prescribe a controlled medication without first seeing the patient. Physician offices, already overburdened, would be filled with patients seeking relief from simple colds and allergies. Wait times to see primary-care physicians would increase.

Although there are three PSE-prescription bills in the legislature, there is another measure, SB 536, co-authored by Sens. Mike Young and Carlin Yoder that would ban non-prescription PSE sales only to convicted meth criminals, who typically have very high recidivism rates. The experience with this additional approach has been remarkable. Oklahoma and Alabama, two states with the longest experience with this type of law, have had declines of nearly 80 percent since adoption two years ago. Prosecutors and law enforcement and narcotic officials in these states have remarked on the stunning progress from their “meth-offender” bills, which build on the success of the NPLEx system.

The same could be true in Indiana. It’s the next logical step.