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Posted on Sat, Jun 11, 2011 : 4:39 p.m.

Evidence backs making pseudoephedrine prescription-only to curb meth lab epidemic

By Guest Column

Some folks may recall when pseudoephedrine (PSE) could only be obtained by prescription before 1976. Two things were missing back then: millions of office visits to obtain PSE prescriptions and the methamphetamine lab epidemic. Two states took advantage of this historical truth and returned PSE to prescription-only. The results? Not surprisingly, astonishing drops in meth labs and no strong objection from consumers.

Prescription laws target only the small number of PSE-containing decongestants that are located "behind the counter." Nothing "on the shelf" is affected. PSE is not in any pediatric formulas and is not ideal for seniors because it elevates heart rates. Current law limits and logs PSE sales to each consumer because PSE is the essential ingredient needed to make D-methamphetamine, a highly addictive version of meth often made in a 2-liter soda bottle that generates hazardous fumes, toxic waste and sometimes explodes.

After Oregon and Mississippi returned PSE to a prescription there was little to no public outcry because pharmacists and physicians coordinated the transition well for allergy sufferers, and cold sufferers never lost any options "on the shelf."

Prescriptions for allergy sufferers were called in to pharmacies or rolled into the next office visit and 6-month refills were offered for convenience. Co-pays made the drug even cheaper for those with insurance and the retail price - $6 - didn't change for those who did not. Based on Oregon Medicaid stats, extra office visits were rare.

In Oregon, the total annual cost increase to Medicaid was less than $8,000. Compare this to the millions of dollars for meth lab clean-up, police response, court costs, rehab, incarceration, child protective services, and follow-up social services that Michigan taxpayers absorb. Add to this property damage and the costs to regional transferring hospitals, fire departments, emergency medical services and the millions in meth lab burn care each year. Meth labs not only drive up the cost of health care, they clearly drive up taxpayer burden. Returning PSE to prescription status will alleviate much of this expense for Michigan, as it has for Oregon and Mississippi.

Since enacting the law in 2006, Oregon's taxpayers have enjoyed a sustained dramatic decline in meth labs and property crime rates plummeted to a 50-year-low. Similarly, Mississippi has enjoyed a 67 percent decrease in meth labs since enacting their prescription law last summer. The law's ability to curb meth labs is limited only by surrounding states that still offer over-the-counter PSE. This obviously makes a compelling case for the entire nation to return PSE to a prescription. It has also prompted drug companies to go on the offensive.

To prevent a major dent in profits, drug lobbyists distract lawmakers from PSE prescription legislation with electronic tracking systems like NPLEx/MethCheck that block excessive PSE sales by linking pharmacies in a database system. These systems force meth cooks to hire a workforce to buy legal limits of PSE. The buyers are often paid in meth, making more addicts, more cooks, and still more meth labs.

After implementing electronic-tracking legislation, meth labs increased 34 percent in Arkansas, 164 percent in Oklahoma and Tennessee led the nation with a record 2,082 labs. Kentucky has seen their meth lab incidents skyrocket by 248 percent since implementing MethCheck.

Despite the obvious failure of electronic tracking, drug company lobbyists have been successful at steamrolling MethCheck into law in several states over the protests of public servants who are left to clean up more meth labs with less money. Several states have recently enacted this disastrous legislation but have yet to implement it. State Sen. John Proos just introduced a bill that would mandate MethCheck in Michigan.

Sadly, meth labs have become an accepted norm in Michigan. In five minutes a meth cook can walk into a store and buy everything he needs to destroy himself, his family and neighbors. Meth labs have burned down homes and apartment buildings, blown up in hotels, and littered Michigan's roadsides and woodlands for years.

The fingers of the meth lab epidemic have extended from the southwest to Traverse City, Bay City, Jackson, Lansing and even the Upper Peninsula. This increasing public health threat requires effective evidence-based legislation rather than politics, and the research is in: the prescription law works. It always did.

Dawn Johnston lives in Kalamazoo and is a flight nurse.


Ming Bucibei

Mon, Jun 13, 2011 : 5:19 a.m.

Cutting otc of pseudo would only stop the "home grown" tiny meth labs!! This would be a really bad and ineffective idea-- controlling & authoritarian--not appropriate !! Most of the meth is produced ouside of the USA in large criminal labs & there would be no effect on the supply of meth in the USA The "war on drugs" is worse than a total failure--criminal legal sanctons create more & worse problems Does no one see the lesion of prohibition?? probhition does not work!! Ming Bucibei


Sun, Jun 12, 2011 : 1:49 p.m.

Megan McArdle devoted a blog post earlier this year on why this proposal makes no sense: <a href="" rel='nofollow'></a>

Basic Bob

Sun, Jun 12, 2011 : 1:46 p.m.

Regarding Oregon and Mississippi, they have both decriminalized marijuana. Apparently they believe meth is more of a public health threat than cannabis. It would be nice to see politicians in Michigan wise up.

Basic Bob

Sun, Jun 12, 2011 : 1:30 p.m.

Please don't let the government decide which medication works. This is what I see as the real public health threat. I take Pseudoephedrine occasionally for congestion. I usually take a half dose because for me, it's like ten cups of coffee. (I see how it could be turned into meth.) The PE formulation does absolutely nothing for my symptoms and I stopped buying it.

5c0++ H4d13y

Sun, Jun 12, 2011 : 12:16 p.m.

Whether a drug is prescription or not should be based on how safe it is to use without a prescription. By using prescription laws to reduce illegal drug production you are asking the FDA to make a judgement on how a drug can be misused in production of an illegal substance. The FDA is already slow and dysfunctional so why make it worse? Pseudoephedrine is already behind the counter. You already need to show and swipe a drivers licensee to get it. I would bet that's more scrutiny than some health clinics would enforce. Plus why burden doctors with a drippy nose? Health care costs are already sky high. Find a difference solution for this problem.


Sun, Jun 12, 2011 : 3:45 a.m.

Please, no. I need Claratin D to LIVE. Only around the dead of winter do I MAYBE drop from using a decongestant. I tried to go off them and for maybe ONE MONTH I could breathe. Then it kicked back in again and I had to go back on it. While I do pay out the nose for insurance and would probably be one of those who would benefit from changing it over to RX I think there would be many more who would suffer needlessly. What we have in place now seems to work. I go to the pharmacy, they take my name and ID, etc, and I get my meds. As long as I don't show up every week there is no need to question me. What's wrong with that?


Sun, Jun 12, 2011 : 1:01 a.m.

Ms. Johnston is correct that the term &quot;meth lab&quot; is hardly accurate as it conjures images of white lab coats, sterility and safety. The &quot;labs&quot; are actually little more than a stove in some backroom, home, or trailer that are death traps if you don't follow the recipe perfectly (and sometimes even when you do). However, she only alludes to the fact that it takes quite a bit of over-the-counter pseudoephedrine to make meth. It used to be much easier for the &quot;cooks&quot; because they'd clean out a couple pharmacies or grocery stores in the evening. It is much more difficult now with the behind-the-counter policy. Adding another impediment (i.e. doctor prescription) won't stop the meth problem. It will only add expense to legitimate consumers. Although some doctors are complicit with drug diversion, most will not have a problem calling in a prescription for pseudoephedrine in small quantities. The &quot;workforce&quot; to purchase meth will still exist and meth labs will still propagate. It's a cheap drug that people want. If it gets more expensive to make then people will buy it from sources in Mexico or elsewhere. In Oregon, going to a picture ID and logging of sales was enough to reduce meth lab incidents from 40/month to about 9/month(<a href="" rel='nofollow'></a>. Going to a prescription only pseudoephedrine system reduced meth lab incidents to 2/month. So it helps, but the big question is it is worth it and that's something we have to answer for ourselves.


Sun, Jun 12, 2011 : 1:02 a.m.

The link above has an extra parenthesis, the correct link is: <a href="" rel='nofollow'></a>


Sun, Jun 12, 2011 : 12:40 a.m.

Sweet. I have been working on methods to convert meth back to pseudoephedrine. Looks like the new business should be booming.


Sat, Jun 11, 2011 : 11:59 p.m.

The biggest difference between the original Sudafed (pseudoephedrine) and the Sudafed-PE (phenylephrine) decongestants is that the phenylephrine is not absorbed into the system as well as the pseudoephedrine. My experience with these products and most data suggests that the efficacy of these ingredients is often dependent upon the frequency that the person uses decongestants. The more frequently a person uses decongestants, the more likely that this person will experience better results with the pseudoephedrine than the phenylephrine. That being said, MethCheck is a huge pain for patients and pharmacy staffs. The patients must make sure that they get to the pharmacy during hours of operation, and the pharmacy staff is diverted away from other duties (filling prescriptions, billing insurances, talking to physicians, etc...) to stay in regulation with MethCheck. But this would not improve by making pseudoephedrine rx only. I doubt that MethCheck has affected the illegal use of pseudoephedrine to a great extent; if the abusers want it bad enough, they're going to get it one way or another. So as flawed as the MethCheck system is, it is better than requiring a prescription for pseudoephedrine. There are too many legitimate chronic allergy and sinus problem sufferers to make pseudoephedrine an rx only product. The fact that too many people don't have insurances to afford a visit to their physician has already been mentioned, and I'm sure that many physicians would rather not be given the responsibility of having to follow-up with every request for pseudoephedrine. What I do recommend is talking with your physician (if you have one) and pharmacist to see if your symptoms are best treated with pseudoephedrine or not. Too many patients end up using unnecessary ingredients that are not needed to help improve their symptoms.


Sat, Jun 11, 2011 : 11:37 p.m.

Wasn't a Detroit doc busted recently for writing fraudulent prescriptions for controlled substances?

Macabre Sunset

Sat, Jun 11, 2011 : 11:27 p.m.

Pseudoephedrine is mild and works wonderfully on a cold. To have that taken away because some idiot has a plan for defrauding pharmacies is beyond annoying. I will be sure to vote against any legislator who supports this inane proposal. Dawn Johnston obviously lives in a world where everybody has wonderful health insurance. At the public expense, of course. Most of us, however, do not have drug plans as part of our health insurance. Who knows what it would cost if heavily regulated? Who knows what cut the pharmacies would take? And why should I have to tie up my doctor's office and pay for a full office visit (again, only the cadillac plans keep that a low co-pay) every time I have a cold? This is a wasteful, harmful proposal.


Sat, Jun 11, 2011 : 9:54 p.m.

1. The fake &quot;on the shelf&quot; sudafed is worse than crap. It doesn't work for me and is a complete waste of money. 2. I jump through enough hoops to get the pseudoephedrine from behind the counter. Missing work in order to get a prescription is pointless (and I'm one of the lucky ones with a job and health insurance) . 3. Everything the feds have done with &quot;war on drugs&quot; has, shall we say, been ineffective. This will be just as ineffective. Chaz H said all this much better than I did.


Sat, Jun 11, 2011 : 9:32 p.m.

That would be super annoying. The fake sudafeds don't work, but I don't want to go running to my doc every time I need one.

Chaz H

Sat, Jun 11, 2011 : 9:05 p.m.

I happen to be somebody for whom regular allergy medications have no effect. Over the counter Nyquil no longer helps me at all since they took the pseudoephedrine out. Often the only solution to stop a severe attack is to head to the pharmacy and pick up something from behind the counter containing pseudoephedrine. Having to make a potentially costly trip to the doctor beforehand would leave me suffering for a longer period, and potentially unable to work while waiting to get in to see a doctor. How about those who suffer from severe allergies that have no insurance? Fighting drug epidemics through legislation is not the answer. The federal government has been proving this since I was a child and a &quot;war on drugs&quot; was declared. Education is the answer, not legislation. Teach people to make good decisions on what (or what not) to put into their own bodies. Teach people to take responsibility for themselves and not rely on the government to make everything that can be turned into something harmful illegal.