In a hearing held yesterday morning, members of the Senate Caucus on International Narcotics Control investigated solutions to the growing problem of illegal methamphetamine production fueled by the sale of OTC cold medicines. The hearing focused on the benefits of legislation adopted by Oregon in 2006 that requires prescriptions for all products containing pseudoephedrine (PSE).
The model has been criticized by pharmacy groups, including the National Community Pharmacist Association (NCPA) and the National Association of Chain Drug Stores (NACDS), who argue that it limits access to commonly used medications and increases health care costs for patients and providers.
Regulations to curb meth production have yielded mixed results over the years. Currently, patients must show a valid federal or state photo ID to buy products containing pseudoephedrine, and can only buy them in limited amounts. Retail sellers of products used to make meth must also self-certify with the Drug Enforcement Agency. These and other measures included in the Combat Methamphetamine Enhancement Act have resulted in a national decline in the number of meth labs; however, that decline has begun to slow, and meth labs are increasing in some areas, according to Sen. Chuck Grassley (R, IA), co-chair of the Senate Caucus on International Narcotics Control.
Grassley and co-chair Sen. Dianne Feinstein (D, CA) attribute these increases to “smurfing,” a strategy in which smugglers visit multiple locations and purchase the maximum legal amount of PSE from each. Some states have implemented electronic tracking systems to deter smurfing, but many individuals have been able to trick the systems using fraudulent identification. Fake IDs account for 70 to 80% of identities recorded in electronic systems, a retired member of the Los Angeles Police Department told Feinstein. Meth cooks employ a range of backhanded tactics—from employing the homeless to varying their daily rotations—to build their supply of PSE, the detective said.
Based on the results of Oregon’s experiment, Feinstein is optimistic about the ability of prescription mandates to limit the production of methamphetamine. She said Oregon had “virtually eliminated” meth labs in the state since the legislation was enacted in 2006. As evidence of the law’s success, Feinstein cites a report by state authorities that recorded only 10 lab seizures in 2009, compared with 189 in 2005. Yet Grassley and others suggest those figures may reflect a different scenario—one in which underground meth production is simply more difficult to detect.
Support for real-time electronic tracking systems remains strong, especially from NACDS, who said in a statement that "a national electronic logbook could potentially be a 'win-win-win' for policymakers, law enforcement officials, and consumers." To maximize their potential, Grassley and NACDS said the systems must be implemented and standardized nationwide. A similar statement by NCPA also acknowledged electronic tracking as a potential alternative, but urged the need for seamless integration with pharmacy operations and continued federal support in installing and maintaining the systems. “This has to be a long term commitment, and cannot be an unfunded mandate on community pharmacies,” the organization said.
Grassley suggested a third option—one that recognizes the ability of pharmacists to handle the safe and legal distribution of PSE. In his home state of Iowa, pseudoephedrine-containing products can only be purchased from a pharmacy, “effectively limiting supply to professional pharmacists,” the senator said in his opening statement to the caucus.
Both senators addressed the potential economic impact of scheduling PSE as a prescription-only product, and expressed openness to alternatives that balance the needs of individual patients with the importance of reducing methamphetamine production. By collaborating with lawmakers as they continue to weigh legislative options, NCPA and NACDS hope to be instrumental in developing a workable solution for all parties involved.