A pharmacist in Indiana is looking to leverage pharmacists' professional judgment in determining a patient's need for pseudoephedrine products that can be used to make meth.
A pharmacist in Indiana is looking to leverage pharmacists’ professional judgment in determining a patient’s need for pseudoephedrine products that can be used to make meth.
Harry Webb, RPh, owner of Webb’s Family Pharmacy in Rochester and Akron, Indiana, told Pharmacy Times he is trying to find solutions to the “urgent clandestine methamphetamine manufacturing epidemic” in his area.
Indiana leads the nation in meth lab seizures, with more than 1400 annual incidents, according to Drug Enforcement Administration figures.
In Webb’s territory of Fulton County, which is home to around 20,000 residents, there have been 86 meth lab seizures in the past 2 years.
“As a practicing pharmacist in a small town, I have first-hand exposure to this meth manufacturing epidemic,” Webb said. “I firmly believe pharmacists can solve this problem once the board of pharmacy adopts rules and possible penalties for those who ignore common sense.”
Legislative Efforts Targeting the Meth Problem
Webb is part of a Citizen Action Committee formed in March 2014 to combat the “meth lab merry-go-round,” he explained.
With the help of State Senator Randy Head, the committee members have been working to propose legislation similar to a law passed in Arkansas that helped decrease the number of meth labs in the state.
In 2011, Arkansas became the first state to allow pharmacists to make a judgment call on pseudoephedrine sales in their pharmacies.
Sen. Head will be introducing a bill modeled after Arkansas’ approach, Webb said. What the committee is working on locally is a “very elegant solution” to the problem, Sen. Head has said.
Ideally, the bill would make it unlawful to sell pseudoephedrine products anywhere except in a licensed pharmacy with a licensed pharmacist or technician. The licensed pharmacist would use his or her “professional determination” to decide whether the patient had a legitimate medical or pharmaceutical need for the product.
Webb would also like to see the state’s pharmacy board involved in creating regulations regarding pharmacists’ determinations.
In addition, the bill would waive liability for pharmacists who restrict pseudoephedrine sales.
“Most practicing pharmacists I have talked with say it is not hard to spot an illegitimate request,” Webb said. “Once chain pharmacists realize they will not be fired, they will do the right thing.”
Indiana pharmacy customers would also be limited in the amount of pseudoephedrine products they could buy in a single purchase. Sales would be entered through the National Precursor Log Exchange (NPLEx) so that they could be monitored by law enforcement.
In addition, patients with drug-related felonies would not be able to buy potential meth-producing products.
Last summer, Fulton County pharmacists agreed to change their sales policy so that pseudoephedrine products are only sold if the pharmacist can determine a legitimate need.
When pharmacies in Fulton County implemented this policy on a local level, sales of pseudoephedrine products in neighboring counties went up.
Sales in Fulton dropped by 8%, while neighboring Pulaski County pseudoephedrine sales went up 42%, according to Webb.
How to Recognize Meth Smurfing
Meth-makers often hire people to buy ingredients for them in a practice known as “smurfing,” which is similar to straw purchases of guns.
Smurfs may be friends or family of the meth producer or an acquaintance who wants to make quick money, Webb said. He noted that some meth cooks will pay $50 a box to a smurf or exchange pseudoephedrine products for other drugs.
A tip from Webb: most surfing happens in groups, so pharmacists should be suspicious if they see several people coming into the store in a short amount of time to buy the maximum amount of a pseudoephedrine product.
“Legitimate customers are usually treating acute symptoms and are not asking to buy the most they can,” Webb said.
The average patient might ask about availability of Mucinex D or Clairitin D, or inquire about what a good treatment would be for a sinus headache.
Smurfs might reveal they have more knowledge about the products and use slang like “20-120s” to represent a 20-pack of 12-hour Sudafed 120 mg, or “96 reds” to mean a 96-pack of pseudoephedrine 30 mg.
Webb said only 2 boxes of Sudafed are needed to cook a batch.
While a box of Sudafed might be worth $50 to a meth-maker, it takes around $20,000 to $55,000 to clean up a meth lab, which highlights how expensive the problem is.
“It is my hope to present pharmacist legitimization as an effective alternative to making pseudoephedrine a controlled substance,” Webb said. “If it is adopted, I am confident it will significantly reduce our clandestine meth lab problem that is costing this state millions of dollars. And our patients will still be able to get pseudoephedrine products if and when they need them to treat sinus symptoms.”
Best Practices for Pharmacists
Pharmacy staff can remove all non-meth-deterrent pseudoephedrine products and replace them with products like Nexafed and Zyphrex D. These products can serve as a decongestant but “significantly disrupt” meth making, according to Webb.
If a patient specifically asks for a pseudoephedrine product, he or she can be directed to a consultation with the pharmacist.
“We need to demonstrate that the pharmacy profession can and should eliminate this problem,” Webb said. “Wouldn’t it be wonderful for our profession to step up and solve a substance abuse issue, instead of being often being perceived as enablers?”