Methamphetamine: Prescription-only or e-tracking systems?
Nationwide debate on smurfing and illegal meth labs heats up
Oregon was in the midst of a methamphetamine war during the early part of this decade, with hazardous meth labs springing up in basements, garages, and kitchens across the state. By 2003, Oregon law enforcement officials were encountering, on average, 39 meth labs each month.
To restrict the illegal sales of products containing pseudoephedrine (PSE), the main ingredient needed to produce illegal methamphetamine, Oregon became the first state to pass a law requiring prescriptions for PSE products such as Sudafed and Claritin-D. The result? In a 3-year period following the rule, Oregon reported only 46 meth-lab incidents.
Real solution or quick fix?
Oregon's prescription-only approach practically eliminated its illicit methamphetamine problem, but some pharmacists, consumer groups, and the drug industry describe it as a quick fix that will increase healthcare costs and inconvenience consumers, and they say it won't work nationally as well as electronic sales-tracking systems would.
[Pseudoephedrine] is a valuable drug. You shouldn't have to call your doctor, wait two weeks for an appointment, then take off a couple of hours from work to get a prescription, said Fred Mayer, RPh, MPH, a Drug Topics editorial board member and president of Pharmacists Planning Service Inc., a consumer, public health, and pharmacy-education foundation in San Rafael, Calif.
Many but not all law enforcement agencies disagree. Some say that prescription-only laws are the only way to dismantle the illegal methamphetamine trade, as was demonstrated in Oregon.
There is a solution to this human misery in the form of returning pseudoephedrine to prescription status, as it was prior to 1976, said Kent Shaw, assistant chief of the California Bureau of Narcotic Enforcement (CBNE).
The battle pits an effective and proven regulation against the profits of the pharmaceutical industry, thinly veiled as concern about consumers' access to cold medication.
The battle moves to Washington
The contentious debate over prescription-only versus electronic sales recently reached Washington, D.C., where members of the U.S. Senate Caucus on International Narcotics Control heard testimony for and against adding a prescription-only element to the federal Combat Methamphetamine Epidemic Act (CMEA) of 2005.
The April 13, 2010, hearing co-chaired by Sens. Dianne Feinstein (D-Calif.) and Charles Grassley (R-Iowa) included testimony from pharmacists, consumer groups, and law enforcement officials.
Since 2006, CMEA has required states to regulate over-the-counter sales of pseudoephedrine and ephedrine products.
It set daily limits on the purchase of these products and required pharmacies to place the products out of customer reach, to maintain sales logbooks, and to verify customer identification.
Smurfers muddy the waters
That approach worked until meth cookers began using "smurfers," criminals who go to pharmacies and retailers and use fake identification to buy illegal quantities of PSE products.
Police say that using the log system mandated by CMEA to catch the smurfers is like searching for a needle in a haystack.
Using the information provided by e-tracking systems is not much better, they say, because the criminals don't use their real names.
In some states, such as California and Arizona, smurfing is well organized and has progressed into its own black-market industry, stated a 2009 position paper from the Advisory Board of the National Methamphetamine and Pharmaceuticals Initiative (NMPI), a group of federal, state, and local law enforcement officials and prosecutors with the mission of reducing methamphetamine crimes.
According to the position paper, prescription control is the only effective means to prevent illicit methamphetamine labs in the United States.
Municipalities fight back
Cities and states are scrambling for answers. Consider:
-Ten states — Alabama, Arkansas, Illinois, Iowa, Kansas, Kentucky, Louisiana, Oklahoma, Missouri, and Washington — adopted the National Precursor Log Exchange (NPLEx), an electronic, web-based PSE sales-tracking system designed to detect and stop excessive purchases and provide information to the police. With NPLEx, a customer's photo identification is scanned by the pharmacy and the data is entered into a Web-based portal. When a transaction that would exceed the legal limit is entered, a message is instantly sent to the retailer or pharmacy, recommending denial of sale. The information is also transferred instantly to the database, where it is available for review by law enforcement.
-In February, Mississippi became the second state to require a prescription for PSE products. Several other cities and municipalities have also gone the prescription-only route.
-In California, where the CBNE estimates that the problem costs the state $114 million yearly, state legislators are debating whether to mandate electronic sales-tracking systems or to go prescription-only.
Armed with the Oregon example, which some call indisputable evidence, many law enforcements groups in California and elsewhere are pushing for a prescription-only law.
Oregon has seen a dramatic decrease in meth arrests and our nation's steepest decline in crime, Shaw said.
The prescription-only debate
An estimated 15 million Americans use PSE products, and some pharmacists and consumer groups believe the smurfing problem can be solved without adding the additional cost of a physician's visit for legitimate purchasers.
They believe prescription-only laws will increase workloads for pharmacists, increase Medicaid costs, adversely affect the poor, and eventually increase the cost of PSE products. (According to the 2009 NMPI position paper, none of these things happened in Oregon).
E-tracking supporters also point to some states that have significantly reduced meth-lab incidents without resorting to prescription-only laws.
Making pseudoephedrine a prescription product will have the detrimental effect of unreasonably burdening patients who rely on their local community pharmacists to provide timely access to beneficial OTC medications, including the counseling services that allow patients to make the right decision on which therapy will best suit their symptoms, said Bruce Roberts, RPh, former executive vice president of the National Community Pharmacists Association.
That's why we believe a possible alternative of allowing for electronic tracking of OTC medications containing pseudoephedrine may make the most sense, but it must not be implemented in a fashion where the cost burden falls on pharmacies over time.
The e-tracking alternative
The Consumer Healthcare Products Association (CHPA), which represents the drug industry, advocates strengthening CMEA by mandating nationwide participation in NPLEx.
The drug industry has committed itself to paying to link pharmacies and retailers to the national e-tracking system.
NPLEx offers capabilities for controlling the illegal diversion of pseudoephedrine that go far beyond anything available in the prescription arena, CHPA President Linda Suydam testified during the April U.S. Senate hearing.
A prescription mandate would simply drive the meth cooks underground and cut off access to information critical to finding illegal meth labs.
Jim Acquisto, a former law enforcement official who is director of government affairs at Appriss, the Louisville, Ky., company that makes the web-based tracking system used by NPLEx, concedes that e-tracking will work only if all pharmacies and retailers are linked.
Appriss has provided e-tracking systems to nearly 20,000 pharmacies and retailers in 43 states.
Acquisto said e-tracking has advantages over prescription-only laws.
If I buy my limit in New York, then fly to California and try to buy more six hours later, this system will stop me and make that info available to the police, Acquisto said.
Prescription laws don't talk from state to state. And they are vulnerable to prescription-writing fraud.
Getting around the system
Shaw called e-tracking modern-day snake oil and said that many of its supporters are naive about the sophistication of the meth producers.
There's also the problem of the occasional employee in collusion with the smurfers, since the e-tracking systems have an override that permits employees to complete any sale.
Shaw said a CVS manager was caught using fake identification to buy $2,958 worth of pseudoephedrine pills to sell on the black market.
[E-tracking] does nothing today, and it will do nothing tomorrow, Shaw said, noting that criminals have already found ways to beat that system.
Jun 15, 2010