William Spafford Smock, MD, FACEP, FAAEM, a Professor of Emergency Medicine at the University of Louisville School of Medicine speaks his mind about pseudoephedrine, meth labs, and the Kentucky legislators who failed to pass a prescription pseudoephedrine law that would have helped the state eliminate its meth lab problem.
Pseudoephedrine Scheduling …. or a date with methamphetamine?
Methamphetamine is a pox: it burns, it scars, it poisons, it kills. It ruins countless lives and is a tremendous financial burden on our justice and healthcare systems.
Pseudoephedrine is the prerequisite precursor for methamphetamine. NO other over-the-counter medication can be used to manufacture or “cook” meth, period! The availability of pseudoephedrine is the Achilles’ heel of the methamphetamine industry. Limit access to the drug to only those with a medical need for it, and kill the industry. It’s a no-brainer, right? So what’s the hold up?
Pseudoephedrine is the most commonly used over-the-counter decongestant sold in America today. Its manufacture and sale are an $800 million dollar industry, in this economy nothing to sneeze at. And herein lies the answer to the scheduling question. The mere $20 million bill that Kentucky bore in meth-related criminal justice costs in 2009 pales in comparison to the pharmaceutical industry’s profits. But what about the medical costs borne by the State? One week in University’s Burn Unit can easily top $100K. Who pays for this healthcare? How many meth cooks do you think have the Blues or Humana PPO?
The federal Combat Methamphetamine Epidemic Act of 2005 moved pseudoephedrine behind the counter. It also requires pharmacies to collect information on purchasers. This information is used to track specific individuals and to limit the quantity purchased to no more than 9.0 grams in a 30-day period. Nine grams translates into a minor pharmaceutical stockpile of 300-30mg tablets per month. If a person were to take the maximum “recommended adult dose” for 2 weeks continuously his/her needs would total 96 tabs. So why are 300 tablets made available every month? Is this the extent of the effort exerted to fight an epidemic? No wonder we’re losing. Who do you think got the last word on this issue in Kentucky’s recent legislative session as KY House Bill 497 to schedule pseudoephedrine died in committee? Was it the doctors and police that daily deal with this disease or the industries that reap the profits?
In 2005 the State of Oregon took the courageous step of restricting the sale of pseudoephedrine to individuals with a valid prescription. So what happened on July 1st, 2006 when the law went into effect? Did thousands of Oregonians go around with untreated congestion? Did the workload of pharmacists, family physicians, ER docs and allergists increase? Did medical costs skyrocket or the cost of pseudoephedrine increase? The answer to all these dooms-day predictions is a resounding: NO! And guess what, “smurfing” (“smurfing” is the practice of paying friends, acquaintances and strangers, to purchase a 30-day supply) stopped, the number of meth labs plummeted, meth-related healthcare and criminal justice costs dramatically declined, doctors and pharmacists were not overrun, and on my last trip to Oregon I didn’t meet one person with a stuffy nose.
As healthcare providers we understand that there is very rarely only a single drug to address a condition or disease. Aren’t we lucky that nasal congestion can be treated with a multitude of over-the-counter remedies?
There is broad-based support and sound medical reasoning for again making pseudoephedrine a “prescription only” drug (it was scheduled by the FDA before 1976). Police departments, prosecuting attorneys, Fire and EMS agencies, emergency physicians, health departments and medical societies, all recognize the devastating impact of methamphetamine and are lining up in support of legislative changes that will protect the health of Kentuckians and save lives. Nationally the story is the same, the DEA and the United States Department of Justice strongly support the “prescription only” route to limit pseudoephedrine.
As a Professor in the Emergency Department at the University of Louisville Hospital I see the hollow eyes and rotten teeth of the meth addicted young woman who sells what is left of her body for her next fix of this extremely addictive drug. I hear the screams of the young man who was the meth “cook” (before the bottle exploded in his hands) as the skin of his hands and arms is peeled away by the burn unit nurses. I touch the pain as I push a chest tube between the ribs of a bleeding delivery boy, shot and robbed by a meth addict who would do anything to get money to buy some more meth. Unfortunately, these Kentuckians will most likely never meet the representatives and senators from this great Commonwealth who had the power to change their date with methamphetamine.
William Spafford Smock, MD, FACEP, FAAEM
Professor of Emergency Medicine
University of Louisville School of Medicine
Chairman, GLMS Public Safety Committee