Requiring a prescription for pseudoephedrine: How effective is that?

The State of Mississippi passed a law in 2010 which banned sales of pseudoephedrine without a prescription. The law has resulted in a dramatic improvement in which 698 total methamphetamine (meth) incidents with 314 operational labs were identified in 2010 while there were 119 incidents with only 8 labs in 2013. Other states such as Tennessee are considering similar laws and Oregon already has a law in place as restrictive as the Mississippi law. In Tennessee, there has been a product tracking program which restricts sales, but has not resulted in a decline in the number of meth lab incidents. These statistics make it clear that banning sale of pseudoephedrine without a prescription has stopped a large number of the producers from operating within the state with precursors obtained in the state.

Along with the numbers of incidents and labs decreasing, usage has decreased. According to the Center for Disease Control’s Youth Risk Behavior Surveillance System, among Mississippi 9th through 12th grade students, usage dropped from 6.3% in 1999 to 3% in 2011. Usage of certain drugs is well known to follow trends and there was already a decline is usage occurring even prior to Mississippi’s law being enacted. Educational programs have attempted to teach youth about the dangers of meth usage and this has helped to have a positive effect along with the law changes. The United States Government Accountability Office (GAO) reported that the number of homes with drugs where Mississippi children were present fell by 81 percent after the Mississippi law took effect.

This all looks great, however, the current improvements may only be temporary. Oregon has had a law similar to Mississippi’s since 2006 and then saw arrest rates related to methamphetamine increase by 36 % from 2009 to 2012. The Tupelo Daily Journal reported that there had been an increase in the number of meth arrests in 2013. While local meth labs have declined in Mississippi since 2010, in Alabama, they saw a decline in the rate of meth labs in 2011 and have only a tracking program in place. Therefore, the picture is not completely clear how effective the law will be in the long term.

Initial declines in meth incidents may result from product being initially unavailable until drug trafficking can bring it back into the state through other means. The primary supply (80%) of meth now comes from Mexico, according to the U.S. Drug Enforcement Administration. Mexican drug cartels are now replacing the small in-state producers. Coastal areas of Mississippi have had an increase in local production. In Hinds County, MS, nearly ten kilograms of meth was found during an arrest valued at $1.3 million; it originated in Mexico. It has taken time for these drug cartels to get their distribution linkage of small groups together so that they provide for the demand that will increase if the supply is here available and they would not be supplying it if it were not being used.

The Mississippi Bureau of Narcotics has had to shift its focus from the local small suppliers to having to track the drug cartels which are fewer in number, but have the potential to supply even more meth than what used to be available. While a home lab can produce a few ounces of meth, these Mexican “super labs” can produce a reported ten pounds of “ice” daily, according to a GAO report to Congress. Also, the homemade meth is only half as potent and dingy colored compared to the crystalline appearing ice which is said to look like rock candy.

With the passage of more time, it will be more clear if Mississippi’s law will continue to have the effect that was intended. While the users of meth now are getting greater access to more potent forms of the drug, Mississippi consumers are still frustrated with not being able to treat their colds without greater expense and inconvenience which results in lost productivity at home and in the workplace. Those leaders, such as State Senator Chris McDaniel (currently contesting the runoff for the seat held by Thad Cochran), who urged caution and voted against the more restrictive laws in Mississippi, appear to have more foresight than was initially apparent to the more short-sighted among us.

David P. Smith is a family physician who blogs at Rebel.MD.

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  • ninguem

    “Behind the counter with ID” is good enough. We saw that in Oregon.

    The paper trail of the ID, even if fake, is enough to allow police to track the smurfs and eventually the labs. The yokels running the meth labs, at least for a while, got bulk pseudoephedrine from Canada, though I’m told that route got closed.

    Prescription status is overkill.

  • John C. Key MD

    There are lies, damned lies, and statistics and law enforcement can put out any numbers they want. I doubt that the restrictions have been meaningful at the street level; meth is all over the place in my South Texas community, “behind the counter with ID required” or no. The meth war is lost, along with all the other drug wars and the reason for the loss is a decline in our culture, not a decline in law enforcement.

    Law enforcement has no helpful role in drug abuse prevention and recovery. The criminal justice system only makes drug abuse victims unhirable and unhousable. The disorder is its own punishment.

    • ninguem

      The Oregon stats on the number of meth lab bust, showed little change when the limits were placed, as smurfs just hit multiple stores. It didn’t change when it went “behind the counter”, but DID drop when it went “behind the counter” WITH ID THAT THE PHARMACIST RECORDED.

      My presumption FWIW, is that the police now had a paper trail to track down the smurfs and from there to the distributors and labs.

      At the same time, if it’s anything like Oregon, the meth on the streets didn’t change, as much like “Breaking Bad”, the little backwoods yahoos cooking meth with pseudoephedrine, turned into big industrial processes run by large gangs and organized crime, with different precursor drugs.

      So…..I dunno…..it’s a quibble, but “behind the counter” works, and it doesn’t. Agree, same amount of meth as before, just changed the production line. Maybe made worse, in that the gangs are really bad news.

      To make pseudoephedrine by prescription, makes things more cumbersome, and does not help the drug problem.

      Now all that being said, and I haven’t checked this and can’t remember myself, I’ve been told pseudoephedrine WAS a prescription drug in times past, and made OTC.

      IF that’s true, I guess it means things have gone full circle.

      • NormRx

        I sold Novafed and Novafed A, both were prescription. Novafed was a 12hr. pseudoephedrine and the A was with chlorphenerimine. Both drugs were available OTC, but by keeping it Rx most insurance plans covered them.