August 11, 2013

What's a little meth when your nose is stuffy?

There can be no doubt that methamphetamine production is a menace on many levels. From the devastating effects of addiction on the individual, to the communities and agencies who must support the broken families, to the agencies that must clean up contamination left behind abandoned labs, to the criminal justice system that must try to stop the manufacture and dealing of the meth, to the health system that must try to repair an addicted body, it's truly a picture of falling dominoes to the tune of $23,384.4 million annually, according to a Rand study.

A recent study by the General Accounting Office compared the methods that states are using to reduce methamphetamine production. Regulations were implemented by various states beginning in 2004 in attempts to stem the production of methamphetamine. In 2006, the CMEA (the Combat Methamphetamine Epidemic Act) placed federal limits  on how much pseudephedrine-containing (PSE) drugs can be bought and require PSE products to be kept behind a counter. Purchasers are required to show a photo ID. Pharmacies are required to keep a log of those who buy the drugs. As well, many states implemented the NPLex system, a database that tracks PSE purchases by individuals. Initially these regulations and systems enjoyed success. For example, in Alabama, in just the first quarter of 2010, 26,354 purchases were blocked, amounting to a total of 64,000 grams of PSE (Subcommittee Report of the Alabama Drug Abuse Task Force).   Following these efforts, methamphetamine incidents declined sharply after peaking at 24,000 total incidents in 2004 to a low of 7,000 incidents in 2007. 

However, they soon began to increase again. In 2010, 15,000 total incidents were reported.  Meth lab incidents in Kentucky have increased from 297 in 2007 to 696 in 2009 despite implementation of the NPLex system. It didn't take long for meth producers to get around the various obstacles presented by the CMEA by hiring gangs of "smurfers" who buy the small quantities allowed (sometimes using false IDs), and then combining the purchases until they have enough to make their next batch of meth. In addition, new methods of meth production have made it easier and cheaper to produce meth.

It's clear that something else needs to be done. Two states have gone one step further, and now require any PSE product to be prescribed by a medical provider (PSE products had required prescriptions until 1976). The GAO study reports that Oregon and Mississippi's adoption of this policy appears to have helped to reduce meth lab incidents. For example, in Mississippi, the number of reported meth lab incidents declined from their peak by 66 percent to approximately 321 labs in 2011.

The West Virginia legislature is considering a bill to require prescriptions for PSE products. They are right to be so concerned. A few months ago, the Clandestine Drug Lab Remediation Program in West Virginia said 271 labs were uncovered in 2012, an increase of 50 from 2008. Just since the start of this year, authorities report 40 labs have been busted. Granted, NPLEx was just implemented in January of this year, but if the meth producers are any bit as savvy as the producers in other states, we can assume that many labs are going undetected.

The OTC (over the counter) drug industry is fighting hard to kill this bill. Their objection is that it will be harder for patients to acquire PSE products. One of the "officials" arguing against this bill is Carlos Gutierrez, director of governmental affairs for the Consumer Healthcare Products Association The Consumer Healthcare Products Association represents the country's leading makers of consumer healthcare products. Their job is to make sure their clients' products are as easy to buy as possible and that no legislation passes that will hurt any stockholders of their clients (amount spent on "lobbying activities" in 2012: $768,162)  He argues that a doctor might write a prescription for someone to get a PSE product for an entire year and that the product would go into a meth lab. This is ridiculous for a number of reasons. First of all, most doctors won't write a prescription for an entire year. Second of all, PSE products aren't supposed to be taken long term (just read the warnings on the package: -- 7 days is the recommended limit).  

As well, pharmacy associations such as the National Community Pharmacies Association and the National  Association of Chain Drug Stores are opposed to the bill. 

Granted, the arguments against this bill are many: a doctor's visit will most likely be required in order to get the prescription, tax revenues will be lost because prescriptions are not taxed, the argument that prescription drugs are already abused, healthcare costs would rise, etc.

However, evidence from the two states who have implemented the new requirement have defied most of those arguments. Added costs to the Medicaid program in Oregon, for example, were only $8,000. The co-pay, when insurance was used for the prescription drug, usually made it even cheaper to the patient, and for those who didn't have insurance, it only cost $6. 

We require prescriptions for other dangerous drugs, such as Oxycontin and Percoset, and yes, a certain amount of those drugs sadly end up in the wrong hands. However, what kind of toll would we be looking at if those drugs didn't require prescriptions? Also, meth labs are dangerous. They require the the precision and care of a scientist. Meth labs can explode, cause years of contamination, endanger health care and law enforcement personnel. Methamphetamine, whether in an area where a cook, or use, has occurred, can readily become airborne both as a particulate and a vapor. It can thereafter settle on any flat surface and be picked up by passersby or re-aerosolized and inhaled. This is most important where toddlers and young children are present. Practically anyone associated with a meth cook area: family, friends, law enforcement, custodial personnel, will have positive urine tests for methamphetamines (Atlantic Environmental Incorporated). In other words, it is a HAZARDOUS MATERIAL that should be under the strictest possible regulation.


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