Limits on legal drug help curb meth abuse

Washington -- States are discovering that restricting the sale of certain cold medicines is going a long way toward reducing the enormous burden that methamphetamine use places on health and law enforcement services.

The federal government is now attempting to follow the states' lead with a bill introduced earlier this year that would restrict the sale of pseudoephedrine.

The manufacture and use of meth has been on the increase in recent years, especially in rural areas. Among the reasons for the stimulant's popularity is the ease with which it can be manufactured using readily available ingredients, such as pseudoephedrine.

Passage of a tough Oklahoma law last year, the first in the nation to require that pharmacists supervise the sale of such cold medicine to prevent theft or the purchase of large quantities, has been an effective deterrent.

"When the law was instituted, it was almost instantaneously that we began having fewer methamphetamine problems," said Doug Cox, MD, an emergency department physician and state legislator from Grove, Okla.

"A large number of psychiatric patients brought into the emergency room would test positive for methamphetamines," Dr. Cox said. "Once that law kicked in, we were seeing fewer of those folks."

In addition, the number of meth lab seizures in the state dropped by about 80%.

Patients apparently understand that there is a serious methamphetamine problem in Oklahoma and haven't complained about having to get cold medications from their pharmacists, Dr. Cox said.

Meth, which is a derivative of amphetamine, has been used by more than 12 million people in the nation, according to the 2002 National Survey on Drug Use and Health. Chronic, long-term use can lead to psychotic behavior, hallucinations and stroke.

When used during pregnancy, the drug can cause premature births, said Rizwan Shah, MD, medical director of the regional child protection center at Blank Children's Hospital in Des Moines, Iowa.

National studies suggest that such children have a smaller head size and difficulty organizing their sleep cycles and tolerating stress, Dr. Shah said. A few children, those exposed to large amounts of meth before birth, have had strokes or bleeding in the brain. "Those are the kids who have some neurological problems," she said.

Meth use has been a problem in Iowa for about a decade, Dr. Shah said. Last year about 1,200 meth labs were shut down by the police.

Some states, including Iowa and Illinois, have joined Oklahoma in strictly restricting access to pseudoephedrine by requiring pharmacists to supervise its sale or by allowing its display only behind a counter or in a locked case. Missouri requires that cold medicine with the drug be placed behind or within 10 feet of cash registers and in clear view.

Twenty-eight states already limit access to other meth ingredients, which can include liquid farm fertilizer and lye. Ten states have put limits on how many packages of cold medicine a person can purchase, according to the National Conference of State Legislatures.

Nationwide restriction

The congressional legislation, introduced by Sens. Jim Talent (R, Mo.) and Dianne Feinstein (D, Calif.), is modeled after Oklahoma's law. A companion House bill was introduced by Rep. Roy Blunt (R, Mo.).

"Meth use has swept across the nation and reached epidemic levels," Feinstein said when introducing the bill. "The most effective thing we can do to make meth harder to manufacture is to put cold medicine behind the counter at pharmacies and require purchasers to sign for it and show photo ID."

The measure would emphasize the role of pharmacists in policing the sale of over-the-counter medications, a task pharmacists are reluctant to take on.

"It is a lot of work for pharmacists," said Mary Ann Wagner, vice president of pharmacy regulatory affairs at the National Assn. of Chain Drug Stores.

Wagner noted that pharmacists recognize the seriousness of the meth problem, but said they also want to explore other options, including placing the medication behind another store counter or in a locked cabinet.

The most onerous part of the new procedures called for under the bill would be the maintenance of a log book of purchasers, Wagner said. Some states also require that pharmacists check a purchaser's identification to see if they had obtained additional cold medicine during the month.

"Since the log books aren't connected in any way, what's to prevent someone from going to the pharmacy across the street to purchase additional pseudoephedrine?" Wagner asked. Some type of electronic surveillance might be the answer, she said.

The federal legislation would permit buyers to purchase up to 6 grams of pseudoephedrine at one time and 9 grams over a 30-day period. It would allow others to sell the cold medications in rural communities without pharmacies as long as the same precautions are followed.

The bill, called the Combat Meth Act, also calls for the creation of a Methamphetamine Research, Training and Technical Assistance Center to develop effective treatments for meth abuse and disseminate information and technical aid to states and private entities on how to improve current treatment methods.