Congress takes on growing meth problem

Congress appears poised to address the burgeoning problem of methamphetamine abuse by limiting consumers' access to decongestants containing pseudoephedrine and ephedrine, which are key ingredients used in cooking the drug.

Under the Combat Methamphetamine Epidemic Act, pharmacies and retail outlets would be required to keep products with pseudoephedrine and ephedrine behind the counter or in a locked cabinet, and employees would need special training before being authorized to dispense them.

The legislation, which combines a measure approved by the Senate in September and a bill proposed in the House, has been attached to the Patriot Act reauthorization bill, which Congress is expected to consider before adjourning for the year.

The measure would place the first federal restrictions on the amount of pseudoephedrine pills that consumers can purchase. Sales of gel and liquid medicine would not be restricted because they are not normally used in making meth.

If the bill is enacted, consumers would be kept to a daily purchase limit of 3.6 grams, or 120 pills, and a monthly limit of 9 grams, or 300 pills. They also would need to present a government-issued ID when buying pseudoephedrine products and to sign a logbook recording the transaction.

The legislation would not preempt state restrictions, such as an Oregon law that requires a prescription for buying medicine containing pseudoephedrine, and an Iowa law that limits monthly purchases to only 7.5 grams. So far, 37 states have imposed limits on pseudoephedrine products.

Some physicians who specialize in treating patients with drug addictions say they support limiting access to pseudoephedrine, but they're not sure how effective it will be in stemming the tide of methamphetamine abuse. The drug is a highly addictive stimulant that can cause violent behavior, heart failure and brain damage.

"Intuitively, it sounds like a good idea. But I think any drug dealer worth his salt could get around that very easily by just going to different pharmacies," said Peter Rogers, MD, MPH, a pediatrician at Columbus (Ohio) Children's Hospital who specializes in adolescent medicine and is certified in addiction medicine.

Most states do not have computer databases for tracking consumer purchases from one store or pharmacy to the next, but a few states are starting them. Oklahoma, which in 2004 was the first state to limit pseudoephedrine sales, launched a database Nov. 1. West Virginia, which passed similar legislation in July, plans to start tracking sales Jan. 1, 2006.

Dr. Rogers, who treats many adolescent drug addicts, said he believes most meth dealers are even likely to find ways around databases, purchasing limits and other measures designed to curb the sale and use of methamphetamine. "The people who make and deal drugs are always one step ahead of us."

Most meth used in the United States is imported. But small, makeshift meth labs are a major concern not only for the drugs they produce, but also because of the fires, explosions and hazardous waste often caused by the chemicals used in cooking meth.

In the case of Oklahoma, its law restricting pseudoephedrine sales is credited with a dramatic reduction in the number of small-time, clandestine meth labs found by law enforcement. The number dropped more than 80% within 10 months.

But state law enforcement officials reported in July 2005 that Mexican drug cartels have apparently moved in to fill the void. They said seizures of Mexican-made versions of methamphetamine had jumped fivefold in Oklahoma since pseudoephedrine was placed behind the counter. There are no signs that meth use has fallen.

The real key to reducing meth abuse is improving access to treatment, Dr. Rogers said. "But insurance companies are very reluctant to cover treatment. It's sad."

Chances of passage

The congressional measure appears to have solid, bipartisan support in both the House and Senate. But its attachment to the controversial Patriot Act reauthorization bill, still being negotiated, could slow its passage. A coalition of Republican and Democratic senators has threatened to filibuster the Patriot Act bill unless major changes are made.

Nevertheless, "we're optimistic it will be passed," said Rich Chrismer, a spokesman for Sen. Jim Talent (R, Mo.), who is a lead sponsor, along with Sen. Dianne Feinstein (D, Calif.), of the Senate-passed meth legislation.

In addition to limiting sales of pseudoephedrine and ephedrine, the measure would authorize an international monitoring system to track their import and export. The bill also would toughen penalties against meth traffickers and smugglers and against people who cook or deal meth in the presence of children. It would authorize $40 million in fiscal years 2006 and 2007 to help states assist children who are living in a home in which meth or other illicit drugs are used or manufactured.

The bill has been endorsed by many law-enforcement groups and the National Assn. of Chain Drug Stores. "We're fairly positive that this legislation will be a step in the right direction," said NACDS Senior Vice President Mary Ann Wagner.

Physician groups have not taken a position on the measure. "We haven't signed on to the legislation, which is not to say that we won't," said John Friedman, a spokesman for the American College of Emergency Physicians. "The misuse of any medication is always a concern for emergency physicians."

At its 2005 Interim Meeting in November, the AMA House of Delegates called for a report that would formalize the Association's position on addressing methamphetamine abuse. Delegates adopted a resolution "that our AMA work with appropriate organizations to study the problem of meth use and addiction, and develop recommendations to address this emerging health problem."

The extent of the problem can be seen in the increasing prevalence of meth-related arrests and emergency department visits. Meth is also a major cause of child abuse and neglect.

The National Assn. of Counties released a study in July that found that nearly 60% of surveyed counties said meth is their largest drug problem.