Federal anti-meth law targets access to pseudoephedrine

President Bush recently signed into law a measure to combat methamphetamine abuse through increased funding to investigate and prosecute offenders and limits on consumer access to products containing pseudoephedrine, a key meth ingredient.

But there is an important piece not addressed by the legislation, according to physicians who provide care for meth addicts and their children.

"Unfortunately, the thing that is absolutely lacking -- it's just a glaring hole in the legislation -- is treatment," said Kathryn Wells, MD, medical director of the Denver Family Crisis Center at the Denver Health Medical Center.

"I don't think we can fully address the issue of meth addiction in our country if we don't address treatment," said Dr. Wells. She serves on the executive committee of Colorado's Drug Endangered Children program and is a board member of the Colorado chapter of the American Academy of Pediatrics.

The number of people seeking treatment has skyrocketed during the past decade. For example, the number of meth users admitted to substance abuse clinics nationwide more than quadrupled, from 28,000, or 2% of all drug treatment admissions, in 1993 to 136,000, or 7% of admissions, in 2003, according to a March 1 report by the Substance Abuse and Mental Health Services Administration.

The need for treatment programs is increasing dramatically, and lack of funding is an obstacle in meeting the demand, states the National Assn. of Counties. The group surveyed 200 county behavioral health officials in late 2005. Sixty-three percent reported they do not have sufficient capacity in county programs to treat meth addicts, and 57% say the reason is lack of funding.

The Combat Methamphetamine Epidemic Act, which became law March 9 as part of the Patriot Act reauthorization bill, does not authorize more funding for methamphetamine treatment.

But the president has proposed boosting meth treatment grants provided through SAMHSA from $19 million in fiscal 2006 to $34 million in fiscal 2007, according to agency spokesperson Shelly Burgess.

Members of Congress have said they also hope to significantly increase federal funding for meth treatment during the appropriations process this year.

Sen. Jim Talent (R, Mo.), who sponsored the Combat Meth Act with Sen. Dianne Feinstein (D, Calif.), told AMNews he is "very strongly supportive of increasing the funding and availability of meth treatment."

According to Senate staffers, an increase in meth treatment funding will be considered this year as part of legislation to reauthorize SAMHSA, the jurisdiction of the Senate Health, Education, Labor and Pensions Committee. Talent said he will work with the senators writing that bill.

Treatment funding was omitted from the Combat Meth Act for jurisdictional reasons, according to Talent's aides. The legislation was passed through the Judiciary Committee last year. Taking the bill through the HELP Committee as well likely would have slowed its passage, they said.

In the House, lawmakers who belong to the "Congressional Meth Caucus" also plan to focus more attention this year on the need for prevention and treatment resources, according to staffers.

Cold medicine access tightened

Although the new anti-meth law does not address treatment funding, it is the first comprehensive methamphetamine legislation enacted at the federal level.

"Many of the things that are in the legislation are really important in order for us to address the issue of methamphetamine," Dr. Wells said. "It's a very nice, multipronged approach."

The new law restricts consumers' access to pills containing pseudoephedrine and ephedrine. As of Sept. 30, 2005, retail stores are required to keep these products behind the counter or in a locked cabinet.

Consumers are limited to buying 3.6 grams, or 120 pills, per day and 9 grams, or 300 pills, per month. They must present a government-issued ID and sign a logbook to purchase them.

At least 37 states also have restricted sales of pseudoephedrine products. Some states, such as Iowa and Oklahoma, have adopted stricter limits that will not be pre-empted by the new federal law.

The American Medical Association, the American College of Physicians and the American Academy of Pediatrics did not take a position on the bill. But physicians generally support the restrictions on access to pseudoephedrine if it means preventing meth cooks from getting access to needed ingredients, said Donna Sweet, MD, chair of the ACP Board of Regents and a professor of internal medicine at the University of Kansas School of Medicine-Wichita.

"It's such a little thing that I don't think most physicians have a problem with that," she said.

Going after the makers and sellers

The measure provides $99 million each year for the next five years for the Meth Hot Spots program, which trains state and local law enforcement to investigate and prosecute meth offenders. It also toughens criminal penalties for meth production and trafficking.

The bill will allot $20 million during each of the next two years to help states assist children who live in a home in which meth or other illicit drugs are used or manufactured.

That funding will provide important support for state efforts to help these children, who often face physical and mental health issues caused by abuse, neglect and living in proximity to meth and dangerous chemicals used in making the drug, Dr. Wells said.

"These kids are in environments where their caregivers are becoming disconnected with the needs of the child," she said. "Our hope is this funding will help us develop the means to track these children over time and see what the outcomes may be."

The measure also authorizes the U.S. attorney general to award three-year grants to state criminal justice and child welfare agencies that collaborate to address meth use among pregnant and parenting women who are criminal offenders.