2.16.2012

Standing in line for my pseudoephedrine

Interesting essay from the Atlantic about the societal costs of curbing access to the cold medicine pseudoephedrine.  It's the latest bouncing around the blogosphere following the introduction of legislation to make an effective cold medicine prescription-only. 
In Do We Need Even Tighter Controls On Sudafed?  Megan McArdle argues that requiring cold suffers to go to their doctor to get a prescription for pseudoephedrine (PSE) creates an unnecessary burden on the health care system when compared with its impact on cleaning up amateur meth labs. 
The author seems to have done some math, but her research into the history and scope of meth appears limited to a few episodes of Breaking Bad. (For an excellent investigation into the history of the current epidemic, I suggest this Oregonian investigation. She states that controls on pseudoephedrine are aimed at controlling meth lab explosions from "amateur" cooks (who cooks meth as a hobby?) in the midwest.
Actually, meth was a long time Northwest phenomenon. For two decades law enforcement officials had trouble getting anyone back East to take it seriously.  I know, because I was a cops and courts newspaper reporter in the days when meth was exploding in the 1990s. These days, I'm on the other front line -- treating meth addicts daily for the toxic effects of abuse.
This is not a case of toxic labs and benign recreational drug -- the drug itself is toxic too. Making tighter controls on the ingredients was originally an effort to make it harder to get the drug, not just more difficult to make. 
Rural communities -- ill funded an ill equipped to do toxic clean up work -- were overwhelmed when meth was home grown. Fragile ecosystems, national parks, wildlife refuges and rural water supplies were contaminated and endangered by meth labs. Oregon's requirement for prescription-only pseudoephedrine helped cut these meth lab incidents down to zero
Indeed, controls like those imposed in Oregon and Washington helped create the large scale meth factories in Mexico. This is not a product we want Made in the USA if we can help it. When Mexico banned the main component of meth cooking outright in 2009, production started shifting back to the United States -- this time to places in the country with larger potential markets and less restrictive purchasing of the main ingredient.  
Outside of Oregon, meth cooks have found ways around the registration laws by using proxies and false ID to get PSE in states that don't require a prescription. 
As Oregon lawmaker Rob Bovett recently wrote for the New York Times in an Op-Ed that kicked off the debate:
The only effective solution is to put the genie back in the bottle by returning pseudoephedrine to prescription-drug status. That’s what Oregon did more than four years ago, enabling the state to eliminate smurfing and nearly eradicate meth labs. This is part of the reason that Oregon recently experienced the steepest decline in crime rates in the 50 states.


The problem is that pseudoephedrine is an effective cold medicine where as the replacement ingredient in Sudafed  Phenylephrine (hydrochloride)  is not. That means that some people will go the extra mile to "get the good stuff."  Here is Washington, you have to sign a registry and show ID at the pharmacy counter -- it is embarrassing, but not much of a hassle. I've done it. 
In Oregon, you need a script. Oregon Sen. Ron Wyden is now proposing that the drug be prescription-only nationwide. 
Sure, if you imagine all those cold suffers that currently buy Sudafed over the counter going to their primary care doc to get scripts, that's going to add up. Most folks will just suffer through the cold or buy something else. The companies that make PSE will see profits dry up.
Thus far, however, the authors of this debate fail to mention the societal costs of Meth in realistic terms. Meth addicts make up a substantial population of those treated in the Emergency Room for everything from abscesses, life-threatening infections, meth-induced psychosis and dental pain. 
Making PSE prescription only is an escalation in an arms race over a dangerous and toxic drug with massive societal impacts -- much greater in scale that the profits of a drug company or the comfort of those suffering through a runny nose. 


Required Reading: Unnecessary Epidemic

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