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Oregon's Prescription Requirement for Cold Medicine Has Little Effect on Meth: Study

Pseudoephedrine

First Posted: 02/21/2012 12:39 pm Updated: 02/21/2012 12:43 pm

Since 2006, the state of Oregon has had the strictest pseudoephedrine laws in the country. The popular decongestant, a common additive to over-the-counter cold and allergy medications, is also used to make black market methamphetamine. As meth use soared and volatile homemade meth laboratories proliferated in the early 2000s, many states began to put restrictions on the sale of the drug. The most common such restriction was to move the medications behind the counter, and require customers to show identification before purchasing them. But Oregon was the first state to require a doctor's prescription to purchase cold and allergy medication. After a drop in meth lab seizures across the state in the years after the law was enacted, several other states have considered the prescription requirement, although so far, only Mississippi has passed one.

According to a new report published by the Cascade Policy Institute in Portland, the law hasn't been nearly as successful as its proponents claim. The report was funded by the Consumer Healthcare Products Association, a trade group that represents the manufacturers of over-the-counter medications. But the data are compelling.

For example, while it's true that methamphetamine "lab incidents" have dropped by 90 percent in Oregon since 2004, the report points out that the bulk of that decline took place before the state's prescription requirement took effect in 2006. Moreover, the report points out that six other states near Oregon showed similar declines in meth lab incidents over the same period, despite not having a prescription requirement. The report also notes that while Oregon did experience a 23 percent drop in methamphetamine-related admissions to substance abuse treatment centers from 2006 to 2009, that figure mirrors a similar drop across the entire country.

The prescription requirement also has some significant costs. A trip to the doctor requires a fee for an office visit, transportation costs and missed time from work, all of which can be especially burdensome on parents. The Cascade report points out that the hassles associated with visiting a doctor likely cause many patients to seek less effective treatment or no treatment at all, resulting in a longer recovery and lost productivity. One 1992 study published in the Journal of Law and Economics found that the increasing availability of over-the-counter cold and allergy remedies prevented 1.6 million annual doctor visits. That number would likely be much higher today if all states had Oregon's law, resulting in higher health care costs, lost productivity, and lost time for doctors who would be spending time with sneezy patients that they could be spending with those suffering more serious illnesses.

Meth is also still readily available in Oregon, which suggests the decline in overall abuse may have more to do with general trends in drug use or better awareness of meth's particularly nasty effects than with supply-side policies. According to a 2011 report from the Office of National Drug Control Policy, there remains a "sustained high level of methamphetamine availability" in Oregon. But instead of coming from makeshift labs in basements and backyard sheds, like much of the country the state now imports its meth from "superlabs" in Mexico by way of international drug smuggling syndicates, the report says. That shift also could bring the ancillary effects of organized crime.

The aftermath from the Oregon law -- its heralded success, followed by a sober reassessment finding that the problem has merely taken a new form -- is nothing new. In 2006, Congress passed a provision, tacked on to the Patriot Act renewal, that imposes daily and monthly limits on the amount of pseudoephedrine -- the decongestant -- that one person can purchase, requires customers to show identification before making a purchase, and puts various restrictions and requirements on manufacturers and retailers. It was similar to the law already in effect in many states.

The national results have been similar to what has happened in Oregon: a steep drop in meth lab incidents and seizures, but no real decline in the drug's availability. The laws largely put an end to homemade meth labs, but opened market space for the superlabs and international cartels. It also may have created new black markets and a new class of criminals. The Associated Press reported last year that the law has dramatically increased the black market value of cold medication. College students, homeless people and others interested in quick and easy money have become "pill brokers," selling medication that retails for six or seven dollars per box to the meth cooks for $40 or $50.

The laws restricting the decongestant have had some other unintended effects. They've given rise to a new way of making meth that requires less pseudoephedrine, called the "shake and bake" method, and it has taken off. The AP reported in 2010 that the new method, which involves shaking a cocktail of volatile chemicals in a two-liter bottle, only makes enough of the drug for one or two people. But if done wrong, the resulting chemical burns can be worse than those from exploding backyard and basement labs.

Overeager enforcement of the meth laws has also ensnared some innocent people, including several incidents in which parents and grandparents (especially families with multiple children with severe allergies) have been arrested for inadvertently exceeding their legal allotment of cold medication. In fact, when the federal government made its very first arrest under the new meth law, the Drug Enforcement Adminstration celebrated with a press release. William Fousse of Ontario, New York, the release explained, had purchased nearly three times the amount of cold medication he was allotted under the new law. But even federal prosecutors would later admit they had no evidence Fousse was manufacturing meth. He says he was unaware of the new law, and was stocking up on cold medication because it helped him recover from hangovers. He was still convicted and sentenced to a year of probation.

In 2005, 49 convenience store clerks in Georgia were arrested by federal law enforcement officials for selling the ingredients to make meth to undercover officers. Of the 49, 44 were Indian immigrants who didn't speak English as their primary language, yet they were expected to understand the meth-maker lingo the agents used in their stores. (Defense attorneys would later point out that the agents were in fact using terms used more in TV and movies than by actual meth cooks.) In Mississippi, which like Oregon requires a prescription to purchase pseudoephedrine products, a woman was pulled over, searched and arrested this month for driving to Alabama to buy cold medication. Mississippi law also bars state residents from crossing the state border to purchase the medication.

Policy makers have consistently taken a "shoot first, ask questions later" approach to pseudoephedrine policy. Back in the early 2000s, politicians lambasted manufacturers of over-the-counter cold medications for their alleged complicity in the meth trade because they were marketing drugs containing pseudoephedrine when they could have been using phenylephrine, which has no value to meth cooks. The problem, as cold sufferers would soon learn, is that phenylephrine also happens to be useless as a decongestant. This inspired Rep. Henry Waxman (D-Calif.) to call for an investigation of one manufacturer (Pfizer) for marketing a useless drug.

Proponents of laws restricting consumer access to pseudoephedrine argue that the dramatic drop in the number of meth labs across the country alone justifies the policy. The volatile labs are dangerous not only to the meth cooks, but to neighbors and to the police officers who attempt to shut the labs down.

But drug war opponents argue that such labs can be the result of the government's broader prohibition on amphetamines. Opponents such as the late economist Milton Friedman have long highlighted the similarities between particularly noxious illicit drugs like homemade meth and crack cocaine and toxic, prohibition-era concoctions like wood alcohol or bathtub-distilled gin. Legalizing alcohol all but eliminated them.

For now, lawmakers seem committed to ratcheting down access to pseudoephedrine. Over the last few years, at least a half dozen states and several local governments have considered following Oregon's lead in requiring a doctor's prescription for cold medication. The evidence suggests these laws may well put the few makeshift domestic meth labs out of business for good. But they're likely to have little effect on the overall supply of the drug. It will also likely mean more business for international cartels. And more hassle and possible legal trouble for cold and allergy sufferers who need effective cold medicine.

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