CHPA supports preserving access to pseudoephedrine and strengthening our nation's effort to stop illegal sales.
Pseudoephedrine (PSE) is a safe and effective active ingredient found in leading cold, allergy, and sinus medicines to provide congestion relief. While over 18 million American families rely on these medicines every year, PSE can also be used in the illegal manufacture of methamphetamine. As a result, some policymakers and law enforcement officials in a number of states support requiring a doctor's prescription to obtain PSE-containing medicines, even though the vast majority of these medicines are sold to law-abiding consumers.
The U.S. Department of Justice National Drug Intelligence Center's "National Drug Threat Assessment 2011" notes that the large majority (75 to 80 percent) of methamphetamine is imported into this country from outside sources, specifically Mexico. Domestic methamphetamine production — where so-called "meth cooks" manufacture the drug in small labs by using readily available ingredients, including over-the-counter (OTC) medicines containing PSE — is regionally based with 82 percent of domestic lab incidents concentrated in ten states.
In 2005, Congress passed the Combat Methamphetamine Epidemic Act to address the criminal diversion of PSE to the illegal production of meth. This federal law requires:
PSE-containing OTC medicines to be secured and sold from behind a sales counter;
Daily purchase limits of 3.6 grams (approximately a 15-day supply) per day and nine grams per 30 days; and
Purchasers must present government-issued identification and sign a logbook accessible by law enforcement.
As a result of state and federal initiatives, meth labs declined nationally by more than 65 percent from their peak in 2004 to a low in 2007. Unfortunately, meth lab incidents in certain parts of the country crept up again. One reason for the recent uptick in meth lab incidents in certain states is the prevalence of a new form of meth manufacturing known as the "one-pot" or "shake-and-bake" method. Unlike other meth-manufacturing forms, the one-pot method incorporates new ways to make smaller quantities of meth in more frequent batches.
Some assert that another reason for this is that meth criminals have devised new methods for bypassing PSE laws, such as "smurfing" — the practice of hiring individuals to purchase small batches of PSE from multiple stores.
The Solution: Preventing Illegal Sales via Blocking Technology
More than half of the states (over 30) have gone beyond federal requirements and adopted laws featuring PSE electronic illegal sales blocking technology. A common form of this technology employed by states is the National Precursor Log Exchange, or NPLEx. Electronic blocking technology unifies the logbooks that were previously kept in each individual store. This prevents criminals from visiting multiple stores to skirt legal limits and allows law enforcement officials to access purchasing activity in real time.
Electronic blocking technology:
Stops meth crimes before they happen by giving retailers a tool to block illegal sales;
Provides law enforcement with real-time purchasing data and alerts — helping them identify meth cooks and ultimately, meth labs;
Allows retailers, in a process similar to a credit card transaction, to automatically block unlawful PSE sales; and
Ensures that responsible consumers continue to have access to the cold and allergy medicines they rely on for relief.
CHPA continues to work with states to improve this technology to stop the illegal sales of PSE-containing medicines. In Oklahoma and Indiana, we worked with the legislature to prohibit sales to prior meth offenders.
In addition to efforts to strengthen this technology, CHPA has developed a voluntary anti-smurfing educational program for the retail setting in select states. Given recent reports of hardened criminals approaching third parties to avoid federal daily and monthly gram limits, manufacturers developed a program aimed to educate potential "smurfers" that purchasing these medicines for others for payment can lead to prison time.
The Downside of Rx Policies
Consumers value cold and allergy medicines containing pseudoephedrine because they are effective and reduce unnecessary and costly visits to the doctor. When surveyed about a prescription requirement, consumers have consistently expressed opposition. A February 2013 national survey of asthma, allergy, cough cold, and flu patients by the Asthma and Allergy Foundation of America found that a 62-percent majority of respondents oppose prescription-requirement laws.
Additional economic impacts to consumers, taxpayers and the healthcare system at large include:
An estimated 579,000 new doctor's visits with projected costs of $26.6 million in the first year alone;
Greater absenteeism and lost work productivity, when the common cold already costs this nation an estimated $25 billion in lost productivity each year;
Increased health insurance premiums due to additional doctor visits and higher drug costs; and
Decreased sales' tax revenues in many states, as over-the-counter medications are subject to sales tax while prescription medications are not. A 2011 Avalere study estimated that a prescription requirement would cost states $219 million in lost sales tax revenues over ten years.
Reducing or cutting off the supply of PSE does not guarantee a reduction in demand or use of methamphetamine. Mexico, for example, banned pseudoephedrine in 2009 yet the country supplies as much as 80 percent of America's meth, according to an estimate by the Drug Enforcement Administration. Despite these efforts taken by the Mexican government, drug traffickers and meth cooks have simply found alternative ingredients to use, such as phenylacetic acid.
The rise in prescription drug abuse also reinforces the fact that scheduling a drug is not a guarantee of preventing abuse. In fact, illicit use of prescription drugs is the fastest growing category of drug abuse, and there are no limits to how much PSE an individual can buy with a prescription.
Rx and the Oregon Myth
While many proponents of a prescription mandate cite Oregon as the solution to meth, the state still continues to struggle with meth-related crime. When analyzing meth production rates in Oregon, it is important to understand that while Oregon has experienced a drop in meth labs of the last decade, the majority of the decline came in the years preceding the state's 2005 prescription requirement law. Moreover, neighboring states have also experienced markedly similar rates of decline. From 2004 to 2012, for instance, Washington state saw a 99 percent drop in meth labs. During the same time period, Oregon's decline was 97 percent.
According to a recent report by Oregon's High Intensity Drug Trafficking Area program, meth-related crime continues to be rampant in the state. A majority of law enforcement officials (61 percent) surveyed for the report said meth is the state's greatest drug threat. Similarly, the study reported that meth arrests rose 36 percent from 2009 to 2012 (Oregon's prescription requirement law took effect in 2006) and that 25 percent of all individuals entering drug treatment centers use meth.
A Stronger, Smarter, Lasting Solution
CHPA takes the diversion of its members' medicines very seriously and remains committed to working with elected officials to ensure states have the necessary tools to combat illegal sales of PSE. Mandating prescription-only sale of these common cold medicines, however, would be ineffective and burden those who depend on these medicines for relief with unnecessary and costly visits to the doctor.
CHPA is committed to advancing solutions to illegal sales that penalize criminals and ensure law-abiding consumers continue to have access to a wide range of treatment options, including nonprescription medicines containing PSE.
Voluntary Guidelines for Anti-Smurfing
Asthma and Allergy Foundation of America 2012 survey on access to PSE