Earlier today I testified about methamphetamine laboratories to West Virginia Governor Earl Ray Tomblin’s Advisory Council on Substance Abuse. Like more than a dozen other states in the “meth belt,” my home state is suffering from a wave of explosions, fires, burns, poisonings and environmental destruction stemming from laboratories operated by small-time “meth cooks.” Fortunately, as I told the Advisory Council, this is a problem that we already know how to solve.
Meth cooks make their drug using pseudoephedrine (PSE), which they extract from certain cold medicines such as Sudafed. The precise proportion of these cold medicines that are purchased to produce methamphetamine is not known, but it is clearly very large. A recent study published in JAMA found that per-capita consumption of PSE-containing medicines in counties with meth labs exceeds that of counties without labs by as much as 565-to-1.
In light of this connection, the states of Oregon and Mississippi returned PSE-containing products to prescription-only status, which was how they were regulated until 1976. Meth labs have virtually disappeared in both states.
Most state legislatures in the meth belt have introduced legislation to copy Oregon and Mississippi’s approach, but these bills have all failed. Part of the reason is intense lobbying by the companies that produce PSE-containing products, but another part is that some voters and legislators believe that cold and allergy sufferers will have a hard time getting relief if a prescription for PSE-containing medications is required.
This worry is not usually well-founded, as there are more than 100 over-the-counter cold medications available which provide relief to almost all people with stuffy noses, fevers and the like. However, in the rare case of an individual who truly needs a PSE-containing medication, innovative biochemistry has come to the rescue with the development of medications that contain PSE that is harder for meth cooks to extract.
These companies created cold medications (e.g., Zephrex-D) which use polymers or lipids to bond with PSE in a fashion that reduces the possibilities for conversions to meth. Even if the possibilities for PSE extraction are reduced by only two-thirds by these new medications, meth cooks would effectively be put out of business because their required materials would exceed the value of the drug they make. Meanwhile, consumers with chronic allergies do not suffer reduced access to PSE-containing products.
The public policy option available to meth belt states is thus something that should satisfy all parties. PSE-containing cold medications would be returned to prescription-status, with an exemption for such medications that independent laboratories prove yield only a de minimus amount of PSE for meth preparation.
It’s a rare opportunity for a clear win-win in public policy. That’s why I strongly encouraged Governor Tomblin’s advisors to pursue it with courage and enthusiasm.
Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. Dr. Humphreys has no financial or personal connections to any company that produces cold medications (extraction resistant or not).
Previously: Examining how addiction in the U.S. has changed over the last decade, Can an antidepressant help meth addicts stop using?, The Florida Governor’s questionable actions on drugs and Stanford Health Policy Forum focuses on America’s methamphetamine epidemic
Photo by 16 Miles of String