Pseudoephedrine and Pharmacists

statehouse picEphedrine, pseudoephedrine and meth received a lot of discussion during session, especially when House Speaker Brian Bosma (R-Indianapolis) came out in November and said that something needed to be done about the state’s meth problem. The Chamber supported HB 1157/SB 161, which included putting individuals with drug-related felonies on the National Precursor Log Exchange (NPLEx) and thus would trigger a stop-sale alert; both bills passed. The Chamber has historically been opposed to making ephedrine products prescription only because of the inconvenience to consumers that need these products and the impacts on businesses that supply them; HB 1390 in its original form would have done that.

During the last week of session, the Chamber provided a written letter to the General Assembly on the conference committee report for SB 80 that was voted on in the House. The letter stated that the conference committee language prohibited consumers from
accessing multi-ingredient, time-released allergy products, such as Claritan-D, Allegra-D, Zyrtec-D and Mucinex-D – the most effective products for consumers suffering from allergies. The multi-use products are less likely to be used in meth than the single-ingredient products referenced in the conference committee report. The letter also suggested how to fix the problem.

Representative Ben Smaltz (R-Auburn) was the House sponsor and although he did not make the changes necessary to fix the conference committee report of SB 80, he did agree that the House-passed third reading version of SB 80 should be concurred upon in the Senate.That essentially amounted to the same thing as the fix and addressed the concerns the Chamber had.

The Indiana Chamber joined CVS, the Consumer Healthcare Products Association, the Indiana Pharmacists Alliance, the Indiana Retail Council, Bayer and Johnson & Johnson in penning a letter to encourage the Senate to concur on the House-passed version of SB 80 because it allowed legitimate cold and allergy sufferers the medicine they need while dramatically reducing sales of pseudephedrine to meth cooks and those they hire to purchase the drugs. Senate Bill 80 allows individuals who have a relationship with a pharmacist to purchase ephedrine and pseudoephedrine products.

It also allows the pharmacist to sell lesser amounts of ephedrine and pseudoephedrine products if there is no relationship. The House version was what ultimately became law.

A More Effective War On Meth

EDITOR’S NOTE: Indiana legislators are currently negotiating a compromise on efforts to limit methamphetamine production through controls on pseudoephedrine and ephedrine purchases. The following opinion is submitted by Alex Brill, a fellow at the American Enterprise Institute and former chief economist for the U.S. House Committee on Ways and Means.

Communities across the country are being torn apart by methamphetamine (meth) abuse and addiction, and local legislators are taking notice, especially in Indiana.

Demand for meth remains high, and meth produced in Mexico has replaced domestic supply. In 2016, many state lawmakers are again considering legislation to address the meth problem but unfortunately are focusing on a recurring misguided solution: requiring a prescription for medications that contain pseudoephedrine (PSE), an ingredient in some cold and allergy medicines that is used in domestic meth production.

In Indiana, lawmakers are considering legislation that would require at least a pharmacy consultation before an individual could purchase a PSE-based medicine. For anyone who does not have a relationship with the pharmacist, a prescription could also be required. This type of policy would unduly burden law-abiding cold and allergy sufferers and would do nothing to address either the growing supply of meth from Mexico or the underlying causes of addiction.

As I noted in a recent study, requiring a prescription for PSE-based medicines would impose significant costs on consumers, private insurers, and state and federal government. According to Avalere Health, a national prescription-only policy would result in an estimated 1.2 million new doctor visits per year, including over 25,000 in Indiana alone. If such a policy were imposed nationwide, consumer out-of-pocket costs would jump $42.7 million, private insurer costs would spike $56 million, and Medicare and Medicaid would pay $19.5 million more. On top of this would be the indirect costs imposed on the millions of consumers who would be forced to take time off from work or school to visit a doctor for a prescription. For those who are unable to do so, their colds and allergies may go untreated, as a PSE-based medicine is the only oral decongestant that works for some people.

There is another option for states, like Indiana, that face immediate pressure to reduce domestic meth supply: the National Precursor Log Exchange (NPLEx), which allows law enforcement to electronically track the purchase of medicines that contain PSE in real time (making it easier for them to identify potential criminal activity and intervene at the point of sale), and drug-offender block lists that ban those convicted of drug-related criminal offenses from purchasing these medicines.

Alabama and Oklahoma have both introduced NPLEx coupled with a drug offender block list and have seen 77 and 88 percent declines, respectively, in meth lab seizures. In addition, state policymakers should support federal efforts to increase drug interdiction at the U.S.-Mexico border to address the meth supply coming over the border.

More must be done to address the meth problem, but the tools being used must be shown to be effective. My recent study draws a clear conclusion: lawmakers should reject the costly, burdensome, and ineffective strategy of requiring prescriptions or a pharmacy consult for PSE-based medicines. Instead, our leaders should work to reduce the supply of illicit drugs from Mexico and curb the demand by those in our country suffering from addiction.