To fight meth, Nixon wants prescriptions for cold medicines

JEFFERSON CITY | Cold medicines containing a key ingredient found in methamphetamine should be available only by prescription in Missouri, Gov. Jay Nixon and Attorney General Chris Koster said Tuesday.

Only two other states in the nation require a prescription for cold medications containing pseudoephedrine, and some critics argue it’s inconvenient and leads to higher health care costs.

Nixon and Koster, both Democrats, appeared together in four cities to make their case that tougher restrictions on the sale of popular over-the-counter medicines such as Sudafed could help slash production of the destructive drug known on the street as meth.

Meth fighting measures enacted in recent years, including a computer tracking system for pseudoephedrine sales, just aren’t enough, they said.

“The law enforcement community is broadly united in the position that requiring a prescription for pseudoephedrine is the strongest step — against methamphetamine production our state can take,” Koster said in a statement. “If we truly wish to attack this crisis, then the tool to do so is within our reach.”

If approved by lawmakers, Missouri would join Oregon and Mississippi in requiring a doctor to write a prescription for the purchase of medicines containing pseudoephedrine. The compound is the active ingredient in some decongestants but also the single necessary component for the production of meth.

Twenty-one cities and counties, mostly in southeast Missouri, already mandate such prescriptions.

Federal law also requires pharmacies to keep drugs containing the substance behind the counter and to maintain a record of sales. In September, Missouri rolled out an electronic system that alerts sellers if an individual attempts to buy more than the amounts permitted by law and allows authorities to track purchases in real time.

“We have already enacted several measures to fight meth, but it’s time to take this significant next step,” Nixon said.

Missouri has long struggled with methamphetamine production, recording more than 1,774 meth-lab incidents in 2009, and 1,716 through October of this year, according to the state Highway Patrol data.

Those numbers have declined in recent years — after peaking near 3,000 in 2002 and 2003 — since retailers began tracking purchases. But the reductions could be even greater if a doctor’s note is required before purchasing pseudoephedrine, officials argued.

“It is an unneeded epidemic,” Franklin County Narcotics Enforcement Unit Detective Sgt. Jason Grellner said of methamphetamine production. “We knew the answer to this problem all the way back to early ’90s was to reschedule pseudoephedrine as a prescription drug.”

As evidence, Grellner, who also is vice president of the state Narcotics Officers’ Association, pointed to Oregon, where the cold medicines were made prescription-only in 2006. Meth-lab incidents there declined from 472 in 2004 to just 13 in 2009. Mississippi required a prescription beginning in July and has seen incidents drop 65 percent in the past four months.

Mandating a prescription makes it more difficult to “smurf” the substance — that is, to purchase large quantities by canvassing multiple pharmacies, said Lincoln County, Ore., District Attorney Rob Bovett.

“We’ve eliminated smurfing,” Bovett said. “It just doesn’t exist in Oregon.”

Bovett led Oregon’s meth-fighting efforts and also advises other states on addressing the issue. There’s opposition to the move from the pharmaceutical industry, which contends that prescription-only access could drive up costs, inconvenience customers and burden the health care system.

Consumer Healthcare Products Association spokesman Tom Heapes said the measure proposed by Nixon and Koster would “significantly impact how cold and allergy sufferers access some of their medicines.”

“While well-intentioned, requiring a prescription for over-the-counter medicines containing pseudoephedrine would impose a significant burden on Missourians, despite there being a better and more effective solution to address the state’s meth production problem already in place,” Heapes said in a statement.

Patients with simple allergies or colds would have to go through the time and expense of visiting a doctor for something they currently diagnose and treat effectively by themselves, noted Mandy Hagan, a lobbyist for the association.

The better solution, drug makers contend, is the electronic tracking system currently being implemented statewide. The industry has helped finance installation of the system, and Hagan said it has blocked thousands of inappropriate sales in Missouri.

But law enforcement officials, including those in states that require prescriptions, deride the effectiveness of the tracking system and dismiss the industry’s concerns. The tracking system does little to stop smurfing and is ineffective against buyers who use multiple fake IDs to purchase the drug, officials said. Matt Mallinson, a pharmacist and owner of Matt’s Medicine Store in Independence, supports tougher controls on the drug.

Requiring a prescription for pseudoephedrine could put a safe and effective drug out of reach for many legitimate patients, Mallinson acknowledged. But as a father of six, and a member of the Independence school board, he thinks the benefits would outweigh the costs.

“We will have deprived the patient of a very effective over-the-counter nasal decongestant,” Mallinson said. “That, as a pharmacist, saddens me. But if this is what’s required to keep our children safe, then by all means we will support it.”

Tuesday’s proposal by Nixon and Koster is not entirely new. Bills introduced earlier this year in Missouri to require prescriptions for the drugs went nowhere, failing even to pass out of committee.

Nixon pledged to work with the Republican-led General Assembly to push the bills toward passage in the session that begins next month.