AlterNet / By Scott Thill

Surprise: Making Sudafed Prescription-Only Is Smart (And Pisses off Greedy Drug Companies)

A growing regulatory movement is afoot to revoke the over-the-counter status of drugs containing pseudoephredrine and instead require a doctor's prescription.

May 3, 2011 |

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In 2005, the Combat Methamphetamine Act revoked pseudoephedrine's front-of-counter status in an attempt to limit the availability of popular products like Sudafed to illicit methamphetamine manufacturers, colloquially known as smurfers. Today, a growing regulatory movement is afoot to revoke its over-the-counter status altogether and instead require a doctor's prescription for the sympathomimetic drug, which is used both by cold-wracked hordes as a nasal decongestant, as well as meth cookers looking to capitalize upon its chemical class as an amphetamine.

"Methamphetamine is an extremely serious problem that deserves a strong and effective regional and national response," Elizabeth Funderburk, senior director of communications for the pharma-friendly non-profit Consumer Healthcare Products Association, told AlterNet. "However, requiring prescriptions for common cold and allergy products that have been relied on by consumers for years and even decades will not solve the problem of methamphetamine. It will only place new costs and access restrictions on the 20 million law-abiding Americans who rely on these medicines for relief of their symptoms each year."

It's a fair point. Doctor's visits are already a proverbial pain the ass. Then there are the additional costs to consider: According to the CHPA, if half of American pseudoephedrine consumers were forced to go through the annoyance of a doctor's visit just to get their hands on Sudafed and other drugs containing the stimulant, they'd have to annually shell out north of $750 million. Of course, how many of those consumers are actually smurfers is anyone's guess.

But given that America's yearly meth epidemic is mostly worsening, in spite of the Combat Methamphetamine Act's best intentions, the cost and annoyance to law-abiding citizens pissed off at having to visit a doctor to purchase nasal decongestants may actually be worth it. According to a 2009 Rand Corporation Study, the societal cost of meth lies somewhere between $16 and $48 billion dollars. Factor in the surprising stats coming out states like Mississippi and Oregon that have already pulled pseudoephedrine's over-the-counter card, and making Sudafed a prescription drug starts to look like a can't-lose bargain.

“It’s a no-brainer,” Tennessee Methamphetamine Task Force director Thomas N. Farmer, who's advocating the prescriptive approach in his state, told the New York Times. But the biggest reason it's a no-brainer is because it's only recently, cosmologically speaking, that the controversial pseudoephedrine has become an over-the-counter presence in the first place.

"I think the public does not realize these precursor drugs were on the prescription-only list until 1976 when the drug companies convinced the FDA to release them into the marketplace, where they have been heavily promoted as an essential drug despite expert medical testimony which warns that for many groups of people, such as children and the elderly, they should only be taken under a doctor's supervision," Nevada state senator Sheila Leslie, whose proposed bill SB 203 sought to make pseudoephedrine a prescription-only drug, told AlterNet. "The drug companies have convinced us that the average person cannot live without this drug, despite more than 130 similar products available over the counter which do not contain the precursors."

Senator Leslie's SB 203 stalled after it became clear that she didn't have the votes necessary to pass the bill in the Nevada state senate. Despite the fact that law enforcement agencies in Oregon and Mississippi have been rewarded with astonishing decreases in meth labs and property crime rates after passing their respective prescription-only laws, their counterparts in Nevada couldn't muster more than neutral support to help make SB 203 a reality. Industry harassment didn't help matters, according to Leslie.

"The drug companies used the same scare tactics here that were used in other states," she told AlterNet. "Robo-calls to scare seniors and others, expensive radio and newspaper advertising, the creation of fake advocacy groups that sounded very similar to the real health advocacy groups that supported the bill."

The industry, and its advocates, are fiercely protecting their economic turf. Pseudoephedrine-based products pull down around $600 million annually for companies like Johnson & Johnson, who bought Sudafed in 2006 -- around the time Oregon decided to go the prescription-only route -- from Pfizer, which itself spent millions for years trying to tweak, pardon the pun, the drug so that smurfers and cookers couldn't use it to make meth. Now that Johnson and Johnson is left holding Sudafed's bag, the last thing it wants is declining availability of what had been for decades a routinely lucrative and obtainable drug. Instead, industry favors a technological solution, whose promise has yet to backed up by straightforward numbers worth shouting about.

"The common-sense solution is electronic tracking of pseudoephedrine sales," Funderburk told AlterNet. "Thirteen states have adopted electronic tracking systems. In the four states that have been running long enough to have a track record, this stop-sale system has blocked 40,000 grams of pseudoephedrine per month that would have been above the legal limits."

Admirable, but unimpressive. States like Kentucky and Oklahoma that implemented statewide electronic tracking initially experienced decreases in meth lab seizures, but those were either quickly erased or reversed mere years later after the black market adjusted to the new technocratic normal. Whether it's the Combat Methamphetamine Act's identification requirements and record-keeping, or electronic tracking, simply punching names into a database isn't going to stop or perhaps even slow the meth epidemic.

"In the most technologically advanced country, the best solution we can come up with is to go into the pharmacy and write my fucking name in a log book,” Methland author Nick Reding wisecracked in January at Stanford University's Health Policy Forum.

As much as it may hurt, the only solution that has actually seemed to work over the long-term is kicking pseudoephedrine back to controlled-substances curb, where it sat until the industry found enough political latitude to capitalize upon its latent billions for decades. But who knows how long the prescription-only solution will hold? According to the U.S. Office of National Drug Control Policy, prescription drug abuse is America's fastest-growing drug problem, whose overdose victims have eclipsed the combined casualties of the '80s crack cocaine and '70s heroin epidemics.

What's more unsettling is the world's continuing addiction to the simplistic idea that our problems can be solved by pills whose solutions and side effects are as, if not more, dangerous than the illnesses, real or imagined, that we are running away from.

"Our country has become too comfortable with some drugs and that dependency is fostered through massive advertising campaigns and a sense that there must be a pill for every ailment," argued Leslie, whose bill is being considered in 15 states this year, and introduced federally as well. (A promising initial hearing in California this month may help pave the way for a reintroduction to Nevada's 2013 legislative session.)

"In this case, we are prioritizing convenience over the destruction of our society, and it's costing the taxpayers billions," she added. "Tragic doesn't even begin to cover it."

Scott Thill runs the online mag Morphizm.com. His writing has appeared on Salon, XLR8R, All Music Guide, Wired and others.

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