Boards of Pharmacy, State Legislators, and Law Enforcement Continue to Tackle Methamphetamine Problem

May 3, 2011 1:28 PM Topics: Pseudoephedrine

Originally published in the May 2011 NABP Newsletter

On February 23, 2011, Sheriff Joe Guy of McMinn County, TN, released a community memorandum requesting retailers in his jurisdiction to stop selling pseudoephedrine (PSE) products for 100 days – his plea illustrates the severity of the methamphetamine problem still plaguing many communities with meth labs and meth-related crimes. On a national level, recent data shows that use of the drug has increased between 2008 and 2009. For example, the number of recent new users ages 12 and older of meth increased 62% from 95,000 in 2008 to 154,000 in 2009, according to the 2009 National Survey on Drug Use and Health. The problem continues to demand the attention of law enforcement, law makers, and pharmacy regulators across the country as they take various actions to control the sale in their states of PSE products, the key precursor ingredient in the illegal manufacture of meth.

All states require that PSE product sales are logged in order to enforce federal restrictions on PSE sales limits under the federal Combat Methamphetamine Epidemic Act of 2005, which became effective nationwide in September 2006. The adoption of laws and implementation of electronic tracking systems for PSE sales in several states helps to put a dent in meth production by centralizing PSE sales data to help prevent the practice of smurfing (individuals traveling from store to store, each time purchasing the legal limit of PSE for use in meth production).

In 2010, several states passed laws requiring the implementation of electronic tracking systems, bringing the total to 13 states, and other state legislatures are currently debating similar bills. Following the lead of Oregon and Mississippi, a few state legislatures are also considering PSE by prescription only laws.

Amendments under the federal Combat Methamphetamine Enhancement Act of 2010 (Public Law 111-268) went into effect April 11, 2011, and require that sellers of PSE products self-certify that they understand and are in compliance with related requirements for selling these drug products. The law also requires the Attorney General to develop a list of all self-certified individuals and to publish the list on the Drug Enforcement Administration (DEA) Web site. Further, distributors of listed chemical products are required to sell only to self-certified regulated sellers.

Under the new law, mail-order distributors must follow consistent regulations in order to help ensure that individuals are not exceeding their legal limit for PSE product purchases. Specifically, mail-order distributors must receive from the purchaser a copy of an identification card that provides a photograph and is issued by a state or the federal government. The name and address on the identification must be verified to correspond to the name and address provided by the purchaser.

States With Electronic Tracking Requirements

Thirteen states currently have laws requiring that PSE sales are tracked electronically, with three recently adopting the laws and/or implementing their tracking systems. Under emergency rules developed by the Missouri Department of Health and Senior Services, the National Precursor Log Exchange (NPLEx) was implemented in Missouri on September 28, 2010. The Kansas State Board of Pharmacy adopted the Kansas Electronic Methamphetamine Precursor Logging tracking system, also part of NPLEx, through rules and regulations on August 24, 2010. In addition, the South Carolina Law Enforcement Division (SLED) joined the NPLEx to develop a tracking program that was implemented in South Carolina in January 2011 (see “State Board News” on page 110).

In the state of Washington, a bill to implement statewide electronic tracking of PSE retail sales of methamphetamine precursors, specifically pseudoephedrine, ephedrine, and phenylpropanolamine passed in the 2010 legislature. The law went into effect on June 10, 2010 and the Washington State Board of Pharmacy has approved rule language to implement the law.

The states of Alabama, Arkansas, Florida, Illinois, Iowa, Kansas, Kentucky, Louisiana, Oklahoma, Tennessee, and West Virginia also have adopted and implemented laws requiring the electronic tracking of products containing PSE. A new law in Arkansas (Act 588) passed in March 2011, strengthening PSE laws by requiring that a pharmacist use professional judgement, patient medication history, and patient screening to determine that a PSE product is for a legitimate medical need.

A bill (LB 20) to require electronic tracking was introduced to the Nebraska legislature January 2011 and was approved by Governor Dave Heineman on April 14, 2011.

Success with Electronic Tracking

Much data demonstrating the results of tracking programs and other actions to combat meth production is relatively new and there is still some debate as to which actions are the most effective.

Electronic tracking can provide an advantage over paper logs as data is centralized and can be shared among pharmacies in a state, and, in many instances, across state lines. Sharing aggregate data in real time helps stop the practice of smurfing, because pharmacists are able to more accurately determine if a PSE purchase would exceed an individual’s legal limit. For example, South Carolina’s implementation of NPLEx facilitates this process as the system provides a “do not sell” recommendation if appropriate at the time of purchase. Customers can then be directed to a public Web site that provides information explaining why they were unable to make their purchase. In Kentucky, where NPLEx was developed and first implemented, the system helps to block the illegal purchase of about 10,000 grams of PSE per month, enough to manufacture about 5,000 grams of meth. Iowa’s NPLEx, implemented in September 2010, quickly demonstrated success in this regard. The system approved 200,000 purchases of PSE products, but blocked over 10,000 sales between September and December 2010. As noted by the Kansas State Board of Pharmacy, blocking illegal purchases across state lines helps prevent meth cooks from obtaining the precursor ingredient from any retailer connected to their system, including those in neighboring or nearby states.

New data and evidence continues to show the impact of tracking systems in some states. For example, as of February 28, 2011, SLED, South Carolina’s implementation of the NPLEx tracking system, which launched January 1, 2011, had blocked more than 6,000 boxes of PSE from being sold to consumers who had already reached their legal purchasing limit.

In other states, the real time data provides a more accurate picture of activity for law enforcement to take appropriate action. The NPLEx system offers the capability for states to share PSE purchase data and has shown success in aiding law enforcement. For example, using NPLEx, a detective with the District Attorney’s Office in Delaware County, OK, was able to begin tracking smurfers in neighboring Missouri, increasing his success in shutting down meth labs in Oklahoma.

The state of Georgia does not require electronic tracking, but some pharmacies voluntarily participate in the Georgia Methamphetamine Intelligence System (GMIS) used by the Georgia Bureau of Investigation (GBI). Law enforcement officers told the Times-Georgian that within the first 30 days of operation GMIS data enabled GBI to identify 126 people who had purchased more than the legal limit of PSE.

Counterpoints

According to an Associated Press report, Missouri State Highway Patrol statistics indicate that 1,960 meth lab incidents occurred in the state in 2010, a 10% increase from 2009. Some interpret that meth lab incident increases indicate that the meth problem is getting worse, despite precursor tracking laws. Another interpretation could be that tracking systems allow law enforcement to identify, locate, and shut down meth labs more frequently using the real time aggregate data.

Prescription Only PSE

Two states – Oregon and Mississippi – have adopted the strictest PSE laws to date, requiring patients to present a prescription in order to purchase the products. The Mississippi Bureau of Narcotics reports a nearly 70% decrease in meth-related cases statewide since the implementation of the law in its state. Comparing data from the periods of July 2009 to February 2010 (prior to the prescription only law) with data from July 2010 to February 2011 (after implementation of the prescription only law) shows a reduction from 607 meth lab incidents to 203 meth lab incidents in Mississippi.

Oregon, the first state to adopt a PSE by prescription only law, with rules adopted in April 2006, and effective July 1, 2006, has seen a steady reduction in the amount of meth lab incidents. According to DEA, Oregon had only 12 meth lab incidents from January 1, 2009 to December 31, 2009, a 94% decrease from the year prior to the prescription only law. There were 191 incidents in 2005, prior to the Oregon law. In 2006 there were 51 incidents; in 2007, 23; and in 2008, 21 incidents.

While not requiring a prescription for all PSE purchases, the state of Oklahoma has implemented tougher restrictions for meth offenders. The Oklahoma State Board of Pharmacy has implemented a regulation stating that any person with a previous meth-related drug offense may not possess PSE at all. If a pharmacy sells PSE over the counter, then the customer’s name is automatically checked against the Meth Registry and the sale will be blocked if the individual has a meth-related drug offense. In addition, the state has classified all PSE-containing medications as Schedule V prescriptions and requires that they be submitted to the prescription monitoring program database.

PSE Prescription Only Legislation

Legislators in several states are considering PSE by prescription only bills. Two bills to require a prescription for PSE products have been introduced in Kentucky. House Bill 281 would make meth prescursor drugs Schedule IV controlled substances and prohibit a practitioner from dispensing more than 9 grams of PSE to an ultimate user per month. The similar Senate Bill 45 was also introduced in Kentucky.

Bills introduced in Indiana (Senate Bill 474), in Tennessee (House Bill 181), and in Arkansas (House Bill 1444) would classify meth precursor ingredients as Schedule III drugs, thus requiring a prescription for PSE products. In these states the bills have been referred to committee in the 2011 legislative session.

Senate Bill 40 in Hawaii would reclassify pseudoephedrine as a Schedule V drug that may only be dispensed with a prescription with certain exceptions; the bill is currently being considered by the state’s legislators.

Public Safety at Stake

Although recent tracking data shows improvements on a local basis, the National Drug Threat Assessment 2010 indicates that overall domestic methamphetamine production in 2009 showed no decline and was fueled primarily by organized smurfing. The report also indicates production in Mexico increased in 2009 and there was a 58% increase from 2008 to 2009 in the amount of meth seized at the United States southwest border. This may seem disheartening as it suggests the difficulty of controlling meth use by controlling domestic production.

Even if PSE laws do not have an immediate impact on meth use nationwide, assessing which federal and state laws and programs are most effective at preventing illegal meth production in the US is vital to eliminating the scourge of meth labs that harm communities in numerous ways.