A New Option for Eliminating Methamphetamine Labs

The 2014 legislative cycle in a number of states will witness efforts to curtail the methamphetamine labs that cause so much death, destruction and environmental despoliation from West Virginia to Oklahoma. Oregon and Mississippi have proven that putting cold medicines that contain pseudoephedrine (e.g., Sudafed) on prescription-only status virtually eliminates meth labs. But other states that have tried to pass similar laws have been overwhelmed year after year by the might of the cold medicine industry, which spends more money on lobbying in meth belt state legislatures than any other (notably, in West Virginia, coal industry lobbyists express envy at the cold medicine industry’s influence).

One of the industry’s central arguments is that people with colds and allergies need PSE and will suffer from reduced access. However, new technologies in medication production render this argument moot. As I describe today at Stanford School of Medicine’s SCOPE Blog, it is entirely possible to write legislation in such a way that meth labs are choked off while access to PSE-containing medications is maintained.

There is thus a policy compromise on the table that could draw diverse support on a hard-fought, important policy issue. That will bring smiles to the faces of decent and intelligent people. But drug policy, like public policy in the U.S. generally, includes a faction of perennially angry people to whom compromise is a dirty word. Expect such ideologues to fight hard against the public interest on this one.

Comments

  1. James Wimberley says

    The coal industry, which is responsible for massive air pollution and hence (I assume) allergies, should have a marriage made in hell with the cold medicines industry. A nice illustration of the old jokes about the GDP-enhancing complementarity of crocodiles and the manufacturers of wooden legs.

  2. Mike says

    I always like to be optimistic about things that try to deal with meth. It’s nasty stuff and does no one any good. I would comment at length on how making marijuana more difficult to find in rural areas through increased law enforcement in the last couple of decades probably opened a number of doors for the meth epidemic to thrive, but I digress…

    I can see temporary improvements from totally replacing old-style cold pills with bound-PSE (is that a good term?) products. It would certainly take this problem out of the drug stores…

    Or maybe not.

    Cook to meth head: New recipes are rough, I’m gonna have to charge you 200% more.
    Meth head: Sure, no problem, I’ll get it.

    That won’t last long, though. At those prices, the Mexican cartels, who already supply major markets in many urban areas, will see fantastic opportunities…just saying.

    • Mike says

      Or maybe the cook’s prices go up 300% (as my notoriously inept math catches me up again)?

      Doesn’t matter. We’re dealing with meth here. It’s just one more obstacle to be overcome on the way to keeping the peaking going.

      And that would make it that much more profitable to smuggling.

    • strayan says

      “It’s nasty stuff and does no one any good.”

      Mike, meth is medicine and can make you healthier:

      http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088582.pdf

      I encourage you to read this paper about moral panics and methamphetamine:

      http://www.tandfonline.com/doi/abs/10.1080/10282580701677519

      That’s not to say that making meth yourself is without hazard.

      Even making alcohol can be extremely dangerous:

      http://www.news.com.au/national/top-winemaker-killed-in-blast/story-e6frfkp9-1111115337004

      http://www.brisbanetimes.com.au/queensland/man-hurt-in-brisbane-winery-explosion-20121122-29s4b.html

      Which is why we have work, health and safety regulations to reduce the likelihood of these incidents.

      • Mike says

        strayan,
        My references are the School of Hard Knocks. Never messed with it much myself, just do not like feeling like I hammered a pound of coffee. The scary stuff is mostly from knowing enough about the milieu from the blue collar end of things. Many people familiar with meth from personal experience feel there’s nothing lower than a meth-head, either because they know one or have been there themselves. YMMV

        Meth was developed to keep soldiers fighting past the point of commonsense. A really unnecessary and unhealthy buzz in any civil society. You’d be much better off with cocaine (provided you’re not smoking that, too), but yeah, moral panic sets in when that’s brought up.

        • Mike says

          Just to be clear here, I do not believe a law enforcement approach to meth is liable to yield much in the way of positive results. It hasn’t yet and the negative effects are notable in their escalation.

          One thing that does come to mind is whether there has been any research done one which is more effective in reducing drug use, one that is heavy on legal sanctions and moralizing, like in the US, or one that simply eliminates the legal pratfalls and deals with addiction as a medical issue?

          Like many, I rather hope the end of prohibition will provide another option for young people, one that is different than alcohol and far safer than things like meth, who do find themselves going through a period where they are what they ingest.

        • Mex says

          Are you aware that other people have positive experiences with meth? I wonder if your experiences are colored by the type of people you see doing meth, and not the drug itself. Let’s say for example you could examine two groups of people, one who drank Opus One (an expensive wine) and another that drank Olde English 800. You would see large differences in income, education, and cognitive ability. But it would be wrong to conclude that drinking Olde English 800 made you poorer, dumber and reduced your education opportunities. And drinking Opus One won’t improve your life. Same thing goes for meth. The are a wide range of people that use meth and other stimulants. Some have trouble, most don’t.

          • Mike says

            Hmmm, my first experience was with Swiss crystal sprinkled over some fine Lebanese hash. The hash was good. The crystal? Meh. And yes there were classy people present. It didn’t help my buzz.

            I don’t doubt there are people who enjoy meth in moderation. My bro used to. I could never see the point.

            I guess I size it up like any other drug. Do most of the people involved with it have a healthy relationship with it and do they have a healthy relationship with other people when they’re using. In the case of meth, I’m afraid the answer is generally no.

  3. Bud Frank says

    I am a life-long allergy sufferer and nothing but meds containing pseudoephedrine have successfully addressed my symptoms. We’re not just talking about the sniffles; allergy attacks can be debilitating and sometimes even dangerous. There are ways to restrict access to these drugs by mandated record keeping and sales volume limitations combined with regulatory checks without requiring an Rx. This is what California does. Requiring an Rx (which would likely involve scheduling appointments with MDs) would exponentially increase costs and limit access, and I couldn’t even guess the effect it would have on our limited capacity doctors’ offices and clinics.

    • says

      Actually, the fact that these medications are needed and are not unsafe for the users should mean that we should go back to the old system. If people want to make meth, that’s their business. NOBODY should have to face the horrible situation of a bad allergy simply because drug warriors are upset that SOMEONE ELSE uses meth. Your health is not something that should be traded off in a cost-benefit analysis in an attempt to save other people from their bad choices. The health of an individual is an end, never a means.

      Restricting pseudoephedrine fails the basic tenets of Kantian morality. It is pure evil.

      • J. Michael Neal says

        Cooking meth is not just their own business. It’s environmentally destructive for people in the surrounding area.

        • says

          Which is why meth labs are illegal. (Although there should be licensed ones or zoning.)

          But making meth labs illegal (and thus making meth producers bear the cost of their activities) is a separate issue from saying that ALLERGY SUFFERERS WHO DON’T TAKE METH should get sick and potentially have to go to the hospital in order to prevent meth labs from going up. That’s morally unacceptable.

          • BM says

            Murder is already illegal, so why can’t I buy arsenic and cyanide—excellent, fast-acting rat poisons—like in the good old days? They’re punishing innocent homesteaders who AREN’T bumping off elderly aunts! Hijacking is illegal, so why can’t I bring a gun onto an airplane? They’re punishing innocent vacationing plinkers for the actions of a few lawbreakers. Hydroiodic acid (for etching), sodium hypophosphite (nickel plating), and most radioactive materials (used for radiography, science, etc.) are likewise hard to get. Vehicular homicide is illegal, too, but the cops will pull over a red-light-running cars even when they don’t kill anyone! Is this “morally unacceptable”?

            And “get sick and go to the hospital”? If 80% of American women can talk to a doctor about birth control, someone with a “debilitating, dangerous” allergy can talk to a doctor about pseudoephedrine. Get a prescription, sign your name, telephone in for refills when you run out. It’s not that hard. There’s a whole system.

    • NCG says

      I am wary of this too. Perhaps this new bound-PSE could be developed and put on sale before they try to force so many people to go to the doctors they don’t have.

      And no, I am not expecting the ACA to make it easier for me to go to the doctor. (Not saying I’m against it, I’m just saying it won’t repeal the laws of common sense. Though I will probably have some sort of coverage.)

      • joel hanes says

        The replacement for pseudephedrine is phenylephrine, or “PE”.
        It’s been widely available for many years.
        It doesn’t work as well as pseudephedrine; it also has fewer dangerous side-effects.

        Your plea for PE to be “developed and put on sale before …” was timely in about 1995.

        • NCG says

          It’s funny you say that b/c I thought this post was about a new form of pseudoephedrine, which would be less subject to being made into meth, not some other stuff that doesn’t work as well.

          Maybe you live somewhere where you can’t buy it? Is that the root of the misunderstanding? Where I live you can buy it, but you have to show id. I can live with that. Making it prescription-only would thus be … for me at least … a big problem.

        • NCG says

          Here is the quote from the linked piece that you may have missed, talking about the new method.

          “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.
          - See more at: http://scopeblog.stanford.edu/2013/11/06/breaking-good-how-to-wipe-out-meth-labs/#sthash.sYwFu2pU.dpuf

          Just for the record, I’d rather eat a lipid than a polymer, if anyone cares. But I’m a civilian. I could be wrong about that.

    • Anonymous says

      As a lifelong allergy sufferer you do understand that pseudoephedrine is a decongestant, right? Most severe allergy symptoms call for antihistamines, steroids, or, in life threatening situations, epinephrine, not pseudoephedrine. T

      Getting rid of meth labs isn’t about reducing meth use. It’s about eliminating the extremely serious public health problems that arise from having meth labs in houses and neighborhoods where other people live.

      I live in Oregon in a neighborhood where meth labs used to be a huge problem. Requiring a prescription has been very effective in eliminating them and is a small price to pay.

      • NCG says

        It’s a small price if you’re not the one paying it. And it’s possible those meth labs just moved to Mexico, which in my book at least does not count as a big step forward for humanity.

        I am sorry for people who live near the labs, or work in them, and I do support reasonable measures against meth.

      • says

        Again, it’s really easy to solve the meth labs are explosion hazards problem without screwing over allergy suffers– just license meth labs and supply meth to meth users.

        That way meth users are happy, and allergy sufferers can get their medication with no restrictions. The only people who will be unhappy are authoritarians.

  4. H says

    Almost no one among cold sufferers understands that, at least here in California, the over the counter cold “medicine” found on the shelf in the drug store just plain doesn’t work because the effective ingredients have been removed–although the packaging remains essentially identical. The only reason it is there is to mislead consumers and protect drug company profits.

    To get the stuff that works you just have to go to the prescription counter, show ID and sign. But, more importantly, you have to know to do this in the face of a blizzard of ads and lying packages that assure the unknowing customer that the over the counter stuff is really good.

    I’ve lost track of the number of sick folks who have told me that cold medicines don’t work like the used to. When the learn that the old medicine is available on request and try it turns out the real thing really does still work.

  5. Brett Bellmore says

    The links seem remarkably vague about how this actually works. But assuming it does, it’s good news for Mexican meth labs, I guess.

  6. Ed Whitney says

    A question for Keith:
    The DEA wants this behind the counter, since they say that they could make meth from it. They had the resources of the government to make it, but doesn’t this defeat the purpose of the new product?

  7. Mex says

    This policy compromise will help shift even more production to Mexico, which will mean more dead Mexicans and less dead Americans. “That will bring smiles to the faces of decent and intelligent people.”

  8. Bruce Ross says

    As another mentioned above, in California, a buyer most go to the pharmacy counter, show ID and sign for pseudoephedrine. I believe purchases are also tracked by a database and there’s a limit to the amount one can purchase.

    Has that not also reduced the number of small local labs? I’d had the impression it worked reasonably well. And, living in an area where rural meth cooking used to be common, one doesn’t hear about it much lately. (They just cook it up in Mexico now and smuggle it — but hey, at least we’re rid of the labs.)

  9. aisaac says

    I believe Keith is ill informed. It’s true that there are hundreds of brands of allergy meds, but they have the same dozen or so drugs. There are two types of decongestants, nasal sprays and pills. Nasal sprays suffer from rebound congestion. You can only use them for a few days. The only pills alternative is phenylephrine, which doesn’t really work. That leaves zero realistic alternatives to pse, except for maybe neti pots if you go for that sort of thing.

    zephrex is promising if it will really prevent assist, and nasacort will be otc soon. But a lot of people don’t respond to nasacort, and as a corticosteroid it had side effects.

    The bottom line is that millions of people will suffer without pse, and many people can’t afford doctor visits to get an rx.

    • NCG says

      Neti pots are fabulous, but don’t forget to boil your water first. Check the CDC website, it matters where you live and so forth, in terms of how long you have to boil. And use non-iodized salt. I use sea salt and it works fine. Well, afaik. Perhaps there is a big shoe waiting to fall on me. Oh well.

      • NCG says

        Oops. For the slow people. ; >

        You boil, then *cool* the water. Don’t put boiling water up your schnoz.

      • Ed Whitney says

        NCG has a point; let it cool after boiling.
        A convenient formula is 8 oz of water, 1/4 teaspoon of salt, and 1/4 teaspoon of bicarbonate. Some drug stores sell saline mixtures but home made is twelve zillion times cheaper.
        A bulb syringe will work if you do not want to buy a neti pot.
        Just remember to keep one nostril down, open your mouth, breathe through your mouth, and have a couple of big paper towels handy to blow your schnoz well. Outside or over a big sink minimizes the mess.

      • Brett Bellmore says

        I keep hearing, “boil your water first”, but then I reflect on just how many people go swimming in natural bodies of water, and get water up their noses, and live to tell the tale. And then content myself with water from the hot water tap.

        Sure, you CAN get a remarkably nasty infection by adding salt to tap water, and running it through your sinus cavities. It has happened, in a nation of several hundred million, more than once. Twice, even! Has it happened as many times as people getting hit by lightning out of a clear sky? Which also happens, but we don’t walk around in portable Faraday cages.

        I mean, seriously, isn’t there a point where we ought to draw a line?

        • H says

          Gosh, small chance of getting brain eating amoeba that kills you against five minutes to boil water.

          I know which way I’m going.

          • Ed Whitney says

            Five minutes to boil water but then you have to let it cool off. That takes longer than five minutes, you liberal, nanny-state, sky-is-falling, quiche-eating, seatbelt-wearing wise guy!!

          • NCG says

            Ditto, H. Brett, please boil the water. I agape you enough for that much! You can boil up a bunch at once, and stick it in the fridge in an old rinsed out pickle jar for a couple days (the “couple days” is not from the CDC, it’s just my guess! So there’s a bit of risk for you). Then you just zap a bit in the microwave when you need it. Test temperature with finger first! I am close to sea level, I only boil for 2 minutes. Nothing bad has happened yet.

            I had no idea I was supposed to use bicarbonate. Learn something every day!

            Seriously. No brain eating amoebas up your nose, people. I feel comfortable that that should be a rule.

          • Brett Bellmore says

            I don’t think there’s any question at all, 5-10 minutes precaution is worth it to the one person in a hundred million who would avoid getting infected with a brain eating amoeba. Much as going out for a walk wearing a copper grounding strap and portable lighting rod would be worth it to the one person in a hundred million who’s destined to be struck by lightning on a clear day.

            The question is whether its worth it to the 99,999,999 people who won’t. Which is why we normally take into account the probability of hazards, and not just the cost if they actually eventuate. And live with the understanding that wearing a hard hat to save your noggin if a meteor happens to strike it isn’t really worth the hassle.

            Hm, I wonder how many people contract flesh eating bacterial infections from paper cuts… I do hope you wear those kevlar gloves when you handle paper.

          • Anonymous says

            It isn’t too brave for a Bellmore-style-libertarian to scoff at the risk of brain eating amoeba…poor critter would just starve in there.

  10. Ed Whitney says

    The main problem, hinted at above, is that when you drive up the price of a commodity for which there is inelastic demand, you invite unintended consequences, one of which may being knocked on the head by a desperate addict who needs what you have in your wallet.
    No easy answers here.