A Large Proportion of Cold Medicine is Used to Make Methamphetamine

Pseudoephedrine (PSE) is a chemical that is contained in some cold medicines and is also used to make methamphetamine. For many years, pharmaceutical industry lobbyists have argued that at most 2-5% of PSE-containing medicine sold in the “meth belt” is used by meth cooks. A new study [gated] published in the Journal of the American Medical Association has shown that this claim is false.

The researchers correlated the amount of pseudoephedrine sales in each Kentucky county with the number of meth labs, and found that the link between the two is in fact strong:

A 1-g increase in pseudoephedrine sales per 100 people was associated with a 1.7% increase in laboratories. For a typical county, a 13-g per 100 resident increase in pseudoephedrine sales was associated with approximately 1 additional laboratory.

The disproportionate concentration of PSE sales in counties with serious meth problems was remarkable. Most strikingly, per capita sales of PSE in a county with 25,600 residents were 565 times higher than per capita sales of PSE in a county with 13,800.

Historically, cold medicine industry lobbyists have ignored or distorted scientific evidence on the role of the industry’s products in the meth epidemic. This new study certainly won’t cause them to change their spots; after all, the industry has for years possessed (but not released) the same sales data the researchers used to conduct the study. But the new findings should make it harder for industry lobbyists to throw dust in the eyes of reality-based legislators in meth-ravaged states.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

12 thoughts on “A Large Proportion of Cold Medicine is Used to Make Methamphetamine”

  1. “A 1-g increase in pseudoephedrine sales per 100 people was associated with a 1.7% increase in laboratories. For a typical county, a 13-g per 100 resident increase in pseudoephedrine sales was associated with approximately 1 additional laboratory.”

    These don’t appear to be comparable units. By which I mean, what’s the normal sales per hundred people in grams, so we can tell if a 1 gram increase is minor or shockingly high?

    What I do notice is that you tell us “A Large Proportion of Cold Medicine is Used to Make Methamphetamine”, but didn’t think it relevant to tell us what proportion IS so used, so we could decide whether it was large or small. Nor, as a non-subscriber, could I get these figures from the linked article.

    Really, if you’re going to say, “A Large Proportion of Cold Medicine is Used to Make Methamphetamine”, shouldn’t you at some point mention the proportion?

    Anyway, is making it harder for people with colds to get pseudophed expected, logically, to lower the fraction of pseudophed used for illicit purposes? That wouldn’t be my expectation…

    1. Brett, are you claiming that the paper in JAMA omits these important numbers you require? What evidence do you have that the authors missed these important points you bring up?

      1. No, he’s claiming that the numbers are behind a paywall, and that KH should have included them in the article, since most of us don’t have subs to JAMA.

        But it is a consistent problem here at RBC, where the actual numbers and references are left out of the discussion. I’ve tried for a couple of years to get MK to tell us where the prices come for pot, to no answer.

        1. The numbers in fact are not in the paper, though the paper doesn’t make the specific claims Humphreys makes about the proportion of pseudoephedrine that goes to methamphetamine production either.

          One thing that is apparent from the numbers is that there is a huge variation in per-capita pseudophed sales from county to county. The per county mean is 49g/100 residents and the standard deviation is 39g/100 residents.

          Here are some more relevant numbers: There were 1072 meth labs reported, and each of 116 counties averaged 24,664 g of pseudophed sales, for 2.86 million total g of sales.

          OK, let’s do some horribly crude back-of-the-envelope calculations: if 5% of that were diverted to meth labs, that would be 143 kg, or 133 g per meth lab. A 13-g per 100 resident increase in sales is associated with an extra meth lab, so a single meth lab would be soaking up 133 g if a county had about 1000 residents. That seems very small, so it looks like the numbers support the idea that more that 5% of sales are being diverted to meth labs. OTOH, there are some serious problems here — we should probably be trying to isolate the counties with the most sales/labs, and I also suspect that each lab doesn’t use an equal amount of pseudoephedrine.

          Anyway, it’d be good for Humphreys to show more work here.

          (Full disclosure: I am under the influence of pseudoephedrine right now.)

          1. I don’t have a sub nor university library access, so can’t verify. Nevertheless, I easily found the UK press release that described how they went about getting the numbers. That was enough for me to see it was an interesting result.

            The short blog write-up of a few sentences was just that – a blog post. It is not an article or a peer-reviewed paper. It is a “hey, check this out” with a few words of explanation. I guess if you need to harrumph that not enough information was given, that’s one way to go about it, but the level of information in a blog post is different than an article, and if it were me and someone was pretending to ask for more detail, I’d have a tip jar in the left column. .02

    2. The pharmacist at a Walgreen’s in California told me last month that the limit is nine grams per person per month. One pill contains 30mg, and the recommended dose is two pills every six hours, not to exceed eight pills in a day. So if you’re taking the maximum recommended dose for four days straight, you will consume slightly less than a gram. If you weigh 300-400 pounds, you might need to take significantly more to get the intended decongestant effect.

      I purchased 96 pills of the Walgreen’s brand (or just under three grams) for $11.95 plus sales tax, and I expect that to last me and my wife a year or more. To me, the limit appears absurdly high if you’re not planning to make meth, unless you’re very fat and take the maximum dose every single day, which I doubt describes many pseudoephedrine users. Since I don’t make meth, I don’t know how much pseudoephedrine is required, but it seems as though you’d need a lot more than 300 pills/month to run a profitable operation.

      Given these numbers, I would say that a 1g increase in sales per 100 people is statistically nil.

  2. I can see ways that lobbyists, or even sensible people, might put different interpretations on both of the pieces of data you set out. If you assume that there’s a baseline level of PE consumption by people with colds (that doesn’t really change with advertising or weather or whatever) then it stands to reason that increased sales will be correlated very nicely with increased manufacture, but the coefficient doesn’t tell you a lot unless meth labs are standardized operatons, each consuming the same amount of PE. And the factor-of-565 difference — unless there’s a meth lab on every corner in that high-use county — suggests a lot of variance and leaves open the possibility that a large proportion of the PE sold *in some counties* is used to make meth without the same being true statewide or nationwide.

    Are there solid answers to these objections? I’d sure like it if there were.

  3. I wonder how many low population counties are short on pharmacies that sell pseudophed, such that residents are going to other counties to buy it?

  4. 1. Off topic but are there data that show market shares for imported meth from Mexican meth factories vs local production in meth labs? It seems that a disproportionate amount of political and media energy is spent on relatively smaller suppliers? Certainly PSE is not the problem along I-5 as it is along I-75.
    2. Does the JAMA study also look at the county-level consumption patterns for prescription drugs such as oxycontin? If as I suspect there is a high correlation between PSE and other abused legal drugs in certain counties limiting PSE sales further would cause an increase in abuse in other drugs.
    3. As we know meth is a more acute problem in rural areas. Thus statewide restrictions run into opposition from consumers and politicians from population centers. Has any state tried to limit PSE sales to select counties based on population? If the smurfers had to drive to Lexington or Joplin it would surely hurt the supply chain.

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