Meth, again

It’s a nightmare, and there’s not much we can do about it. But one useful step would be making it harder to buy Sudafed and similar cold remedies in bulk. The combined power of the drug companies and the drugstore chains is making even that simple step politically infeasible.

This New York Times story about “meth orphans” is enough to make you weep. It’s all the more horrible because the meth epidemic has been a slow-motion train wreck. Nothing is happening now that wasn’t fully predictable, at least as a medium-to-high-probability outcome, five or even eight years ago.

Ever since the pseudoephedrine synthesis of meth was publicized on the Web, the production and distibution of the drug has been sweeping slowly north and east from the epicenter in San Diego. For a while, there was doubt that it would expand beyond areas with large numbers of Mexican immigrants, but that barrier has long since been passed. And yet meth has to compete for enforcement and political attention with marijuana and “club drugs,” neither of them a threat of even vaguely comparable magnitude.

The horrible fact is — as I was forced to confess to a reporter who called me last week — there isn’t actually much of anything worth doing about meth. Its risks are hardly a secret, so the potential gains from a big negative advertising effort now are hard to guess. Production demands no special skill or hard-to-get chemicals, is highly decentralized, and is concentrated in rural areas where enforcement is scarce. But even if more enforcement resources were available, there’s no particular reason to think we could make meth much more expensive or noticeably harder to come by.

Right now, there’s no treatment available but talk (by contrast with opiate addiction, where maintenance with methadone, LAAM, or buprenorphine works very well). Talk is better than nothing, as long as people with problems are willing to keep being talked to, but they mostly aren’t.

Pharmacologically, the drug is about as nasty as they come: highly addictive and extremely rough on the body and the mind. (Meth can do in months or years the sort of brain damage that alcohol does only in decades.) On top of that, meth production is an environmental nightmare.

The one semi-promising idea around is making pseudoephedrine-based cold remedies less accessible by putting them “behind the counter.” (The better alternative would probably be to make them prescription-only, as propsed in Oregon; Pfizer, having sat on it for some time, has finally decided to move forward with phenylephrine, a perfectly good substitute that isn’t a precursor of meth.)

But even the much more modest idea of making people to a phramacist before buying Sudafed and its competitors (as a way of making life harder for meth-cookers) has been running into stiff opposition from the drug companies and the drugstore chains. It’s recently been defeated in a couple of states, and there’s still a risk that the federal legislation that has been crawling through the Congress (it’s crawling a little more quickly now that the extent of the meth disaster is becoming clear) will not only be watered down but will include a pre-emption provision to make it impossible for states that want to do something more serious to do so.

I can understand being so concerned about drug abuse as to support a set of drug policies that keep 400,000 people behind bars on drug charges at any given time. And I can understand being so appalled by having 400,000 people behind bars on drug charges as to oppose the “war on drugs.” But how anyone can sincerely support the drug war in general and yet oppose putting Sudafed behind the counter completely escapes me.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: