The pseudoephedrine debate: Available with or without a prescription?

The question of whether to require a prescription for the purchase of pseudoephedrine (the main ingredient in medications such as Sudafed) as a means to help combat the production of methamphetamine,  promises to be one of the  hotly contested issues of the 2012 legislative session. We invited a supporter and an opponent of the proposal to present their sides of the debate.

Jessica Hawkins: Time to say ‘enough is enough’

Jessica Hawkins is the Director of Prevention Services for the Oklahoma Department of Mental Health and Substance Abuse Services, which funds a network of Regional Prevention Coordinators providing community-based prevention services to all 77 Oklahoma counties. 

Substance abuse and untreated addiction must be a priority for Oklahoma.  It is the underlying cause for many of the negative consequences we are faced with in this state such as crime, incarceration, rising health care costs and broken families…issues that will not go away unless we start investing in the things that impact the root problem.

Want a great example? Methamphetamine.  Everybody knows about meth.  It is in the headlines every day.  If there is a picture that illustrates how drug use impacts us all, then this is it.

Methamphetamine abuse absolutely destroys individuals and families.  It causes irreparable damage beyond the user and places innocent people in harm’s way.  Apartment fires.  Home explosions.   Contaminated buildings.  Drug endangered children.  A woman was recently arrested for making meth in a WalMart.  How many people could have been injured if she had not been discovered in time?

But, you know what? We can expect more of the same unless we all get on the same page and say ‘enough is enough, we are through with letting this problem cause so many other problems and we are going to do something about it’.

A bill is being introduced this year to further restrict the availability of certain pseudoephedrine products and make them a prescription-only item.  Other states are doing the same.  Oregon has required prescriptions since 2006, and results have been promising.  According to Oregon Narcotics Enforcement Association, the number of meth lab incidents dropped from 467 in 2004 to only nine in 2010 – a boon for public safety.

However, we know that the law change, in and of itself, won’t make methamphetamine abuse go away.  It is, however, a needed step in the right direction as long as we adopt it as one part of a much larger effort that must incorporate a comprehensive prevention strategy and treatment for addiction.

Are people going to be inconvenienced by the new law?  Perhaps, but not significantly.  Some forms of the medication will still be available over-the-counter, just not the forms that meth-makers like to use.  And, drug manufacturers will likely offer comparable over-the-counter products, just reformulated so that meth-makers can’t use it.

Look, we are all already inconvenienced by methamphetamine abuse.   Why?  Because the people who pay to clean-up the mess are you and me, and I can think of better things to do with that money.  It costs all of us every time local emergency crews respond to those house fires and explosions; when hospital ERs are stacked with uninsured cases; and, when our state systems are bursting at the seams with children who, through no fault of their own, are in need of help so that they are safe.

The real answer is to prevent the problem from occurring in the first place and reducing the risk of reoccurrence when it does, because what fuels the fire is demand.  And, what reduces demand is a comprehensive prevention effort and expanded opportunities for treatment – especially involving people entering and exiting the criminal justice system – to stop the cycle of addiction.  These are proven strategies.

It is not a question about whether or not we should act and do what’s needed to start impacting the problem.  That decision has really already occurred, whether we know it or not.  We are past the point of engaging in debate.  It is either do something or continue to be swallowed-up by the consequences.

Ed Long: Prescription proposal won’t solve the problem

Ed Long is a  former state Senator who served from 1988 to 1996 and chaired the Senate Education Committee. Since retiring from state service, Senator Long has become an advocate for several causes including supporting mental health services to reduce homelessness and the expansion of substance abuse treatment services in Oklahoma.

The methamphetamine problem in Oklahoma is very serious.  Addicts and their families suffer terribly from this illegal drug and there aren’t enough treatment options for the thousands of Oklahomans addicted to meth.  Prisons are overflowing with people who are warehoused because of addiction. There aren’t enough programs or funds to help children and families left behind by addicts, making it more likely these children will also turn to drugs.

It’s obvious our healthcare system and mental health services are already overburdened.  When it comes to Oklahoma residents in rural areas, our state ranks at the bottom of the country in access to primary care physicians, so it’s no surprise there is also a critical shortage of mental health and substance abuse services.

Requiring a prescription for safe and effective medicines containing pseudoephedrine (PSE) has been touted as the silver bullet solution to the meth problem by law enforcement and other advocates.   It sounds like an easy answer, but in reality, it will only burden our doctors even more, drive up the cost of healthcare and clog emergency rooms with uninsured people just seeking relief for the common cold. What it won’t do is actually fix the meth problem.

Preliminary research shows that requiring Oklahomans to go to the doctor even one additional time a year will add almost 300,000 doctor visits to the overburdened system.  That takes doctors away from seeing really sick patients because they will be forced to see common cold and seasonal allergy sufferers who normally could just purchase popular and reliable medicines such as Claritin D on their own.

A patient would have to make an appointment, take time off from work, pay for the office visit and then go to the pharmacy to purchase the medicines.  A prescription mandate would also drive up Medicaid costs in our state and lead to higher out-of-pocket expenses for Medicare patients.

Requiring a prescription for basic and FDA-approved medicines containing PSE will only make it harder for physicians and pharmacists to monitor and track all the drugs they need to prescribe.  At a recent hearing at the state capitol on the prescription drug problem, a Claremore physician told legislators and representatives from the Department of Mental Health and Substance Abuse, “in a health care system where doctors only have a few minutes to spend with each patient, adding mandatory time spent checking databases and conducting urine tests is unrealistic.”

If the system is unrealistic now, how bad will it be when doctors are overburdened with prescriptions for pseudoephedrine?

The opinions stated above are not necessarily those of OK Policy, its staff, or its board. This blog is a venue to help promote the discussion of ideas from various points of view, and we invite your comments and contributions. To see our guidelines for blog submissions, click here.