Pseudoephedrine and Meth: No Easy Solution
This week, Union, a town of about 8,000 people in Franklin County, became the second city in the nation to pass an ordinance requiring prescriptions for medications containing pseudoephedrine. Pseudoephedrine is the active ingredient in nasal decongestants such as Sudafed, but can also be used in the production of methamphetamine. Union’s new ordinance has renewed calls by sources such as the Riverfront Times to expand this regulation to the rest of Missouri. The Riverfront Times argues that the benefits of preventing meth production and use (assuming that the sort of regulation in question would actually accomplish that goal, which is a big assumption) far exceeds the costs of “inconveniencing consumers,” but the evidence points to costs far more complex than mere inconvenience.
No one can deny that meth production and use has a serious economic, legal, and social impact on communities. But the nasal congestion that drugs like Sudafed treat has an impact as well. Acute rhinosinusitis (or ARS, the technical term for nasal congestion lasting less than four weeks) affects approximately 32 million adults annually in the United States, or about 16 percent of the population older than 18. The effect on work and school absenteeism is predictably large, with 98 percent of workers citing minor illness such as colds and allergies (the primary causes of ARS) as a major cause of short-term absence.
ARS results in approximately $6 billion in annual costs, nearly 90 percent of which are associated with doctor or emergency room visits. In fact, ARS and other upper-respiratory illnesses are the leading cause of primary care visits after hypertension and routine checkups. Unfortunately, there is little that primary care providers can do for ARS, with treatment generally combining symptom control through over-the-counter decongestants with prescription antibiotics. Yet a recent study found that antibiotics provided little benefits for ARS, because bacterial infection complicates only 13–38% of ARS cases (compared to the 85–98 percent of cases in which antibiotics are prescribed; why doctors continue to prescribe a clearly ineffectual course of treatment is a topic for a separate post altogether).
Indeed, it appears that the only effective treatment is symptom management with decongestants, and currently decongestants containing pseudoephedrine remain the clear winner in terms of efficacy. Studies have failed to prove the efficacy of phenylephrin, the main alternative to pseudoephedrine that is used in formulations such as Sudafed PE.
So, with no effective alternative to treat nasal congestion, mandating a prescription for pseudoephedrine-based decongestants would leave ARS sufferers in a tight spot. Sufferers must opt to call out sick and stay home, find time to go to the doctor’s office (if you can get an appointment) or the emergency room, or just push through it and go to work unmedicated — and I hardly need to tell an allergy sufferer how little work generally gets done in that state.
The end results of this regulation are all unappealing: increased absenteeism, reduced productivity, or increased primary or emergency care visits. The last may not seem like such a bad thing, but hospitals and doctors, who are currently slammed by increased volume because of influenza, might have a different opinion. Increased volume leads to increased wait times for patients, keeping those with minor illnesses away from their jobs and lives (and in close proximity to contagious patients) and keeping those with serious illness from getting the treatment they need, especially since emergency rooms may be tied up by people with minor illnesses when primary care providers are booked up. And, as mentioned above, these visits already account for $5.4 billion of the $6 billion in annual costs associated with ARS; increasing the number of visits would cause those costs to balloon.
With the contagious illness season coinciding with the ARS season, we need to be empowering patients to manage their own symptoms whenever possible, rather than restricting that capability. Meth production and use certainly has its costs, but so does an overly restrictive regulation, such as Union’s. Balancing the benefits and the dangers of drugs such as pseudoephedrine is not an easy task, but an “easy,” all-or-nothing solution such as this one amounts to taking the easy way out.


Being a Franklin County native and former SMI Intern, I have a few thoughts on this matter.
1) Union is just south of my hometown, Washington, MO. (w00t).
2) Though your article was thorough and brought up some very good points, points which I had not thought of before, you neglect to balance the costs you mention with the costs of drug abuse plaguing our great state.
3) I fail to see the drastic results of making Sudafed prescription only. Yes, there will be increased costs to the economy, but how is Sudafed being prescription only and different than other drugs being prescription only. Am I wrong to assume drugs are kept by prescription only because they are easily abused and their threat to society by being readily available as over the counter medications outweighs the benefits they bring by being readily available? I would say Sudafed fits into this category of costs outweighing benefits. Yes, I admit it’s nice to be able to go to Walgreens and buy Sudafed when I’m really clogged up, up there. But I, like many, am willing to sacrifice that utility if it curbs meth production.
4) The Voss family has a few ties to this issue. The town in question, Union, is a small town indeed. I can’t imagine them having more than 6 pharmacies. The largest of which is the Walgreens on the corner of Hwy. 47 and Hwy. 50. My sister Laura and her husband are both Walgreens pharmacists and am fairly certain have both worked at that particular Wags. If anybody would have something to say on this issue, it would be my older sister, but unfortunately she isn’t picking up her cell phone and is thus unavailable for comment. But no worries. I myself at one point was a pharmacy tech at the Washington Walgreens. Honestly, this is as much as an issue there as in Union, or anyway in Franklin County for that matter. In my opinion, the current regulations on purchasing decongestants containing pseudoephedrine are too lax. If I remember correctly (and please correct my if I am wrong [Eric]), all that is necessary to buy Sudafed is a driver’s license, filling out a form detailing your name, age, address, and quantity of purchase, and I believe there is a maximum amount you can purchase, 2 boxes (I am unsure of the milligrams and frankly, do not feel like Googling it.)
So, in conclusion, I would support the measure to make a prescription requirement statewide. I enjoyed the article and look forward to hearing more about the issue as it progresses. Hopefully in the future I see more stories about Franklin County, specifically Washington, on this blog. It seems the amount of Washington related stories has dropped significantly since mine and Eckelkamp brothers’ tenures ended at the SMI.
Comment by Jake Voss — October 15, 2009 @ 8:39 p.m.
You are correct, Jake, there is a tremendous cost to meth use as well, as I mentioned more than once in my post. I certainly did not intend to say that the costs of upper respiratory illness outweigh the costs of meth; from what figures I have seen, they do not. As I stressed in my concluding paragraph, I do believe that something needs to be done about the meth problem in communities like Union, I just don’t believe this is the solution.
However, your belief on prescription regulation is a common misconception. To see why, it’s easiest to turn the question around and ask rather why some drugs aren’t prescription-only. Generally speaking, drugs are allowed to be sold over-the-counter when two conditions are met: the condition being treated does not require medical supervision, and the drug can meet elevated safety standards. It’s not so much an issue of “abuse” in the pathological sense, it’s really more concern about people attempting to self-diagnose, self-treat, and thus perhaps self-harm.
Pseudoephedrine is a great example of this standard at work. With ARS there is no advantage to medical supervision, since the only effective treatment is the highly safe, highly effective symptom reduction effected by drugs like Sudafed, and it is rarely complicated by infection or serious illness. Also as I indicated above, empowerment of patients is important for the health-care system as a whole. After all, if it weren’t, why have any over-the-counter drugs at all?
Just as your opinion is colored by your roots, so is my opinion colored first by a lifetime as a daughter of a pediatrician slammed by colds and flus all winter long and now as an employee of Children’s Hospital, where emergency unit patients are literally being seen in tents in the parking garage because patient volume has increased over 100% this season. Of course these different perspectives are exactly why I think the key to finding solutions to the meth problem (and others) is interdisciplinary collaboration, rather than measures such as these that are almost entirely crafted by law enforcement and legislators.
Comment by Chaya Kristen Chopra — October 15, 2009 @ 9:40 p.m.
I’d like to take this opportunity to paste a lengthy quote from the venerable Sheldon Richman:
Comment by Eric D. Dixon — October 15, 2009 @ 10:13 p.m.
[...] Comment! The rumors are true! A few weeks ago I began an internship at the Show-Me Institute. I am loving it, of course, and today I debuted on the SMI blog, Show-Me Daily. Head over there to read my first post, titled “Pseudoephedrine and Meth: No Easy Solution.” [...]
Pingback by New post at Show-Me Daily « Missouri Women's Forum — October 15, 2009 @ 10:55 p.m.
Here is a story on a rash of heroin overdoses in Washington, MO.
http://www.stltoday.com/stltoday/news/stories.nsf/missouristatenews/story/9ABDEAE5446646D88625765000674304?OpenDocument
I am sure they can solve this problem by making heroin illegal, too. That will take care of everything. Oh, wait…
Comment by David Stokes — October 16, 2009 @ 2:35 p.m.
I used to think prescriptions made sense. But this May, when I graduated college and was subsequently and automatically bumped from my family coverage, I found myself without a family doctor or insurance to cover the costs associated with refilling a prescription drug. I
The drug’s cost: $25. The doctor costs (I shopped around): $75-$300. And for what exactly?
Doctor: “So, you want this refilled?”
Me: “Yes.”
Doctor: “Okay.”
As Stokes pointed out, putting pseudoephedrine behind a prescription likely wouldn’t stop meth production. And on top of that, it would make the medicine prohibitively expensive for many.
Comment by Audrey — October 16, 2009 @ 4:09 p.m.
Although I am a firm believer in individual rights, I agree with Union. The horrors of drugs (meth),in Franklin County has been so deadly, that frankly anything anybody can think of, is helpful. Praying for the Victims of drugs….Ponytail Tim
Comment by Tim Harper (ponytailtim) — October 19, 2009 @ 8:54 a.m.
“horrors of drugs (meth),in Franklin County has been so deadly, that frankly anything anybody can think of, is helpful.”
Vote Vroman for Franklin County Sheriff
I promise to deliver
-Random house to house searches
-Generous informant payoffs
-Exorbitant surcharge on anything remotely connected to meth manufacturing
When Im done you’ll wish you just had a drug problem
Comment by vroman — October 21, 2009 @ 12:17 p.m.
Vroman, you will never beat Sheriff Gary Toelke. That guy is a rock star. He found about a baker’s dozen worth of kidnapped kids included Ownby and Hornbeck.
Also, some new developments:
http://www.emissourian.com/site/news.cfm?newsid=20381872&BRD=1409&PAG=461&dept_id=33071&rfi=6
Comment by Jake Voss — October 26, 2009 @ 11:34 a.m.
[...] at the Show-Me Institute’s blog, Sarah Brodsky notes that when sufferers have no good alternative to Sudafed, they must call in sick, “find time to go [...]
Pingback by Common Sense with Paul Jacob – Brought to You by Citizens in Charge Foundation » Archive » Tough Medicine, Tough Luck — November 19, 2009 @ 2:28 a.m.
[...] in October, my co-blogger Chaya Kristen Chopra pointed out that a similar ban in Union, Mo., would force people with nasal problems to seek out expensive [...]
Pingback by State Policy Blog » Blog Archive » Keep on Pushing that Boulder, Sisyphus — December 10, 2009 @ 9:41 a.m.
Is This Small Inconvenience Really So Bad?
By Brenda Luehrs, Washington07/31/2009
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To The Editor:
This is to all of the people who do not want to be “inconvenienced” when they need pseudoephedrine-based medicines.
I hope and pray that none of you ever have to experience what meth can do to a person. You do not have to do meth to be affected by it.
I hope that the people who make meth never come in contact with you – children, grandchildren, or anyone else you are close to and suck them in.
I hope you realize that no one is exempt, it can happen to anyone. I hope you never have to wait for days to hear from someone who is addicted because they are on their three-day high, praying that they make it home safe.
I hope that you are never afraid to go to sleep at night when they do show up. I hope you are never afraid to go check on them because you are afraid of what you will find.
I hope you never find out that someone you know, and thought was your friend, is actually selling, and doing meth with your loved one.
This person could be anyone, you never know, it could be a close friend, a business person, the car dealer down the street, you just never know. It is shocking who does it.
I hope you never get to the point where you trust no one.
I do hope, however, that you make yourself very aware of the problem and do your “small part” to maybe save a few lives.
Look around at all the problems in this world and think to yourself, “Is this small inconvenience really so bad?”
Count your blessings.
This is not going to solve the entire problem but may help slow it down. Why make it easy for them?
Comment by Brenda Luehrs — April 27, 2010 @ 10:03 p.m.