Pubdate: Sun, 26 Dec 2004 Source: Tribune Review (Pittsburgh, PA) Copyright: 2004 Tribune-Review Publishing Co. Contact: http://triblive.com/ Details: http://www.mapinc.org/media/460 Author: Mary Pickels COLD MEDICINES ATTRACT ILLEGAL-DRUG MAKERS Eight months ago, the U.S. Food and Drug Administration banned the use of the stimulant ephedra in dietary supplements. However, an ephedra compound, pseudoephedrine, remains a common ingredient in over-the-counter cold and asthma medications. The compound acts as an amphetamine, and its purpose in over-the-counter medications is to constrict blood vessels, aiding the decongestant process. But it may be attracting consumers with a different agenda. Pseudoephedrine is a common ingredient in the production of methamphetamines. Illegal "meth" labs have been a growing problem in western Pennsylvania. Earlier this year, investigators raided labs in Bell and Hempfield townships along with Kittanning Township in Armstrong County. Many area drugstores and grocery stores stock their shelves with products containing pseudoephedrine. Those medications, an FDA official said, have been regulated for safety and efficacy and their dosages reviewed. Mike Loughran, registered pharmacist at Loughran's Pharmacy in Hempfield Township, was aware of pseudoephedrine's potential for recreational drug abuse. Possibly because the pharmacy is a small one and not located in an urban area, he has had no problems with suspicious buying patterns. "You would need a fairly large supply," he said, in order to produce methamphetamine. Even used directly as a stimulant, he said, pseudoephedrine would have to be consumed in large dosages. "It is an ingredient that can be used," he said, "and it's easily accessible, if you get enough." The Wal-Mart chain of stores has limited over-the-counter sales of products containing pseudoephedrine since 1997. "We actually partnered with the DEA (Drug Enforcement Administration)," said Wal-Mart spokeswoman Sharon Weber. "... We saw the use of methamphetamines as detrimental to the community. ... We wanted to say, 'We are against this.' ... If that means limiting (sales), so be it." The stores' scanners automatically prompt registers if customers try to purchase more than three products containing pseudoephedrine, Weber said. Costco Wholesale retailer also restricts pseudoephedrine sales, limiting customer purchases to one package. The DEA mentioned the company in a 2003 meeting between the agency and retailers, and asked that other retailers selling such medications voluntarily consider setting sale quantity limits. Products containing another ephedra derivative, ephedrine, can be found easily on the Internet. Most cite a version of these ads, found on two sites: "Attention: This version of ephedrine was not banned by the U.S. government," or "Yes, it is ephedrine ... safe, effective and legal." The products are advertised as decongestants. Several of the ads limit orders to six bottles. The FDA official backed up the ads' claims of legitimacy, if they are being sold for the use they claim. Potential for abuse A year before the ban, Edward P. Krenzelok, director of the Pittsburgh Poison Center at Children's Hospital in Pittsburgh, said ephedra abuse was common. In addition to its appeal to dieters, athletes and body-builders, who sought out the advertised benefits of fat burning and muscle building, the Chinese herb also appealed to people seeking a high, Krenzelok said. He has no such concerns about pseudoephedrine. "It doesn't seem to have any of the same effects ephedra had," Krenzelok said. Pseudoephedrine, he said, has been around as a decongestant product for years. "It's probably the best oral decongestant," he said. "... And its safety profile is high." He said he'd heard nothing about an uptick in its use as an attempt to gain a high. "We usually find out about those things," he said. "... It doesn't really concern me as something that's out there with abuse potential." Jana Kyle is a prevention supervisor with the Fayette County Drug and Alcohol Commission. She has noticed in recent months that some retailers have moved products containing pseudoephedrine closer to the check-out counter, possibly to prevent shoplifting. The abuse of over-the-counter drugs in an effort to achieve a high is a long-standing problem, she said. "That is not getting any better," she said. "They are cheap and accessible." She said some people also fool themselves, believing that if something is available over the counter, it's not really a drug. But she said she has not seen an increase in the use of pseudoephedrine in an effort to replace the loss of ephedra. The intended uses -- decongestant vs. weight loss -- are not interchangeable. "I have to commend Wal-Mart," Kyle said. "They are trying to prohibit or make a dent in some of the abuse going on. We also have to monitor ourselves. Everybody can't police everybody else." Recreational drugs, Kyle said, "have their pockets and their times. Heroin has come and gone and it's come again. Cocaine came and went and is popular again. ... It goes with the times. Methamphetamine is one of the drugs of the time." But, she added, "If I go in and buy two boxes of cold medicine, it doesn't mean I'm operating a meth lab." Legislating purchase Last April, the Oklahoma Legislature adopted House Bill 2176. It limits pharmacist dispensation of pseudoephedrine to consumers in hard tablet form to 9 grams in any 30-day period. It is the nation's first state legislation placing pseudoephedrine products in hard tablet form into Schedule V as a Controlled Dangerous Substance with the state of Oklahoma. Its purchase requires a signature and photo identification, and sales are limited to licensed pharmacies. The law excludes pseudoephedrine products in the form of gel capsules, liquid capsules and liquid preparations. The National Association of Chain Drug Stores is not sold on the new policy. The NACDS's 200-plus membership of chain pharmacies operates more than 33,000 community pharmacies. In November, Mary Ann Wagner, NACDS vice president of pharmacy regulatory affairs, testified before the House Subcommittee on Criminal Justice regarding the fight against methamphetamine. "Our membership is deeply concerned about the problems of methamphetamine production and abuse," Wagner said in her testimony. She added that many members have instigated voluntary efforts to reduce theft and illegal use of those products, including limiting sales, eliminating over-the-counter access in stores in geographic areas where methamphetamine is a problem and reporting suspicious activity in their stores to law enforcement officials. But NACDS, Wagner said, is concerned that the Oklahoma model may affect legitimate customers using the products for medicinal purposes. She encouraged stronger state and federal laws regarding penalties for arrests and convictions of meth-related offenses. She also suggested that DEA efforts to establish prevention and treatment programs must be accompanied by increased federal funding to meet those same challenges. "Without a multi-pronged approach to combat meth," Wagner said, "it's like giving an aspirin to a patient with a broken leg. It may be a step in the right direction, but it's not enough to solve the problem. We strongly encourage Congress and the subcommittee to explore all avenues before proposing final solutions." Among NACDS recommendations for reducing the methamphetamine problem: significantly increase funding for methamphetamine abuse prevention programs; provide incentives for drug companies to develop an effective decongestant that cannot be converted into methamphetamine; enact import controls on bulk pseudoephedrine and ephedrine; and track and control distribution of pseudoephedrine and ephedrine. Reducing access alone, the NACDS believes, does not address the issue of demand by addicts. Those addicted, the NACDS said in a statement, will find ways to get what they want. - --- MAP posted-by: Josh