Pubdate: Sun, 26 Dec 2004
Source: Tribune Review (Pittsburgh, PA)
Copyright: 2004 Tribune-Review Publishing Co.
Author: Mary Pickels


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

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

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

Pseudoephedrine, he said, has been around as a decongestant product for

"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

"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