Tuesday, April 12, 2005

A Pharmacy of One

This week's column wonders why our legislature can't decide whether pharmacists are too busy to help or really have enough free time to run your life, too. Weird headline, plus in the newspaper version, they jammed all the paragraphs together due to lack of space. The Oregonian series on meth mentioned in the column is worth reading for anyone interested in drug policy, as is Lindsay Beyerstein on pharmacist malpractice here.

East Valley Tribune, Apr. 10, 2005

Pharmacists and their friends at the Arizona Legislature can’t figure out from week to week whether pharmacists have too much to do already, or instead have enough free time to philosophize in addition to filling prescriptions.

First, the Legislature decided that pharmacists needed a law granting them the right to decide whether a customer "deserves" to have a prescription filled. The so-called “conscience clause” means that any zealous pharmacist can let his or her personal moral scruples determine whether you get the medicine your doctor ordered. Merely following the profession’s code of ethics by serving their customers as their physicians directed apparently didn’t fill up enough of pharmacists’ workdays. So they got their buddies in the Legislature to pass a law letting them play judge, jury, and doctor, too.

At the same time, pharmacists got all upset over making any change to how they sell over-the-counter medications containing pseudoephedrine, which illegal drug dealers extract and use to make methamphetamine. Attorney General Terry Goddard sought legislation that would take the pills off open shelves and require purchasers to show identification and sign a logbook. Such a law in Oklahoma is credited with reducing seizures of meth labs by 70 percent, and several other states are moving to adopt their own versions. But not here in Arizona, where business interests blocked the bill. Pharmacists are just far too busy, we’re told, to do anything so effective to prevent diversion of pills to the illicit meth trade.

Thus, we see exactly how far the delicate “conscience” exhibited by certain pharmacists and their allies in the Arizona Legislature extends. Druggists want (and have the time) to play doctor and decide whether you deserve to have your prescription filled. But faced with a meth epidemic, they don’t have nearly enough time to be good citizens. I guess the Legislature considers birth control pills as a much greater public menace than methamphetamine.

The pharmacy industry argues that restricting over-the-counter medications only hurts businesses and consumers and won’t make a difference to illegal drugs. But a two-year investigation by reporter Steve Sua of the Portland Oregonian (well worth reading, and available online here) showed that meth abuse in the western U.S. has fluctuated dramatically during the past decade, exploding and then surprisingly subsiding before exploding again.

Sua examined records of rehabilitation programs, hospital admissions, drug arrests, and drug seizures by Drug Enforcement Agency and local law enforcement. He found a surprising correlation between meth purity and abuse, and also found that federal efforts to restrict the supply of chemicals needed to make meth actually worked for a while, in 1995-96 and again in 1998-99. Fewer meth addicts entered rehab; fewer meth overdoses appeared in hospital emergency departments; police made fewer arrests for meth possession, and identity theft and car theft, which police say are crimes typically committed by meth addicts, actually fell in several Western states.

Within a year, however, the “superlabs” supplying most of the drugs switched to different raw materials, meth quality and abuse both rebounded, and the epidemic resumed. But meth suppliers are still vulnerable, because they only can make the drug from ephedrine or pseudoephedrine -- and unlike with heroin or cocaine, only nine factories, in four countries, make the bulk of the world’s supply. Restrict and control the chemical supply, and you’ll stop the meth epidemic. It happened before, and it can happen again.

But while waiting for the feds to wake up and smell the phosphorus, states can and should restrict the homegrown portion of the meth trade. It’s all in the chemistry -- and smart regulation of the chemicals could stop the local labs in their tracks. Without ephedrine and pseudoephedrine, there’s no meth. All it’ll take is smaller purchases, a little time, and a little inconvenience the next time you need over-the-counter cold medication.

If that minimal intrusion upsets you, just remember that if the Legislature gets its way, it will be worse. Just wait until you get a morality lecture from your pharmacist instead of your prescription.

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