The Cold-Pill Crackdown

By Margot Roosevelt

Every day, a stream of haggard customers would show up at Mark Dodson's drugstore in Altus, Okla. (pop. 23,000), just north of the Texas border. And every day Dodson would find dozens of empty cold-medicine boxes--the pills shoplifted--stuffed behind other products on the shelves or abandoned in grocery carts. Sometimes the 38-year-old pharmacist suspected that a buyer was using sniffle pills to manufacture methamphetamine, a dangerous drug, and he refused a sale. But usually, he says, "I had to give people the benefit of the doubt."

No longer. Oklahoma last April became the first state to classify such common cold remedies as Sudafed and Claritin-D as Schedule V narcotics, forbidding sales in stores other than pharmacies, ordering the pills placed behind counters, limiting the amount sold per customer and requiring purchasers to show a photo ID and sign a register. The medicines contain pseudoephedrine, a decongestant that works by shrinking blood vessels in the nose, lungs and other mucous membranes. Drug traffickers long ago discovered they could dissolve the pills in common chemicals and heat the mixture until the liquid evaporates and a powerful stimulant powder--known as meth, crank, crystal or ice--remains. As a result, 23 other states are considering similar legislation, and last week a federal bill, modeled on Oklahoma's statute, was introduced in the U.S. Senate by a group of bipartisan lawmakers from across the country, including states in which hospital admission rates for meth addiction have soared in the past 10 years; in Arkansas, that rate has increased 17-fold since 1992.

The crackdown on cold pills is the latest example of what pharmacists say is an attempt to turn them into police officers, and many don't like it. The Minnesota Pharmacists Association is trying to head off a bill limiting sales of pseudoephedrine to adults over the age of 18. The legislation, says the group's CEO, Julie Johnson, would require more than 300 products containing pseudoephedrine to be kept behind counters. The National Association of Chain Drug Stores warns that customers would have fewer choices of brands and longer waits in line, while big retailers would have to contend with a patchwork of confusing state laws. That is already true: at least 11 states have enacted some restraints. Meanwhile, some retailers are voluntarily restricting sales. Wal-Mart, for instance, limits customers to three boxes of products containing pseudoephedrine.

But the momentum is building for stricter laws because police officers across rural America are fed up with the time, money and danger involved in dismantling meth labs hidden in remote farms and forests. Originally popular with motorcycle gangs and long-haul truckers, the drug--which is smoked, snorted or injected--can be cooked up in a few hours from a combination of over-the-counter drugs, rubbing alcohol, fertilizers and other chemicals with recipes found on the Internet. Although an estimated three-quarters of the meth used in the U.S. is smuggled in by Mexican gangs, more than 8,500 domestic labs were raided last year. The drug, when abused, can lead to paranoia and violent outbursts. Three Oklahoma state troopers have been killed in meth-related cases since 1999.

Some 65 officials from 14 states gathered in St. Louis, Mo., in December to push for stricter laws, despite opposition from retailers and drug companies defending the $1.8 billion cold-remedy market. According to Lonnie Wright, director of the Oklahoma Bureau of Narcotics, Schedule V reclassification has "revolutionized" meth enforcement in the state, with busts dropping from more than 100 a month in 2003 to about 20. The rate could fall further in the next few months as every Oklahoma pharmacy gets a new computer program showing whether a customer has recently bought pseudoephedrine products elsewhere. "Simply by putting this stuff behind the counter, we have made this a manageable problem," Wright says.

If other states balk at the Oklahoma model, they may find themselves in the position of next-door Kansas, which saw a rash of meth cooks cross the state line after Oklahoma passed its law. "Any state in the Midwest that doesn't pass the bill this year has the opportunity to become the meth capital of the region," says Corporal Jason Grellner, the Franklin County, Mo., deputy who organized the St. Louis meeting. "And believe me, nobody wants that." Texas is considering going even further, requiring a prescription for any drug--such as some Sudafed products--whose sole active ingredient is pseudoephedrine.

Pfizer, the company that makes Sudafed, is moving to respond. In February it begins shipping Sudafed PE, a second line of its cold drug, which replaces pseudoephedrine with phenylephrine, a decongestant that cannot be used in the production of meth and has been available for years in Europe. But the company is also eager to point out ways in which the legislative backlash may be misguided: Pfizer spokesman Jay Kosminsky says that a problem with some current state laws, including Oklahoma's, is that they exempt liquid or gel-cap medications and multi-ingredient medications that contain pseudoephedrine, in the mistaken belief that those items cannot be cooked into meth.

With state laws proliferating, will federal legislation become more likely? The Bush Administration has thus far been reluctant to back any comprehensive approach. "The problem is not as severe in some states as it is in others," says federal drug czar John Walters. "It is probably not true that one size fits all." And in the past two Congresses, even moderate federal bills sponsored by California Democratic Senator Dianne Feinstein--limiting purchases to 190 pills a month--died in committee because of industry opposition. Nonetheless, Feinstein and co-sponsor Jim Talent, a Missouri Republican, say the most efficient way to curtail the spread of meth factories is to deprive them of their raw materials. "This legislation is a dagger at the heart of meth manufacturing in America," says Talent.

Oklahoma pharmacist Dodson agrees because he saw it for himself. The new requirements mean more paperwork, and falling sales of Sudafed in his store. "But to me, it is worth it," he says. "It keeps us safe." --With reporting by Sarah Sturmon Dale/Minneapolis

With reporting by Sarah Sturmon Dale/Minneapolis