Tag: methamphetamine

I have written before about new cold medications that are claimed by their manufacturers to be resistant to the extraction of pseudoephedrine (PSE), a key ingredient of domestic methamphetamine production. These medications hold out the tantalizing possibility of a “have your cake and eat it too” public policy in which PSE-containing cold medication is widely available but meth cooks are put out of business.

According to their manufacturers, these medications (e.g., Nexafed, Zeprhex) work by binding PSE in a lipid or polymer that leaves it with normal bioavailability for people with stuffy noses but limits extractability for meth production. However, the Drug Enforcement Administration is claiming that it is still possible to make meth from these “resistant” medications.

Who is correct depends on what it means to ask whether these medications “work”.

If “work” is defined as whether given infinite production resources, meth could be made from resistant medications, then the DEA is correct: The medications don’t work. A small amount of PSE per box of resistant cold medication can be extracted in a superlab, so if you had an unlimited number of boxes and lab technicians you could eventually make a significant amount of meth.

But if we ask whether these medications “work” in the public policy sense of whether they will curtail meth labs, the data show they will work quite well. It takes about about 10 times as much Zephrex as traditional cold medication (e.g., Sudafed) to make the same amount of meth, which translates economically into an unattractive proposition for a meth cook: The resistant cold medicine required to make meth would cost many times more than the highest price that the meth market will bear.

The DEA is thus correct only in the trivial respect of proving that these medications don’t work in a world in which the laws of economics are suspended. But in this world, they remain a valuable tool in the quest to reduce the destruction caused by meth labs.

The 2014 legislative cycle in a number of states will witness efforts to curtail the methamphetamine labs that cause so much death, destruction and environmental despoliation from West Virginia to Oklahoma. Oregon and Mississippi have proven that putting cold medicines that contain pseudoephedrine (e.g., Sudafed) on prescription-only status virtually eliminates meth labs. But other states that have tried to pass similar laws have been overwhelmed year after year by the might of the cold medicine industry, which spends more money on lobbying in meth belt state legislatures than any other (notably, in West Virginia, coal industry lobbyists express envy at the cold medicine industry’s influence).

One of the industry’s central arguments is that people with colds and allergies need PSE and will suffer from reduced access. However, new technologies in medication production render this argument moot. As I describe today at Stanford School of Medicine’s SCOPE Blog, it is entirely possible to write legislation in such a way that meth labs are choked off while access to PSE-containing medications is maintained.

There is thus a policy compromise on the table that could draw diverse support on a hard-fought, important policy issue. That will bring smiles to the faces of decent and intelligent people. But drug policy, like public policy in the U.S. generally, includes a faction of perennially angry people to whom compromise is a dirty word. Expect such ideologues to fight hard against the public interest on this one.

How many times have you read scary stories in the press about addictive drugs of unprecedented purity? How often in movies has the villain been the one to cook up an incredibly pure drug? “Pure” in these cases is used as a shorthand for powerful and dangerous, but that isn’t what it means.

Purity is a measure of how much of some substance is “what it says on the tin”. Potency in contrast refers to the dose necessary for a substance to exert its effect on the body. Ivory Soap, famously, is 99.4% pure. But its potency when ingested is far less than that of 1% pure heroin.

This ends up mattering more than one might think in drug policy debates. Policymakers and parents get scared when they hear that an addictive drug is pure. But a pure drug can be safer than an impure drug if the potency of the latter exceeds the potency of the former. Even within the confines of the same potent drug, purity can increase safety if the impurities are nasty things such as levamisole or strychnine.

One concrete area where this misunderstanding is influential and sometimes exploited for effect concerns methamphetamine. A prescription requirement for the pseudoephedrine-containing cold medicines that are used to make meth would virtually wipe out domestic meth labs. Opponents of this policy sometimes try to scare people by saying that the result would be an influx of “much purer” methamphetamine made without pseudoephedrine (PSE) in Mexican superlabs (PSE imports are banned in Mexico). Yes, that form of methamphetamine is purer, but it’s less potent and hence less dangerous than methamphetamine made from PSE, even before you count up the burn injuries, explosions and fires that small-scale domestic meth labs cause.