Do the research. Study the data. Consider the facts.
Sgt. Niki Crawford, commander of the Indiana State Police Meth Suppression Section, says that’s her advice to those trying to decide whether to advocate or oppose a proposed requirement that pseudoephedrine — the only ingredient common to all meth recipes — become available only by prescription. That issue is likely to be debated during the 2015 term of the Indiana General Assembly, which began on Jan. 6 and must conclude by April 29.
Among topics that should be researched, Crawford said, are the experiences of Oregon and Mississippi, the only two states that have Rx-only pseudoephredrine laws on the books, Oregon since 2006, Mississippi since 2010.
Both states have seen rapid and steep dropoffs in meth lab incidents while those laws have been in effect. Some argue those declines are because of the laws. Others contend the declines had begun before the Rx-only laws went into effect and that states near Oregon and Mississippi without Rx-only laws also saw similar declines in meth lab busts.
Crawford, who was in 2005 asked to create and organize the ISP meth suppression unit, also suggests that those trying to form an opinion on the Rx-only possibility look at data compiled by ISP concerning meth lab incidents and arrests. ISP also keeps statistics on factors such as meth lab injuries and deaths, and the presence of children in meth lab environments. Those numbers are staggering in their expansion over the last 18 years, 1995 to 2013. (ISP statistics for 2014 are not yet available.)
The first meth lab incidents and arrests that are reflected in ISP statistics (which include all police agencies in the state, not the state police only) occurred in 1995: six of each. Yes, six. And for the first four years of ISP statistics (1995-1998), there were 90 total meth lab incidents and 83 meth lab arrests.
By 2003, the number of meth lab incidents had blown up to 1,011, and the number of meth lab arrests to 860.
After both categories fell in 2006 and 2007, the numbers of arrests have risen each year from 2008 on — to a high of 1,808 meth lab incidents and 1,551 meth lab arrests in 2013.
Those numbers were the highest in the nation — an unwanted No. 1 ranking. And according to the Missouri State Highway Patrol, through September 2014, Indiana had again recorded the highest number of meth lab incidents in the nation: 1,121. Tennessee was second at 813, Missouri third at 800.
Vigo County, according to ISP numbers for 2013, had 40 meth lab seizures, 21 by state police and 19 by other police agencies. Numbers for other nearby counties in 2013: Greene, 19; Sullivan, 17; Vermillion 15; Clay, 9; Parke and Putnam, 5 each.
Whereas Vigo County once had the most meth lab busts in the state, it did not make the top 10 in 2013. Vanderburgh County, with 115 meth lab busts in 2013, led the state.
The top nine other counties in meth lab busts were all east of the U.S. 41 corridor, which for several years had recorded the greatest meth lab activity, at least as reflected by incidents.
Beyond seizures, Crawford said, meth labs can also bring immediate death and injury. ISP data show that between 2000 and 2013, 27 adults and two children died from meth lab situations, for reasons including fires, explosions, police action shootings, homicides, suicides, car crashes and health issues.
During that same period, 236 adults, 13 children and 100 law enforcement officers were injured in meth lab incidents. Seven of those 13 children were injured by fires, four by exposure to chemical vapors and one each by chemical burns and swallowed chemical.
Those injury numbers for children represent a great concern to Crawford and others in her meth suppression unit. Between 2003 and 2013, 2,587 children were identified as being present in meth lab environments investigated by ISP and other police agencies, according to ISP stats. That number reached its highest in 2013 at 458.
That, Crawford said, takes a lasting toll on children, some of whom are prostituted, some of whom are physically abused, some of whom are left hungry and insecure while their so-called guardian is on — or seeking — that next meth-induced high.
Doctor: Tighter regulations a worthwhile approach
As a doctor, Caroline Carney looks at the whole health of patients, analyzes causes and effects and prescribes steps to improve outcomes. As chief medical officer of a statewide health care company who is board certified as a psychiatrist, she has a strong feel for the lengths to which addicts and suppliers will go to obtain pseudoephedrine (PSE) for meth-making. As one experienced in working with health insurance and Medicaid, she sees the effects meth continues to have on Indiana’s low-income population.
Carney, one of the top officials at Indiana-based MDwise (www.mdwise.org), believes placing barriers in the way of those who would subvert the law to obtain meth ingredients — including pseudoephedrine, the only constant in the recipes — is vital in battling the drug and is effects.
Definitive data, she says, are hard to find to determine how effective is Indiana’s current law on pseudoephedrine purchases — which allows electronic tracking of over-the-counter sales and places limits on quantities and frequencies of such purchases.
“We don’t have specific answers about this in Indiana,” Carney said. Based on DEA data, nationally, the use of meth appears to be lessening, which may be a reflection that these practices are working. Any barrier in the production of a drug may impact the ability to make [it] readily available.”
Another approach to controlling meth, is to return pseudoephedrine to its former status as a prescription-only drug. Carney offers a nuanced response to whether Rx-only should become law. “The impact of methamphetamine on families, health care utilization, and police enforcement are important considerations. … Given that Indiana ranks among the highest of all states with meth lab incidents per the Government Accountability Office analysis of Drug Enforcement Administration data (highest in 2013), and the decreases noted in Oregon and Mississippi following legislation, I would support legislation that puts tighter regulations around the purchase of pseudoephedrine.”
Carney refers to the two states that have passed laws requiring prescriptions for pseudoephedrine — Oregon and Mississippi. The effectiveness of those laws has become a political football. Generally, law enforcement and the criminal justice system fall on the pro-Rx-only side of the issue, and generally, pharmaceutical companies, medical associations and drug retailers favor the over-the-counter sales position.
Neutral, scientific data can help clarify that divide, Carney believes. “In Oregon, studies that were supported by ‘big pharma’ showed no effect [from the Rx-only law]. Independent views showed a positive effect of the legislation,” she said.
As to the idea of a two- or three-year trial period of Rx-only pseudoephedrine purchases in Indiana, Carney said: “I would support this under circumstances in which data were evaluated by objective, non-pharmaceutical company funded researchers. …I think the best effect will be in how the law is written, especially if requirements are similar to those for narcotic prescribing.”
An argument over-the-counter sales proponents cite is that, no matter the law, druggies and their enablers will find a way to play the system and still obtain pseudoephedrine.
To that, Carney offers this perspective: “There will always be people who are determined enough to figure out ways to subvert the law, whether this would be an OTC-tracking system, or a prescription requirement. With the latter, it may be more difficult for producers to gain access from doctors because prescribing patterns can be tracked, doctors may be less inclined to write prescriptions for patients they do not know well, and office visit co-pays may limit this. I would have concerns that pressure would be put on urgent care, emergency department, and MinuteClinic-type settings for those providers to hand out prescriptions. The requirement of a prescription, especially if it requires a wet (handwritten as opposed to electronic) signature, should make access to large quantities more difficult.”
Carney also sees great value in prescription pseudoephedrine for reasons not even related to meth: “Before using pseudoephedrine in any form, citizens should first keep in mind whether they actually need the drug, are aware of the significant side effects, and whether the drug will aggravate or exacerbate any other conditions that they may have. ... In the case of using drugs like pseudoephedrine, conditions such as hypertension can worsen — leading to significant downstream health effects. Limiting this to a prescription-only product may increase demand on primary care providers, but should better direct this product to those who need it, for short-term use, and in consideration of the whole health of the patient.”
The meth issue, though, is more than pseudoephedrine, Carney said. “I think that the root causes of meth addiction, and where addiction rates are the highest must be part of this conversation. Meth has grown up in rural America and small, economically depressed towns/cities. Usage disproportionately affects the working class, and low-income persons. Users are at risk for a host of related medical and behavioral health conditions, furthering the economic impact of this drug. We need to talk about meth, and other drugs, in a way that addresses both the reasons for the demand, as well as what to do about the supply.”