HEALTH CARE/Joan Retsinas

Meth Wars: A Letter to Goliath

Dear Goliath, a.k.a. Big Pharm: Puny David gets all the fanfare, holding a slingshot, battling you, the giant. Everybody marvels at him. With righteousness on his side, David wins. At least he wins enough battles to become a legend. You win most of the others.

But maybe all your battles aren’t inevitable. Maybe sometimes you should step down, leave David alone. No battle. No heroics.

Today you are perpetually at battle with Uncle Sam. You work to shackle the FDA; you keep generic drugs at bay (or buy up the generic companies); you stopped Medicare from controlling prices, even though Uncle Sam was paying for the drugs. You have earned your reputation as an almost-omnipotent giant. Generally, you win.

But for this battle, maybe you needn’t flex your muscle. Maybe you should bow out.

The battle centers on pseudoephedrine, a crucial ingredient both in methamphetamine and over-the-counter cough syrups.

The battlegound is rural America. All those Little-House-on-the-Prairie idylls can grow dull, prompting lots of Americans, even middle-class ones, to seek the solace of a pharmacological upper. And methamphetamine initially works. Users like the feeling enough to want more and more and more. And the more they seek that high, the more they neglect their humdrum lives. Crime, child abandonment, unemployment, vandalism – meth opens up a Pandora’s box of social ills.

Not surprisingly, public health departments, along with police departments, school boards, and social welfare agencies, want to stop this frenzy.

One problem is the ease with which ordinary people, with zilch background in chemistry, can concoct the stuff. The ingredients are not arcane; the manufacturing process not complicated. Meth labs – “shake and bake” assembly lines — have sprung up in garages and basements.

But public officials have seized on one strategic weapon: they can limit the easy access to pseudoephedrine. Coughers – as well as would-be drug manufacturers – can get ahold of the chemical simply by buying cough syrup. So states have tried to make that purchase harder, by forcing people – coughers and mom-and-pop drug-manufacturers alike – to show a prescription before the local pharmacist will fill an order for cough syrup. Hardly draconian. But the requirement of a prescription stanches the flow of pseudoephedrine. After Oregon required a prescription, the number of meth labs in the state fell by 96%, and crime sunk to a 40-year low. Mississippi passed a prescription law in 2010; soon after, the number of meth labs plummeted.

But what those health departments see as a victory, you, Big Pharm, see as a challenge. In the 23 other states that dared to introduce prescription-bills, you marshaled your forces. Jonah Engle in the August/September Mother Jones describes your success at squelching these prescription-laws. Your lobbying arsenal is familiar:

Robocalls. Campaign contributions. Newspaper and radio ads. A website.

And the populist spiel also sounds eerily familiar: Legislators want to cut off coughers’ easy, inexpensive access to cough syrup. To punish a few miscreants, legislators want to punish many law-abiding citizens. These restrictions overstep the bounds of government. Prescriptions won’t stop the enthusiasm for meth. Addicts will find a substitute, or get around the prescription-rule. Indeed, the arguments against controls on pseudoephedrine sound like those against controls on guns: people make methamphetamine, pseudoephedrin is just a tool. Those arguments have worked against guns.

To date, only Oregon and Mississippi have limited the sale of this chemical. The persuasive data haven’t persuaded enough legislators in the other states. Against Goliath’s arsenal, the data were powerless.

Public health departments, police departments, social welfare agencies, school boards — like David, they have limited energy, weak slingshots. I know – as do those battle-weary departments – that you, Goliath, will probably prevail. You will safeguard your profits, your market share, your clout.

I am hoping that you withdraw from this battle.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email Opinions don’t necessarily reflect those of the editors of TPP.

From The Progressive Populist, October 1, 2013

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