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5/20/2016

In Indiana, Decongestant Access Hinges Partly on Pharmacists’ Judgment

Cheryl Thompson

Cheryl A. ThompsonDirector
News Center

With partial credit to the Indiana Pharmacists Alliance, a new law in the Hoosier state leverages pharmacists’ judgment to accomplish two goals: (1) to keep pseudoephedrine available without a prescription to residents with a clinical need for the decongestant and (2) to disrupt the supply chain for methamphetamine production.

The law, which goes into effect on July 1, balances the concerns of pharmacists, physicians, and consumer advocacy groups, said Mark Triboletti, president of the Indiana Society of Health-System Pharmacists, one of the academies in the Indiana Pharmacists Alliance.

"Generally speaking, pharmacists were all in favor of making it Rx only," Triboletti said, referring to pseudoephedrine.

Harry Webb, whose pharmacy was the site of the April 28 ceremonial signing of the legislation by Governor Mike Pence, said it will "end the smurfing."

"They come in in droves . . . sometimes," Webb told WNDU-TV about people who buy pseudoephedrine for methamphetamine production. "Some chain stores have sold up to 60 boxes of pseudoephedrine products in just a few short hours."

Indiana led the nation in 2013 and 2014 in enforcement incidents involving clandestine methamphetamine laboratories, according to a 2015 report by the Drug Enforcement Administration (DEA).

In Arkansas, enforcement incidents dropped by 63% in the calendar year after that state enacted a law requiring pharmacists to "make a professional determination, based on a pharmacist–patient relationship," before letting someone purchase pseudoephedrine, a precursor of methamphetamine. In 2014, the most recent year for which DEA has reported data, the number of actions against clandestine methamphetamine laboratories in the state was 5% of what it was in 2010, the year before the government enacted its pseudoephedrine law.

As originally worded, the Indiana legislation, Senate Bill 80, called for pharmacists to judge every pseudoephedrine sales request.

That proposed requirement was revised at the recommendation of the House Committee on Public Health, which includes Representative Steven Davisson, a pharmacist.

Rather than judge every pseudoephedrine request, pharmacists must judge only those requests made by people who do not have "a relationship on record with the pharmacy," the enacted law states.

Another proposal that was modified at the House committee’s recommendation pertained to the deadline by which the Indiana Board of Pharmacy must adopt rules in support of the law.

Triboletti said the Indiana Pharmacists Alliance strongly voiced a call for urgent implementation of such rules, and the enacted legislation instructs the pharmacy board to do so by July 1.

The new law also requires the pharmacy board to consult the Indiana State Police before declaring that a nonprescription pseudoephedrine product is extraction or conversion resistant.

Such a product, the law states, may be purchased by a person lacking a relationship on record with the pharmacy or not having in the pharmacist’s professional judgment a legitimate medical need for pseudoephedrine.

Methamphetamine production in the United States "has decreased significantly since 2010," according to DEA.

This decrease, DEA stated, is most likely due to restrictions on access to precursors in the United States and greater availability of Mexico-produced methamphetamine, which is typically produced using phenyl-2-proponone rather than pseudoephedrine as the precursor.

[This news story appears in the June 15, 2016, issue of AJHP.]

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