CHARLESTON, W.Va. -- As noted in Gov. Tomblin's recent inaugural address, substance abuse is one of the greatest challenges of our state. West Virginia's poverty and poor educational attainment are certainly major contributors to the human and economic toll that give the Mountain State such unwanted national prominence.
Demand can be decreased by approaching these cultural issues with strategies such as adequate funding for early childhood education, high school dropout prevention, and enhancement of outpatient mental health services. Yet, controlling access to the offending drugs is also critical and more efficiently addressed legislatively. Not surprisingly, in the 2012 comprehensive substance abuse act, almost all the provisions touched solely on this issue of availability.
Now in the earliest stages of their implementation, there are two separate technological tools which are key components of the law. The first is an enhanced controlled substance monitoring program to better identify and regulate questionable opiate prescribing activity. This process has been shown to be quite effective in several other states, including Ohio and Kentucky, and already the Tomblin administration has reported a decrease in sales of drugs such as Oxycontin and hydrocodone.
Unfortunately, we did not similarly follow the lead of Oregon and Mississippi by making pseudoephedrine (PSE) products prescription-only, which, since PSE is the main ingredient in methamphetamine production, has shown dramatic success in the fight against meth in those two states. West Virginia's law instead regrettably mandated the universal use of the second tool, the PSE electronic logging system called NPLEx. Despite the previous use of this pharmaceutical industry-funded product in nearly 60 percent of statewide purchases for the last few years, meth lab seizures in West Virginia increased nearly 30 percent in 2012 compared to 2011 and local broadcast media reported that early in 2013 meth lab busts were averaging an astounding two a day. None of this, though, has been mentioned by the administration.
There were also three other notable events last fall which caused additional concerns about the effectiveness of NPLEx:
1. An Oct. 16 research study from the University of Kentucky School of Pharmacy published in the Journal of the American Medical Association, was the first to show a direct correlation between NPLEx-documented PSE sales and methamphetamine production in Kentucky counties. It was unequivocally found that the counties where more PSE is sold are the same as those with more reported meth lab seizures. Unbelievably, there was a 565-fold variation in sales between the highest and lowest counties. Statistically, this is extraordinarily improbable, as is the likelihood that the demand for PSE in all these counties is due solely to colds and congestion.
2. In 2011, pharmacists in North Carolina began using the same NPLEx system we now use. Despite this, according to the North Carolina Bureau of Investigation, law enforcement busted a record 444 meth labs by late November, over 100 more than the previous record, set in 2011. Because of these distressing numbers, in early December a North Carolina House Select Committee formally recommended the prescription-only option. The committee chair, Republican Craig Horn stated, "We can do something about it that may inconvenience a few people, but seat belts inconvenience people, and they saved hundreds of lives."
3. Most disturbingly, on Nov. 1, Democratic U.S. Sen. Ron Wyden from Oregon and Republican Congressman Phil Roe of Tennessee, in a joint letter to the U.S. Attorney General, raised concerns that NPLEx may actually violate the federal Combat Methamphetamine Epidemic Act (CMEA). The two members of Congress assert that anecdotal evidence provided to their offices raises serious questions about whether NPLEx and the private company operating the program, Appriss, are providing law enforcement access to the data collected by the program, as they are statutorily required. There is also the real concern that some of this data is instead being given to PSE companies for marketing purposes, a direct violation of CMEA.
Sadly, in a very recent conversation in a Kanawha County drugstore which has been using NPLEx for some time, a respected observer heard an employee enthusiastically claim, "This pharmacy sells more PSE products than any other on the East Coast." So, rather than decreasing sales of PSE, this tracking device may actually be increasing them, which is quite consistent with the data seen from other states. You might say that we should give NPLEx time to work, but as Einstein supposedly noted, "Insanity is doing the same thing, over and over again, and expecting different results."
While we are making real progress in reversing the prescription drug epidemic, the same cannot be said about the battle against meth. Rather than enacting a PSE prescription-only policy that clearly works in the states where it is used, our policymakers fell victim to the half-truths of the industry's glib lobbyists and put in place a process that we have good reason to believe will allow continued harm to our adults and children. It's not too late to do the right thing.
Foster, a Charleston surgeon, is a former state senator from Kanawha County and a Gazette contributing columnist.