Patients, doctors unhappy with pseudoephedrine prescription requirement

Friday, October 7, 2011
Medications containing pseudoephedrine such as Allegra-D, Alavert and Mucinex D are kept behind the counter at Broadway Prescription Shop in Cape Girardeau. The Cape Girardeau law requiring a written prescription for medications containing pseudoephedrine has been in affect for nearly a year. (Laura Simon)

EDITOR'S NOTE: The Cape Girardeau city government asked for a clarification following this story's publication. Though the pseudoephedrine prescription ordinance asks for a "written prescription from a physician or other healthcare professional licensed by the State of Missouri to write prescriptions," the city's attorney interprets the law to mean that electronic prescriptions are acceptable.

Layne Burner never thought she would drive to St. Louis and spend $40 to get her allergy medicine.

But because of a Cape Girardeau law that took effect in December and requires patients to have a prescription to get pseudoephedrine, Burner chooses to forgo the hassle of getting an appointment and paying to see a doctor by driving roughly two hours to get the medication without a prescription. St. Louis County does not require a prescription to purchase the cold and sinus medication.

"This is much less hassle than having to schedule an appointment, paying the $25 copay, waiting an hour to be seen just to ask for Mucinex and going and paying the $20 for the medication," Burner said in an email. "I can go to a 24-hour Walgreens in Fenton and be in and out in no time any hour of the day."

The Cape Girardeau City Council voted in favor of requiring prescriptions for pseudoephedrine last year to help prevent methamphetamine production. Eighty-five to 90 percent of pseudoephedrine purchased in Missouri is used to produce the illicit drug, said Jason Grellner, a Franklin County narcotics investigator and vice president of the Missouri Narcotics Officers Association.

When used correctly, pseudoephedrine, commonly found in products like Sudafed and Claritin D, clears the nasal passages and offers relief to a sinus cold by stopping the body's secretions. Scott City, Perryville, Jackson, Dexter and Sikeston have all passed laws that require prescriptions for the drug.

Despite those cities in Southeast Missouri adopting laws that require prescriptions for the drug, Cape Girardeau County prosecutor Morley Swingle opposed the law when it was being debated in Cape Girardeau.

Swingle believes requiring a prescription for the pills creates a financial hardship on people who suffer from colds and allergies, especially those who are uninsured.

In all, nearly 60 Missouri communities have adopted laws that require prescriptions to get pseudoephedrine, Grellner said. A proposed bill to make statewide prescription law failed in the last legislative session.

Oregon and Mississippi require prescriptions to purchase pseudoephedrine products. Oregon had 12 meth lab seizures in 2010. Mississippi's law went into effect in July, and lab seizures there have declined 70 percent.

Because of the increasing amount of communities enacting prescription laws, more people from around the state are going to St. Louis to get the medication without a prescription, Grellner said.

Not all the people going to St. Louis for pseudoephedrine are looking to remedy a runny nose or cough, however.

"Meth cooks travel up there in packs to get as many boxes as they can," Grellner said. "We can arrest people getting pseudoephedrine for meth every 15 to 20 minutes there."

The number of meth lab seizures in Missouri has risen 10 percent in the last year, but the prescription laws being established throughout the state are helping curb the drug's growth by limiting where meth cooks can get the integral ingredient, Grellner said. Seizures in Missouri have grown from 1,976 last year to between 2,000 to 2,100 this year, Grellner said. In the first quarter, Cape Girardeau County meth lab seizures fell from 25 in 2010 to 16 in 2011, Grellner said.

"These bans will definitely help in retarding the growth of meth in Missouri," he said.

Decrease in sales

In addition to hindering meth production, the law has slowed sales of pseudoephedrine at pharmacies in Cape Girardeau.

Walgreens, 1 S. Kingshighway, led Missouri in pseudoephedrine sales in October 2010 with 2,215 boxes sold. Walmart, 3439 William St., logged sales of 2,470 boxes of medications containing pseudoephedrine in November. Both stores no longer record sales in a statewide database that tracks sales of the drug. Because a prescription is needed to purchase the drug, pharmacies are no longer required to enter the sales in the database, Grellner said.

"They're reluctant to report because of steep decreases in pseudoephedrine sales," Grellner said.

Broadway Prescription Shop owner and pharmacist Kevin Wood worked at Target when the law went into effect in December and said the pharmacy lost roughly 90 percent of its pseudoephedrine business.

"We started seeing only customers who legitimately needed it buying it," Wood said.

Broadway Prescription Shop, 710 Broadway, which was taken over by new owners in May, did not see a dip in pseudoephedrine sales because the law was already in place, Wood said.

Before the law came into effect, pharmacists commonly stocked the medication behind counters and would tell people they believed to be meth cooks that the drug was not sold at that pharmacy, Wood recalled.

"It's definitely safer now," Wood said. "We don't want those types in here anyway."

While Cape Girardeau pharmacies saw a decrease in pseudoephedrine sales when the law went into effect, Perryville pharmacies saw their sales more than double. Perryville's pseudoephedrine sales skyrocketed from 400 boxes a month to 1,400, Grellner said. Perryville enacted a prescription law soon afterward.


Becoming a prescription drug did not raise the price of pseudoephedrine, Wood said, but it did cause inconvenience for pharmacists because the Cape Girardeau law dictates that all prescriptions must be handwritten. Most prescriptions for other medications are either phoned in or submitted electronically, Wood said, noting that pseudoephedrine prescriptions are almost the only prescriptions he receives that are handwritten.

Allergist Jana Tuck said she believes the handwritten prescription aspect of the law was an oversight. She normally sends in prescriptions electronically or calls them in.

"It's a poorly written law," Tuck said. "We should be able to send prescriptions in electronically."

As an allergist, Tuck said, she doesn't see too many patients who just need pseudoephedrine. Primary care physicians get the bulk of those who need the drug, she said.

"They stand on the front line and see everyone," Tuck said. "They're the ones writing more prescriptions."

The real hassle falls on the patient, she said.

"People under 40 never see a doctor and now they have to see one when they get a cold," Tuck said. "For the patient, it's much more burdensome."

Burner said a friend suggested she get a six-month prescription for Mucinex, but she still chooses to drive to St. Louis. That six-month prescriptions are available has Burner questioning the law.

"What is the purpose of the law if you can just talk to a doctor and get a prescription that lasts that long?" she said.

Despite her skepticism and willingness to drive two hours to get pseudoephedrine, Burner said she understands why the law is in place but thinks something different could be done.

"I don't agree with punishing those of us who use the medications properly in order to stay healthy," she said. "I just wish there was a better database to keep track of who is buying these products in mass quantities."


Pertinent address:

1 S. Kingshighway, Cape Girardeau, MO

3439 William St., Cape Girardeau, MO

710 Broadway, Cape Girardeau, MO

Map of pertinent addresses

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