State Sudafed system SNAFU; snuffly Sooners suffer

It's cold season, and Oklahoma's whipsaw weather has Sooner noggins clogged with snot and in search of a solution.

A few minutes ago at a nearby chain drug store, I heard one of the assistants say that, at the moment, no one in the state of Oklahoma can buy products containing pseudoephedrine, the active ingredient in Sudafed and dozens of cold and sinus medications. The reason, she said, was that the state's electronic pseudoephedrine tracking system was down. This is the system that tracks how much pseudoephedrine you've bought in the last 30 days.

When you go to the pharmacy counter to buy any product containing pseudoephedrine, they submit your name, address, and ID, and what you're buying and how much to a state computer, which reports whether you're eligible for the purchase or not. With the state tracking system offline, they can't sell any pseudoephedrine. (Or so the pharmacy said. The text of the regulation seems to provide an out if the state system is unable to respond in a timely fashion.)

This Oklahoma Bureau of Narcotics slideshow on the history of pseudoephedrine tracking has screenshots of the state's PSE tracking system, and it illustrates the dramatic decline in meth lab busts following passage of the first limits on the sale of pseudoephedrine in 2004. The real-time electronic tracking system to replace paper logs was in operation in October 2006; its use became mandatory through an emergency regulatory order in December 2006.

While I appreciate the threat that meth itself and meth labs pose to public health and safety, I wonder about the wisdom of putting a cold sufferer's access to an effective decongestant at the mercy of a state-run computer system.

Phenylephrine, the substitute now used in over-the-counter cold medicines, just isn't as effective as pseudoephedrine; some studies say it works no better than a placebo. The Wikipedia article on phenylephrine has a summary of concerns about its effectiveness with links to reports on studies.

A 2006 review of research in the British Journal of Clinical Pharmacology concluded:

PE [Phenylephrine] is a poor substitute for PDE [pseudoephedrine] as an orally administered decongestant as it is extensively metabolized in the gut and its efficacy as a decongestant is unproven. Both PDE and PE have a good safety record, but the efficacy of PDE as a nasal decongestant is supported by clinical trials. Studies in the USA indicate that restricting the sale of PDE to the public as a medicine has had little impact on the morbidity and number of arrests associated with methamphetamine abuse. Restricting the sale of PDE in order to control the illicit production of methamphetamine will deprive the public of a safe and effective nasal decongestant and force the pharmaceutical industry to replace PDE with PE, which may be an ineffective decongestant.

That review may have been too early to take into account the results of Oklahoma's 2004 laws and was definitely too early to include the impact of the electronic tracking system on number of arrests and morbidity.

Oklahoma has recently added another restriction: forbidding previous meth offenders from buying any pseudoephedrine at all. The idea is to stop meth manufacturers from buying amounts of pseudoephedrine big enough to make meth but too small to hit the limit. That seems sensible; it avoids adding additional burdens to those who use the cold medicine for its intended purpose.

But if we're going to have an electronic tracking system, is it too much to ask that the state keeps it up and running?