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Methamphetamine: Implications for the Dental Team

Course Number: 332

Response to the Problem

A major victory in the battle against methamphetamine has been achieved. Since 2006, all states have passed laws requiring that products containing pseudoephedrine be placed behind the counter. Oklahoma was the first state to do so. In 2004, after 3 state highway patrol troopers were killed by meth users, Oklahoma enacted some of the country’s toughest anti-meth laws such as a mandatory two-year prison sentence for possession of meth and life imprisonment for manufacturing meth with intent to distribute. Current federal law requires customers to show a photo ID to buy pseudoephedrine-containing products. The legal limit for purchases is 9 grams per month or approximately 30 tablets of 24-hour Claritin™ or Aleve Cold and Sinus™ or 84 tablets of Sudafed™. Several states including Arkansas, Kentucky, Missouri, Oklahoma, and Washington are using an electronic tracking and block of sale system that uses real time data to track purchases. Purchase information is immediately available within the state, and depending on the tracking system used, across state lines. If the purchase limit has been reached, the retail outlet is notified and can deny the sale. Law enforcement can then investigate, do preliminary interviews and determine if there is a reasonable suspicion of criminal activity.11 Retail purchases of pseudoephedrine (PSE) have been limited to 9 grams per 30 days. Several states, including Arkansas, Iowa, Indiana, Minnesota and Wisconsin, have implemented more stringent laws restricting the retail purchase of PSE to 7.5 grams, or as in the case of Indiana, 7.2 grams per 30 days and Minnesota, 6 grams per 30 days. The maximum daily dose of PSE is 240 mg, thus if a person requiring PSE takes the maximum dose every day for 30 days, a quantity of 7.2 grams would be needed for the 30-day supply. Restricting quantities to a maximum of 7.2 grams per day should have no impact on persons purchasing PSE for legitimate self-care uses. Additional states are considering legislation to restrict purchase quantities to similar limits.11 In keeping with their tough anti-meth focus, Oklahoma is the only state to date to block the sales of PSE to those with previous meth-related convictions.11

Through 1975, a prescription was needed to purchase pseudoephedrine products. In 2006, Oregon became the first state to again require a prescription to purchase pseudoephedrine products. Oregon has experienced a significant decrease in meth incidents and meth arrests and few consumer complaints about the prescription requirement since the passage of this law. In 2010, Mississippi passed similar laws. Arkansas requires a prescription for out-of-state residents only.11 Other states are considering implementing the need for a prescription for purchasing these products.11,34 Phenylephrine, a nasal decongestant, is still available on the shelf but many believe it is not as effective as pseudoephedrine.

The restricted access to pseudoephedrine and ephedrine products has led to an increase in a different meth production method called P2P, from the precursor chemical phenyl-2-propanone (benzyl methyl ketone), that does not require pseudoephedrine.30 While phenyl-2-propanone is highly restricted and closely monitored, it is easy to make from phenylacetic acid and its derivatives.30

Access to fertilizer is restricted and may contain ultraviolet coloring agents to identify its use in meth production. Iowa uses federal funds to purchase locks for fertilizer tanks to reduce the theft of anhydrous ammonia.

Inconsistent state laws and voluntary actions may be insufficient to curb meth’s widespread abuse. One possible solution is a national standard regarding pseudoephedrine-containing products. The Patriot Act, which contains the Combat Methamphetamine Epidemic Act 2005 (CMEA), could create a uniform national policy. Highlights of the CMEA’s provisions regarding the manufacture, distribution and use of methamphetamine include the following:19

  • Access to cold medicines with pseudoephedrine would be controlled by store personnel.

  • Limits on how much pseudoephedrine-containing product a person can purchase would be imposed.

  • Signature and identification would be required for purchase of this drug.

  • The Act would authorize $585 million for enforcement, training and research into treatment. Twenty million dollars is to be used to assist and educate children that have been affected by the production of meth.

  • More manufacturers and dealers would be assigned “king pin” legal status and subjected to harsher penalties.

In 2010, the Combat Methamphetamine Enhancement Act was enacted and places restrictions on distributors and retailers who sell products used in the illegal manufacture of methamphetamine. Distributors may only sell such products to those who are registered with the DEA. Retailers must comply with regulations that limit the amount of product that can be sold to an individual.11

Many states have child abuse or endangerment laws that specify stiffer penalties for meth related crimes in the presence of a child. In 20 states, the manufacture or possession of methamphetamine in the presence of a child is a felony. Nine states have enacted enhanced penalties for any conviction for the manufacture of methamphetamine when a child was on the premises where the crime occurred.63 Children in homes with meth labs are exposed to toxic chemicals and commonly experience physical, sexual or emotional abuse or neglect by parents experiencing a high or coming down from one or by others coming into the home as a result of meth use or sales.16 Living in or around a meth lab constitutes a hazardous lifestyle for a child and subjects them to explosions, fires, booby traps, loaded guns and other weapons, and dangerous animals. Living quarters are frequently substandard and include unclean conditions; exposed wiring; lack of heating, cooling, refrigeration, clean water and sanitary facilities; poor ventilation, and play areas infested with rodents and insects. Parents who abuse meth are unable or unwilling to provide an appropriate child rearing environment. This may cause stress and trauma to the child. Consequences can include emotional problems, delinquency and isolation. Without intervention, these children may themselves become drug abusers.57 Children are present in approximately 10% of all meth-related seizures and accidents.

A second generation meth detection device, a hand held, battery operated scanner, is able to detect meth on skin, clothes, plastic, wood, metal and masonry. The original device was introduced in 2004-2005 and had a high number of false positives. The newer version has eliminated this problem.15 Despite the wide variety of ingredients used to cook meth, the resulting meth molecule emits a unique spectral signal. Legal questions remain: Does this constitute plain sight or does this scanning need a warrant? Is the presence of meth evidence of criminal activity? Trace amounts of drugs show up on everyday items, such as paper money. An investigation into the reason meth is detected is necessary to determine criminal conduct. Current users of the device include home inspectors, housing authorities, hotels, drug treatment centers, prisons, parole officers and the Bureau of Indian Affairs.15 Law enforcement agents can use the scanner without opening baggies or waxed paper thus reducing their exposure to meth. Since small amounts of meth are absorbed through the pores, this represents a health benefit over time.