Indiana lawmakers have yet to gather for the 2016 legislative session, but already the multibillion-dollar pharmaceutical industry has clashed with influential law enforcement organizations over a proposed law that would require a prescription to buy a common cold medicine also used to make methamphetamine.
Advocates, including county prosecutors, say something needs to be done to rollback Indiana's dubious distinction as a leading state in yearly meth lab discoveries, and have previously tried—and failed—to make it the third state requiring residents to get a doctor's prescription for cold medicines containing pseudoephedrine.
This year, they have a powerful advocate in GOP House Speaker Brian Bosma, who has has changed his mind about supporting such a proposal.
Opponents say the measure is punitive and argue that a universal ban would create a costly inconvenience for law-abiding allergy sufferers and burden overwhelmed doctors during busy cold and flu seasons. They say a ban would force those who are sick to visit a doctor just to fight a common cold—a cost the government would have to pay through Medicare or Medicaid.
Here are some things to keep in mind:
Near top in meth labs
Meth lab discoveries have dropped across much of the U.S. since a national peak in 2004. That trend has mostly skipped Indiana. State police report 1,242 meth lab "incidents" as of Oct. 31 of this year, only slightly below the 1,384 labs that federal officials reported for Indiana at the national peak.
A 2013 report by the U.S. Government Accountability Office credited crafty meth makers for developing new cooking techniques, as well as the use of groups of straw buyers who fan out to purchase the needed quantities of cold medicine.
But unlike the image of ad hoc meth lab facilities popularized by TV shows like "Breaking Bad," authorities say 93 percent of the labs discovered in 2015 were much smaller in scale, sometimes involving little more than a one-liter soda bottle
The law would certainly inconvenience consumers, said Jonathan Woodruff, an attorney for the National Alliance for Model State Drug Laws. But decreasing access to cold medicine, he said, can't hurt "because it makes it harder for people to buy it for illegal purposes."
Indiana lawmakers have voted to put cold medicines with pseudoephedrine behind the pharmacy counter, requiring customers to request and sign for them. There are also limits on how much a customer can purchase.
Made in Mexico
Opponents of the proposal say it is a dated solution to an evolving problem. Increasingly, authorities say, the meth trade is in the control of foreign drug cartels that can produce large quantities and have a vast distribution network.
"It's less of an issue of what's being purchased at the drugstore and more an issue of what is coming into the country," said Alex Brill, a health care policy researcher at the conservative American Enterprise Institute. "The marketplace here in the U.S. for meth has definitely evolved over the last four years."
Authorities concede that meth from Mexico is increasingly a problem, but they contend that tightly regulating the sale of cold medicine will free up the resources to focus on drug cartels.
"It won't solve the meth-taking problem in our state, but we believe it will solve the meth-making problem," said Washington County Prosecutor Dustin Houchin, who serves an area with substantial meth use.
The proposal is running into a well-financed campaign from industry groups, including the Consumer Healthcare Products Association, which represent interests that stand to lose financially if the law is passed. Already, TV ads are airing across the state highlighting the inconvenience it would cause for consumers, as well as the cost, which could fall on government programs like Medicare and Medicaid.
Former state health Commissioner Richard Feldman says the popularity of meth presents a vexing challenge for law enforcement.
"But flooding the medical system and clogging it up with patients with a common cold? The added cost to government individuals and families is not justified," said Feldman, who served under former Democratic Gov. Frank O'Bannon.
Critics and proponents both agree a prescription requirement will likely lead enterprising meth cooks to get their cold medicine in neighboring states, none of which have a prescription requirement for pseudoephedrine.
"But the harder it makes it for them, the better," said David Powell, executive director of the Indiana Prosecuting Attorneys Council.
While many states, including Indiana, track pseudoephedrine sales through a national sales database called NPLEx, Ohio authorities do not.
Those factors could all lead to the creation of a black market, said Feldman, who is currently the director of Family Medicine Residency for St. Francis Health.
"What did prescription status do for opiates? Nothing. It's the easiest drug to get on the street," he said. "Why is it going to be any different for pseudoephedrine?"
Two Indiana lawmakers have an alternative proposal that they say will curb illegal sales of a common cold medicine but would not penalize sick people by requiring prescriptions for the drug.
Sens. Randy Head (R-Logansport) and Jim Merritt (R-Indianapolis) said this month that pharmacists should have the authority to approve or disapprove sales for medicines containing the ingredient pseudoephedrine.
Merritt said the bill strikes the right balance because it doesn't require law-abiding allergy sufferers to make a costly doctor's visit. The measure will be considered when the Legislature meets in January.
The proposal would keep pseudoephedrine products behind the counter and require pharmacists to conduct a brief consultation with patients who would like to purchase them.