This is Part 2 of an article that originally appeared on Beacon, where Jonah Engle writes about drug policy, and is posted here with permission. Part 1 is posted here. To read the full article and receive new stories each month, subscribe to Engle’s work.

Bridget Lambert of the West Virginia Retailers Association is unconvinced that the meth lab declines reported in Oregon and Mississippi are attributable to prescription-only laws. She points out that Mississippi’s neighbor Alabama experienced a significant drop in meth labs as did states neighboring Oregon, and they did not make pseudoephedrine a prescription-only drug.

Lambert also cites West Virginia’s problem with the diversion of prescription pain medication as evidence that a prescription-only law wouldn’t prevent the diversion of pseudoephedrine. “We have a prescription drug problem in West Virginia that far exceeds the meth problem and that is purveyed by doctor shoppers,” says Lambert. “So what would the end result be if pseudoephedrine was made a prescription problem? We have a prescription drug problem.”

Last year, The Government Accountability Office (GAO) compared the relative effectiveness of pseudoephedrine prescription laws and NPLEx. It found that even after accounting for declines in neighboring states, prescription legislation contributed significantly to declines in meth labs in Oregon and Mississippi. The GAO did not report that doctor shopping for pseudoephedrine had resulted in either state. Conversely, it found that NPLEx had failed to reduce meth lab incidents.

Neither Delegate Don Perdue nor Senator Foster believed the claims being made by the pharmaceutical industry about NPLEx’s ability to tackle West Virginia’s meth lab problem. “It was an opportunity missed, and unfortunate that we didn’t do what we needed to do regarding the meth labs,” says Dan Foster who retired from the Senate in 2012 and continues to work as a surgeon at the Charleston Area Medical Center.

NPLEx One Year On

NPLEx went into effect in every pharmacy in West Virginia on January 1, 2013. By July, the state had already surpassed the previous year’s total number of meth lab seizures. Overall, 533 meth labs were reported in the state in 2013 — an 85 percent increase over the previous year and a record for the state.

This should not come as a surprise. To date, 29 states have implemented NPLEx, as have several large national retailers across the country, including Right Aid and CVS. While some states have seen declines in meth labs after adopting NPLEx, most have not.

Back at the beginning of 2012, before Governor Tomblin’s Substance Abuse bill was filed, most states that had had NPLEx in place for at least a year had experienced a rise in meth labs. No state had more experience with NPLEx than West Virginia’s neighbor Kentucky. It was the first state to adopt the system, back in 2008. By 2012, meth labs had more than doubled in the state. Initially, Dan Smoot, a narcotics officer in Southeastern Kentucky with over three decades of experience, welcomed the technology. He was the first to pilot it, in Laurel County in 2007. “We wanted it to work,” Smoot told me when I interviewed him in Kentucky in 2012, but Smoot describes NPLEx as a “miserable failure.” He is now a leading advocate for making pseudoephedrine a prescription drug.

CHPA spokesperson Elizabeth Funderburk says the spike in meth labs in West Virginia is not a sign of NPLEx’s failure. On the contrary, she says, “More meth labs is evidence that the system is doing exactly what it’s designed to do.” Higher numbers of meth labs don’t mean there are more of them, law enforcement is simply better equipped to find them. “If you supplied state troopers with more radar guns, they would probably catch more people speeding. It’s the same logic that applies to NPLEx,” says Funderburk.

Forensic drug chemist Mike Goff, who ran the West Virginia State Police Clandestine Laboratory Training and Response Program for 12 years, disagrees. He says police are finding more labs because their number is increasing in the state. NPLEx, he says, is playing a marginal role in finding more labs than before.

Prior to its statewide implementation last year, NPLEx was already used in a majority of pharmacies in West Virginia because some large national chains had installed it in their stores. “As far as using it and then going and getting a lab, that was very infrequent,” says Goff. “Usually we find them as a result of other investigations, domestics or B&Es.” Goff says NPLEx is used primarily after meth labs are discovered to obtain data on purchases in order to identify and prosecute smurfs.

Costly Cleanup

No part of West Virginia has seen a greater surge in the number of meth labs than Kanawha County where 159 labs were reported in 2013.

Beyond the health and environmental hazards posed by meth labs, there are considerable costs to the county says Kanawha County Sheriff spokesperson Brian Humphreys. When children are found in meth homes, Child Protective Services is called in to conduct an investigation and ensure children have a safe place to live. The County Planning Commission boards up properties, which are condemned after a meth lab is discovered and must then ensure that the house is either decontaminated or demolished.

Then there is the hazardous process of disposing of the labs themselves. For this purpose the Sherriff’s office has acquired a specially built “meth truck”. It is stocked with Haz-Mat suits and decontamination equipment. It has special sealed compartments for transporting material from the meth labs. The hazardous waste is then brought to a secured and pressurized room at the Sheriff’s Department that is accessible only from a rooftop parking deck.

It is not surprising that West Virginia’s most populous county has the highest number of meth labs, but that’s not the only category it leads the state in. Last summer, the Charleston Gazette reported that Kanawha County had the state’s highest per capita sales of pseudoephedrine. With 10 percent of the population, the county accounted for 22 percent of all pseudoephedrine sales in the state between January and July of 2013. And this wasn’t only happening in Kanawha. In order, Nicholas, Putnam, Wood, Harrison, and Wetzel counties had the highest per capita sales of the decongestant. “The top counties are the ‘Who’s Who’ of meth labs,” Mike Goff, who now runs the Board of Pharmacy’s Controlled Substance Monitoring Program, told the Charleston Gazette.

The newspaper later identified three Rite Aid stores as among the top sellers of pseudoephedrine in the state. Shortly after, Rite Aid announced that in West Virginia, its stores would no longer sell single entity pseudoephedrine products — which are more attractive to meth cooks than pills where the decongestant is combined with another drug such as an antihistamine. Meanwhile, the Drug Enforcement Agency recently launched an investigation into pseudoephedrine sales by Rite Aid Stores in West Virginia since 2006.

CHPA says there is no link between pseudoephedrine sales and meth labs. However, in 2012, researchers at the University of Kentucky looking into the question drew a different conclusion. Comparing pseudoephedrine sales with meth labs across the state, the study found that “counties with greater pseudoephedrine sales were significantly associated with greater numbers of laboratories.”

The Battle Continues

In light of the surge in meth labs since the implementation of NPLEx, Delegates Don Perdue and John Ellam are once again trying to get a prescription law passed in 2014. And they have an unexpected ally in the Senate.

In 2011, Senator Gregory Tucker voted against the pseudoephedrine prescription bill in the dramatic vote that ended in a tie. Today, he is leading the charge in the Senate for just such a law.

Tucker reflects back on the 2011 debate over meth labs and pseudoephedrine.

“My office was inundated with phone calls. They all were originating out of the same number I think in Iowa or Idaho, but they were West Virginians and that was persuasive,” says Tucker. “It was very contentious, very emotional, and frankly my vote against the bill at that point, I was just plainly wrong.”

Since then, two factors led Tucker to change his mind.

When the State Senate is not in session Tucker works as an attorney in Nicholas County. It is in that capacity that he has witnessed firsthand the collateral consequences of growing numbers of meth labs in the form of child abuse and neglect cases. Most of these, he says, are related to some form of drug abuse. “We are putting the burden on our schools, because they are having to deal with these children who have been pulled from their homes and placed in foster care and they are not trained to do that,” says Tucker. “Our Department of Health and Human Resources is overwhelmed dealing with foster kids trying to get them treatment in a suitable home, trying to reunite the family.”

The past year has seen another potentially significant development — the arrival on the market of two brands of tamper-resistant pseudoephedrine. There are many brands of decongestant that don’t contain pseudoephedrine and therefore can’t be used to make meth, but some find these medicines to be less effective. In late 2012, two midwestern drug companies, Westport Pharmaceutical and Acura Pharmaceutical, each launched a new formulation of pseudoephedrine which they say delivers the therapeutic effects of pseudoephedrine but is sufficiently difficult to convert into meth that they are unattractive to meth cooks.

Tucker’s bill would require a prescription for pseudoephedrine but exempt tamper-proof formulations of the drug which would remain accessible over-the-counter.

“I fell for the arguments that I’m hearing today that are opposed to the bill that I’ve introduced,” says Tucker, “that it will drive costs up, that it will only inconvenience the legitimate users; the illegal users, it won’t bother them at all.” Tucker says by exempting tamper-resistant pseudoephedrine, his bill addresses these concerns raised by CHPA. A companion bill in the House sponsored by Perdue and Ellam makes the same exemption.

But CHPA remains opposed to these bills. “Our industry has has been committed to finding ways to lock resistant technology but those have yet to be realized,” says spokesperson Elizabeth Funderburk. She points out that the new drugs marketed as tamper-resistant have not been approved by the DEA, which in tests was able to extract some amount of pseudoephedrine from pills. Making an exemption for these new drugs “creates a false sense of security,” says Funderburk.

Instead CHPA and the West Virginia Retailers Association are proposing the state create a meth offender registry. People convicted of a meth offense would be barred from purchasing pseudoephedrine.

Funderburk points to a 50 percent drop in meth labs in Oklahoma last year which has adopted NPLEx and also has a meth offender block list.

If anything, this year’s debate over meth laws in West Virginia promises to be more heated than in previous years. In October, more than two months before the start of the legislative session, CHPA began running online ads in West Virginia. For their part, former Senator Dan Foster and the prescription bills’ legislative sponsors have been working to galvanize support from law enforcement, the medical community and city councils. “We are trying to play the political game better, we certainly can’t outspend em,” says Foster.

As in previous years, West Virginia is one of several states debating pseudoephedrine bills. Indiana adopted NPLEx two years ago and ended 2013 with 1,800 meth labs, more than any other state. On Monday, its pseudoephedrine prescription bill died in Committee. Two other NPLEx states, Tennessee and Missouri are second and third for total meth labs in 2013, each with well over 1,000 labs. This year, both states are once again debating further restrictions on pseudoephedrine sales. (Tennessee already has a meth offender block list).

Watching closely is Rob Bovett. The former District Attorney crafted Oregon’s pseudoephedrine prescription law, and supports advocates of similar bills in other states. “If I were driving the industry,” says Bovett, “it needs to focus on a handful of states that really have the potential to pass this thing this year, West Virginia being the top of the list.”

Supporters of a prescription-only bill got a shot in the arm from the Governor’s Advisory Council on Substance Abuse when it approved the measure on November 6 last year.

So far Governor Tomblin has been mum.

This is part two of a two-part series. Read Part 1 here.