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Cold Medicine Goes Behind The Counter

October 16, 2006
By HILARY WALDMAN, Courant Staff Writer

In the two weeks since a federal law put more than a dozen popular cold and sinus pills behind the drugstore counter, the Arrow Pharmacy in Hartford has not sold a single box of Sudafed.

It may be that it's not really cold season yet, pharmacist Eddie Martucci speculated.

Or it may be that customers are put off by a new law that requires them to show a photo ID and sign a logbook before purchasing products that contain pseudoephedrine, the key ingredient in many popular nasal decongestants.

It's a "pain," said Angelo DeFazio, owner of the Arrow Pharmacy on Farmington Avenue.

The behind-the-counter rule, which started Oct. 1, is designed to make it harder for criminals to buy large quantities of legal pseudoephedrine and to use it to produce the illegal drug methamphetamine. The logbook must be made available to agents of the U.S. Drug Enforcement Administration, who are authorized to inspect pharmacies to enforce all U.S. drug laws.

The law, part of the federal Combat Methamphetamine Epidemic Act and included in the anti-terrorist Patriot Act, is designed to keep popular nasal decongestants available without a prescription, while curbing their use to make illegal drugs.

Using large quantities of cold medicine, household drain cleaner, ordinary batteries, and recipes available on the Internet, it has been easy for drug abusers to produce large quantities of crystal meth in home laboratories.

On the upside, DeFazio said, the law allows pharmacists to monitor pseudoephedrine sales and to warn people with problems such as heart conditions that they probably should not be taking the drug. He said, despite the hassles, that he supports the law.

"It's well worth it," DeFazio said. "We've had some of these illegal meth labs in some very obscure little towns."

Beyond the hassle factor, some pharmacists suspect consumers may be buying the wrong cold medicine. Some pharmacists say sales of Sudafed and its generic equivalents are down because customers are confused by a look-alike product called "Sudafed PE" - which does not have pseudoephedrine and is still available on open drugstore shelves.

With only look-alikes on the shelves, some people are accidentally settling for cold products that don't work as well as those behind the counter, said Alan Rosenthal, a pharmacist at Suburban Pharmacy on North Main Street in West Hartford.

In a pharmaceutical journal article published last summer, two University of Florida pharmacists said the alternative product, Sudafed PE, or its generic equivalent, is not effective. The "PE" stands for phenylephrine, a compound that is not sufficiently absorbed into the blood stream to make it effective as an oral nasal decongestant, pharmacists Leslie Hendeles and Rancy C. Hatton said in the journal article.

Pfizer, the maker of Sudafed and Sudafed PE has said that the alternative drug does work and that customers who prefer the original are free to ask for it at the pharmacy counter.

Rosenthal said some of his customers have brought the PE products to the counter and asked for his advice.

"I tell them that pseudoephedrine is a better product," Rosenthal said.

He said few customers have balked at producing identification or signing the logbook once he explained the law. To purchase a pseudoephedrine product, customers must record their name, address and date of birth in a log book that pharmacies must keep behind the counter. They also must show a photo ID.

At some pharmacies, asking for pseudoephedrine products at the pharmacy is nothing new. Last year, several large chain stores including Walgreens, CVS and Wal-Mart voluntarily placed products containing pseudoephedrine behind the counter.

The signature requirement also is not unprecedented, said Martucci of Arrow Pharmacy. He recalled that in the late 1970s a customer signature was required for the purchase of paregoric, an opium-based medicine that was used to treat diarrhea in children and teething pain in babies. Paregoric has since been pulled from the market.