JEFFERSON CITY — Amid a national push to make health care cheaper and simpler, Missouri is considering legislation that intentionally makes it a little more cumbersome.
State lawmakers have filed several bills for the 2010 session that would require a doctor's prescription to get certain cold and allergy medications that currently can be bought over the counter. Supporters hope that creating a new barrier to the medication will make it harder to get the pseudoephedrine used to make methamphetamine.
That Republicans and Democrats, House members and a senator all are proposing an extra step for Missourians seeking relief from colds and allergies, highlights the extent of the state's meth problem.
Missouri this year again leads the nation by a large margin in meth lab incidents, which counts arrests, dump sites and seizures. Through late October, Missouri reported 1,099 incidents — that's nearly 20 percent of the national total and almost 1½ times the number of second place Indiana.
Since 2005, Missourians buying medications such as Sudafed, Claritin-D and Aleve Cold & Sinus that contain pseudoephedrine already have been required to sign a log book and have been restricted in how much they can buy. In 2008, lawmakers tried to go another step by setting up an electronic tracking system, but they did not immediately fund it.
Now several lawmakers are seeking more restrictions.
The Missouri State Medical Association, a critic of the legislation, contends requiring prescriptions would be a burden for both doctors and patients and would increase health care costs.
"To get one of these prescriptions, you have to go to see the physician," said Tom Holloway, a lobbyist for the organization. "The physician cannot write a prescription for a controlled substance without an in-person encounter."
Many patients with insurance would have to make copayments, and doctors would have to see people who otherwise could treat symptoms themselves. For those without insurance, critics say the prescription requirement would force the state Medicaid program to pay for cold medicines.
Supporters in Missouri, which have included state organizations for police chiefs and sheriffs, contend a prescription is a minor burden for getting healthy but promises to cut meth production. Testifying before a Senate committee last year, a Franklin County deputy sheriff brought several cold medications that would still be available on the shelves.
So far, only Oregon has blocked the sale of the pseudoephedrine-based medicines without a prescription through a law that took effect in 2006. In 2005, there were 141 meth lab incidents in Oregon, and this year, there were nine through late October.
Rob Bovett, a leader in Oregon's efforts who is now a local prosecutor, said that making it harder to get pseudoephedrine helps eliminate meth labs. He said the disruption for law-abiding consumers with stuffy noses doesn't limit access to health care because drug stores are lined with medications that do not contain pseudoephedrine.
"It's unnecessary. It doesn't cure cancer. It doesn't cure anything," Bovett said. "It's about a decongestant, and there are plenty of alternatives. The toll that meth takes on our nation — and especially a state like Missouri — is phenomenal. The lives and families it destroys every day, as opposed to easier access to one decongestant — the balance swings heavily in favor of doing the right thing."
Two eastern Missouri cities in particularly hard-hit Franklin County have joined Oregon in erecting their own barriers. Union and Washington — about 50 miles west of St. Louis — each enacted local ordinances requiring prescriptions for certain cold and allergy medications. Local officials said problems from meth had gotten bad enough to do something new.
So Missouri officials must try to balance the popular idea of reducing crime with the less favorable prospect of inhibiting access to a medicine.
Democratic Gov. Jay Nixon campaigned last year on a promise to increase access to health care and the bona fides of serving as the state attorney general for 16 years. He told newspaper editors and publishers earlier this year in Kansas City that he applauds the cities that have tried requiring prescriptions, but he stopped short of endorsing a statewide requirement.
"We look forward to crafting a bill that helps us fight meth, but I do want to also make sure that every Missourian has an opportunity through some method to get relief from the common cold," he said.