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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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PSE Diversion in the US

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	Con Berbatis articles by this author...
Con Berbatis is a pharmacy researcher attached to Curtin University in Western Australia. For i2P, he identifies Australian and global research reports that may be useful for pharmacists to include in their own planning initiatives.

Editor : Up to the year 2005, Australia and the USA appear to have had the highest per capita consumption of pseudoephedrine (PSE) of any country.

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Interconnectivity of Electronic PSE Tracking Systems Shown to Reduce Illegal Manufacture of Meth

Much like bacteria that mutate to resist antibiotics, methamphetamine traffickers have adapted their methods to evade the restrictions that, for a while, weakened their operations. In response to these tactical mutations, regulatory and law enforcement authorities are augmenting their curative strategies. The use of interconnected electronic tracking systems to record and monitor pseudoephedrine sales at the point of purchase has proven effective in reducing diversion of these products. A study published in 2009 in Drug and Alcohol Review, which followed diversion trends by jurisdiction in Australia, confirms the efficacy of this technological remedy.

In the few years follow¬ing implementation of the Combat Methamphetamine Epidemic Act of 2005 in the United States, which restricted consumer pur¬chases of pseudoephedrine-containing products and required pharmacists to log all such purchases, the illicit production of meth¬amphetamine in the US declined. After a signifi¬cant drop in 2007, how¬ever, “methamphetamine availability stabilized and possibly increased after the first half of 2008,” accord¬ing to the National Drug Threat Assessment 2009 compiled by the National Drug Intelligence Center of the US Department of Jus¬tice (DOJ). The report ties the increased availability to escalated domestic produc¬tion of the drug.

DOJ attributes the resur¬gence in US methamphet¬amine production, in part, to producers obtaining the precursor ingredients from local retail sources. To buck the tracking system, meth¬amphetamine traffickers are known to acquire large quan¬tities of pseudoephedrine, the precursor chemical used in the manufacture of meth¬amphetamine, by organizing multiple, successive purchases of pseudoephedrine-contain¬ing products in quantities at or below legal limits in mul¬tiple retail locations – a prac¬tice known as “smurfing.” Pseudoephedrine tracking systems that are not intercon¬nected generally fail to flag these multiple purchases.

To address this shortfall, several states in recent years have implemented or shown interest in implementing electronic tracking systems that record the sales of pseudoephedrine-containing products. Such systems enable retailers to transmit informa¬tion on pseudoephedrine sales to an electronic database accessible to appropriate law enforcement and regulatory agencies at the state level. In¬formation from these systems can be used by enforcement authorities to reduce the number of domestic metham¬phetamine labs by preventing the sale of pseudoephedrine in excess of legal limits, and to identify and prosecute individ¬uals involved in smurfing and others involved in metham¬phetamine production.

Both Kentucky and Arkan¬sas have demonstrated success with linked electronic moni¬toring systems in reducing pseudoephedrine diversion. The implementation of Meth¬Check in 15 Laurel County, KY pharmacies in 2005, and of LeadsOnlabs MethMontior in 18 North Little Rock, AR pharmacies in 2006, both led to increased numbers of local illicit laboratory seizures, in¬creases in methamphetamine-associated arrests, and savings in law enforcement resources. In 2008, Kentucky and Arkan¬sas became the first two states to legislate linked monitor¬ing systems to be installed in pharmacies for recording and tracking pseudoephedrine purchases.

To support states in their efforts to set up linked track¬ing systems, and to encourage and support planning for interconnectivity between state systems, the DOJ Office august 2009 147

of Justice Programs’ Bureau of Justice Assistance (BJA) in spring 2009 was accept¬ing grant applications for a Methamphetamine Precursor Chemical Diversion Train¬ing and Technical Assistance provider. Applications were due June 23 for the grant, which is being funded under the Edward Byrne Memo¬rial Justice Assistance Grant Program.

The recently published results of the aforementioned study conducted in Austra¬lia support the theory that interconnectivity between tracking systems reduces methamphetamine produc¬tion. The study, undertaken by researchers at two Austra¬lian universities, found linked electronic tracking systems to be successful in preventing pseudoephedrine diversion in Queensland, Australia.

The study evaluated the effectiveness of a linked elec¬tronic medication recording system (LEMS), implemented into Queensland pharmacies in 2005 as part of the Pharma¬cy Guild of Australia’s “Project STOP” initiative to prevent the diversion of pseudoephedrine. The LEMS is a Web-based sys¬tem that electronically records pseudoephedrine purchase information at the point of sale and instantaneously transfers the data to a central collection system. A global positioning system depicts the location of the pharmacy where the data were entered. The system enables authorized pharma¬cists, law enforcement officials, and health department staff to view the data to identify cases of suspected diversion and to compare pseudoephedrine purchases with wholesaler supplies to pharmacies.

To measure the impact of the LEMS program on Queensland pharmacies, the study tracked the number of illegal laboratories seized in Australia by jurisdiction from 1996-1997 to 2005- 2006. Based on the histori¬cal trends for lab seizures in each jurisdiction over the span of years, researchers were able to measure actual results against projected results that follow historical trends.

Results indicated that the total numbers of illegal laboratories seized yearly in Australia by jurisdiction from 1996-1997 to 2005- 2006 appeared to stabilize – except in Queensland. The reported number of illegal seizures in Queensland in 2005-2006 was significantly lower than that predicted from historical data. Nation¬ally, however, the num¬ber of labs seized was not significantly different from predictions. In other words, the study found a significant decline in the number of illegal methamphetamine labs seized in Queensland in 2005-2006 compared to that of other Australian jurisdictions that did not use a LEMS. The authors point to this decline as suggestive of the effective use of LEMS in Queensland pharmacies to reduce pseudoephedrine diversion.

While an increased raw number of seizures in a single year would suggest improved enforcement, as it did in Kentucky and Arkansas, the decline seen in Queensland compared to projections based on historical trends and actual results seen in other juris¬dictions, on the other hand, points to a reduction in the existence of these illegal labs in the first place.

“For the 12-month pe¬riod ending June 2006,” the study authors report, “the Australian Crime Com¬mission attributed Project STOP with part of the reduction in illegal labora¬tories in Queensland and with more than 30 arrests following electronic com¬munications from partici¬pating pharmacies.”

While the study authors note that the “reliance on total yearly results of just one indicator, namely a reduction in the number of seized illegal laboratories, is insufficient in drawing firm conclusions,” the trends were indicative enough that in April 2007, 85% of Queensland’s com¬munity pharmacies were enrolled in Project STOP. In 2008, the Pharmacy Guild of Australia began implement¬ing the LEMS nationally through pharmacies with the assistance of a government grant.

Thus far, the evidence points to interconnectivity between pseudoephedrine tracking systems as a promising remedy to the societal ill brought on by the illegal production of methamphetamine

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