Assessing community pharmacist engagement in a policing partnership strategy to reduce the illicit diversion of pseudoephedrine products

The impact of pseudoephedrine regulation at Australian pharmacies through Project Stop: A narrative review

ISSUES

Project Stop, a real-time monitoring program for pseudoephedrine-containing medicines, was initiated in 2005 by the Pharmacy Guild of Australia in collaboration with police in the state of Queensland. The program implemented an online database to record pseudoephedrine purchases (and attempted purchases) to prevent large-scale diversion to methamphetamine production.

APPROACH

This narrative review aims to understand the overall impact of Project Stop, what evidence exists for this kind of intervention in Australia, and what lessons can be learned from its introduction. Systematic database searches were conducted in Embase, PubMed, Web of Science and Google Scholar, with 20 relevant sources selected for inclusion.

KEY FINDINGS

Project Stop successfully prevented some pseudoephedrine from being diverted from pharmacies to methamphetamine production. The intervention has been most effective in jurisdictions that made the program mandatory. Project Stop was also associated with a temporary decline in clandestine laboratory seizures in Queensland, changes in methamphetamine production methods and reduced voluntary treatment admissions for methamphetamine use. Implementation was not associated with an appreciable effect on secondary indicators, such as methamphetamine production and harmful use.

IMPLICATIONS

Future applications of a Project Stop model must ensure ongoing impact evaluation, assessment of its effect on individual's drug-related behaviour and combine it with policies that address drug use as a health issue.

CONCLUSION

Project Stop has been narrowly successful in terms of reducing pseudoephedrine diversion and demonstrates the potential for third-party policing practices directed at the consumer level, in collaboration with healthcare practitioners, rather than only regulating precursor wholesalers.

Pharmaceutical sales of pseudoephedrine: the impact of electronic tracking systems on methamphetamine crime incidents

BACKGROUND AND AIMS

Electronic tracking systems (ETS) are used extensively in pharmacies across the United States and Australia to control suspicious sales of pseudoephedrine. This study measures the impact of one ETS-Project STOP-on the capacity of police to reduce production, supply and possession of methamphetamine.

DESIGN

Using official police data of incidents of production, supply and possession from January 1996 to December 2011 (n = 192 data points/months over 16 years), we used a quasi-experimental, time-series approach.

SETTING

The State of Queensland, Australia.

PARTICIPANTS

No individual participants are included in the study. The unit of analysis is reported police incidents.

MEASUREMENTS

The study examines the impact of the ETS on production (n = 5938 incidents), drug supply and trafficking (n = 20 094 incidents) and drug possession or use (n = 118 926) of methamphetamine.

FINDINGS

Introduction of the ETS in November 2005 was associated with an insignificant decrease (P = 0.15) in the production of methamphetamine. The intervention was associated with a statistically significant increase in supply incidents (P = 0.0001). There was no statistically significant effect on the incidence of possession (P = 0.59).

CONCLUSIONS

Electronic tracking systems can reduce the capacity of people to produce methamphetamine domestically, but seem unlikely to affect other aspects of the methamphetamine problem such as possession, distribution and importation.

Evaluation of pseudoephedrine pharmacy sales before and after mandatory recording requirements in Western Australia: a case study

BACKGROUND

A community pharmacy real-time electronic recording program, ProjectSTOP, enables Australian community pharmacists to verify pseudoephedrine requests. In Western Australia the program was available for voluntary use from April 2007 and became mandatory November 2010. This case study explores the effectiveness of the program by reviewing the total requests for pseudoephedrine products, and the proportion of requests which were classified as 'denied sales' before and after mandatory implementation. Seasonal and annual trends in these measures are also evaluated.

METHODS

ProjectSTOP data recordings for Western Australia pharmacies between 1 December 2007 and 28 February 2014 were analysed. Data included a de-identified pharmacy number and date of each pseudoephedrine product request. The total number of requests and sale classification (allowed, denied, safety, or not recorded) were calculated for each month/pharmacy. The potential influence of mandatory reporting using ProjectSTOP was investigated using a Regression Discontinuity Design. Correlations between sales from the same pharmacy were taken into account by classifying the pharmacy number as a random effect. The main effects of year (continuous variable), and season (categorical variable) were also included in the model.

RESULTS

There was a small but steady decline in the total requests for pseudoephedrine per month per 100,000 population (per pharmacy) from the time of mandatory reporting. The number of denied sales showed a steady increase up until mandatory reporting, after which it showed a significant decline over time. Total sales were heavily influenced by season, as expected (highest in winter, least in summer). The seasonal pattern was less pronounced for denied sales, which were highest in winter and similar across other seasons. The pattern over time for safety sales was similar to that for denied sales, with a clear change occurring around the time of mandatory reporting.

CONCLUSION

Results indicate a decrease in pseudoephedrine product requests in Western Australia community pharmacies. Findings suggest ProjectSTOP has been successful in addressing suspicious sales and potential diversion however ongoing data review is recommended.

Online reporting of pseudoephedrine pharmacy sales: does Australia require a mandatory system?

OBJECTIVE

The objective of our research was to compare the reported pharmacy sales of pseudoephedrine-based medication in state where the electronic recording of sales is mandatory, Queensland, with a state where recording is voluntary, Victoria.

METHODS

Unidentified, unit-record, pseudoephedrine-based medication transaction data (known as ProjectSTOP), for both states, were made available by GuildLink Pty Ltd, the data custodians. Data provided dated from roll-out, 8 November 2005 (Queensland) and 10 August 2007 (Victoria) to 16 October 2012 (the last entry at the time of request). Data were stored on a secure, password-protected computer at the University of Queensland, Australia, where it was prepared and analysed.

KEY FINDINGS

The rate of uptake of ProjectSTOP in Queensland compared with Victoria differed significantly; 1 year after roll-out, 72% of pharmacies in Queensland had used the system compared with 41% in Victoria. There were significant differences in transaction rates between Queensland and Victoria; the transaction rate in Queensland was four times greater than Victoria 1 year after roll-out. Our data show that Victoria captured fewer cases of multiple purchases using the same identification (i.e. suspected pseudo-runner activity) than in Queensland (112 compared with 517 cases in 2011).

CONCLUSIONS

Our findings show, not surprisingly, that by making the electronic recording of pseudoephedrine-based medication sales mandatory, there is increased uptake and use of the recording system ProjectSTOP. Importantly, by using ProjectSTOP comprehensively, the data can provide useful intelligence for the identification of trends and patterns of activity in relation to the diversion of pseudoephedrine-based medications.