Why Do I Have to Get Some OTC Medications From the Pharmacist?

Why do you have to get some OTC meds from the pharmacist?. Vlada Kramina/Ikon Images/Getty Images

You may or may not be aware that there are certain over the counter cold and flu medications that are available without a prescription but they are kept behind the pharmacy counter. You have to ask the pharmacist for these medications and provide your name, address and signature to buy them. 

It hasn't always been this way. Not too many years ago, you could walk into the drugstore or grocery store and buy as many boxes of Sudafed (pseudoephedrine) as you wanted to.


Why the Change?

As it turns out, the active ingredient in the popular decongestant Sudafed, is a key ingredient in the production of methamphetamines (meth). Meth production and addiction became an epidemic in the United States in the late 1990's and early 2000's. As investigators and officials searched for ways to curb the problem, they discovered that people manufacturing the drugs were buying large quantities of pseudoephedrine - a legal, over the counter medication - and using it to produce meth. 

In an attempt to cut down on the production of the drug, many states that were seeing the worst of the epidemic enacted laws that required pseudoephedrine and multiple symptom medications that contain it to be sold behind the pharmacy counter. It is still available without a prescription (in most places), but a photo ID and signature are required before purchase. There is also a limit of how much any one person can buy each day.

In 2006, the Combat Methamphetamine Act of 2005 was signed into law which banned the over the counter sale of pseudoephedrine nationwide and put these restrictions on it's sale in place in every state:

  • Pseudoephedrine may only be sold from locked cases or behind the pharmacy counter
  • Amount that any individual can purchase is limited
  • Anyone purchasing pseudoephedrine must present photo identification
  • Retailers must keep a log with personal information of purchasers for at least two years

Has It Helped?

Some states that were seeing the worst of the epidemic in the early part of the 21st century have seen a decrease in meth production since these laws were enacted. Unfortunately, those that really want to manufacture the drugs have found ways to get around the laws and produce it anyway

There has been talk about taking more drastic measures - such as making pseudoephedrine available by prescription only (meaning you would have to see your doctor first before you could get it) or even adding an official third category of medications known as "Behind the Counter". This BTC category means that pseudoephedrine and likely other medications that may fall into a gray area would live behind the pharmacy counter and require a discussion and assessment of necessity by a pharmacist before being sold but not a visit to the doctor.

The BTC drug category is something that exists already in some countries but there are many concerns and barriers to creating that classification in the United States. 

Two states - Oregon in 2006 and Mississippi in 2010 - have enacted stricter laws requiring a prescription for pseudoephedrine. The number of meth lab incidents has decreased since the prescription law was enacted in Oregon but there is not enough available information about how it has affected meth production in Mississippi. 


"Legal Requirements for the Sale and Purchase of Drug Products Containing Pseudoephedrine, Ephedrine, and Phenylpropanolamine". Drug Safety and Availability 30 Jul 14. US Food and Drug Administration. US Department of Health and Human Services. 11 Jun 15. 

"Pseudoephedrine: Legal Efforts To Make It a Prescription-Only Drug". Public Health Law 17 Aug 13. Office for State, Tribal, Local and Territorial Support. US Centers for Disease Control and Prevention. Department of Health and Human Services. 11 Jun 15.

"Methamphetamine Trends in the United States".  Fact Sheet Jul 10. Office of National Drug Control Policy. Executive Office of the President. 11 Jun 15. 

Branding, Frederick H., R.Ph., J.D.; Narula, Rahul. "A Middle Class in the United States? Behind The Counter (BTC) Drugs". ReedSmith. National Association of Boards of Pharmacy. 11 Jun 15. 

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