Missourians spent more than $9.47 million on pseudoephedrine products last year — and nearly half of those pills may have been used to make methamphetamine, according to one estimate.

That's why support is growing in Missouri to make about a dozen products, including Sudafed, Claritin D and other cold and allergy medications, available only by prescription.

The momentum has made Missouri a battleground state when it comes to the debate among police, pharmaceutical companies and lobbying groups on how best to control sales of pseudoephedrine, meth's main ingredient.

Some local governments are considering the prescription idea, and the Missouri attorney general is gathering statewide support for the plan.

Doctors are divided on the issue, but some local doctors say the drug would not be missed. It works by shrinking blood vessels in the nose, lungs, and other mucus membranes to reduce congestion.

"Are there some people who swear by it? Yes, but it's close to a useless drug," said Dr. Anthony Scalzo, who works in the emergency room at Cardinal Glennon Children's Medical Center. "The overall evidence for its usefulness is questionable."

The Missouri Medical Association, a lobbying group that represents 6,500 physicians, takes a different view.

"Thousands of Missourians depend on pseudoephedrine to relieve the misery of allergies," said Tom Holloway, the group's director of government relations. "Every patient is going to have to go to their doctor's office, pay a co-pay to get a prescription and do this again and again, especially if they're allergy sufferers year-round. The cost and hassle factor will far outweigh the benefits."

Dr. Michael Treisman, a general internist at St. John's Mercy Medical Center, said he would fill prescriptions for the drug over the phone if he knew the patient.

"Having everyone with a blocked nose coming into the office just doesn't sound reasonable," he said.

But he also is among those doctors who have reservations about the drug.

"It causes high blood pressure and, being a stimulant, we try not to use it for an extended period of time," Treisman said.

Pseudoephedrine was a prescription drug until 1976. That's when the U.S. Food and Drug Administration deemed it safe for over-the-counter use. In 2005, Congress set daily and monthly limits on how much pseudoephedrine consumers could buy and required signatures for purchases at pharmacy counters.

That's when pharmaceutical companies filled shelf space with an alternative, phenylephrine. Some estimates show consumers buy more of the alternative than pseudoephedrine.

It's difficult to tell how Missouri's pseudoephedrine consumption compares with other states, because pharmaceutical companies do not have to reveal sales data. But last year, Missouri pharmacies sold 989,000 boxes of cold and allergy products containing pseudoephedrine — not including Wal-Mart's sales, according to testimony given before a Missouri House Committee this year.

Conservatively, that's a box of Claritin D, Sudafed or 10 similar medications for about every six Missourians.

The Missouri Attorney General's office estimates that as much as 40 percent of pseudoephedrine sales are used to make meth, based on an analysis of sales in one Missouri town in August.

In 2001, the U.S. Drug Enforcement Administration commissioned a study of convenience stores in the Portland, Ore., area that found about 75 percent of sales were for meth ingredients.

Those numbers prompted Missouri Attorney General Chris Koster to survey prosecutors and sheriffs across the state to gauge support for prescription legislation. So far, 95 of the state's 115 prosecutors have signed a petition favoring the law, said Missouri Association of Prosecuting Attorneys board member Stephen Sokoloff.

"There are a whole lot of different ways of making meth and a number of different processes, but the one single ingredient they have to have is pseudoephedrine," Sokoloff said.

Mexico banned the importation of pseudoephedrine this year to crack down on drug cartels supplying most of the meth found in the U.S. The move has sent superlabs in California into overdrive. Legislators there also are debating whether to require prescriptions for the drug.

TRACKING SALES

Police say an average meth addict needs about 2.5 grams of pseudoephedrine, or the amount found in two boxes of pseudoephedrine pills, each day to support the habit. Doctors said that's about a monthly supply for legitimate users.

The Missouri Medical Association believes a statewide database that would track pill purchases by logging consumers' identification would block illegal sales and avoid patients' having to make doctor's appointments for prescriptions.

The Consumer Healthcare Products Association, a lobbying group for pharmaceutical companies, has offered to pay $800,000 for such a statewide database.

Treisman is among those who back the database plan. He wonders if a prescription law would stop meth addicts from collecting prescriptions from multiple doctors — a practice known as doctor shopping.

But police officers like Franklin County Detective Sgt. Jason Grellner say meth addicts suffer from extreme paranoia. The idea of going to dozens of doctors to get prescriptions for two boxes at a time makes them less likely to doctor shop, said Grellner, who led a successful charge in June to require prescriptions for pseudoephedrine in Washington, Mo.

In support of his theory, he pointed to the state of Oregon, which required prescriptions in 2006. There, meth lab busts have dropped from nearly 40 a month to about 20 annually, without reports of doctor shopping for pseudoephedrine.

Doctors such as Dr. Sarah Samimi Field, an allergist and immunologist at St. John's Mercy Medical Center, say they would not write prescriptions for endless use of the drug.

"There are some generic prescription nasal steroids that are very affordable and just as effective, if not more effective," Samimi Field said.

Phillip Cummings, a nurse practitioner at the Great Mines Clinic in De Soto, stopped prescribing pseudoephedrine two years ago, instead recommending orange juice and saline nasal sprays to relieve congestion.

He supports a prescription law pending in Jefferson County.

"I've been in medicine 40 years, and to the best of my knowledge, no one has ever died of a stuffy nose," he said.