OBJECTIVES: The illicit production of methamphetamine from the precursor chemical pseudoephedrine (PSE) in domestic clandestine laboratories fuels a significant portion of the domestic methamphetamine supply.  Although states and the federal government have taken steps to control access to PSE, it continues to be available as a non-prescription drug in all but two states.  The purpose of this project was to assess the relationship between PSE sales and indicators of methamphetamine use, specifically methamphetamine-related hospital admissions, in Kentucky. METHODS: Regression models were calculated to predict methamphetamine-related hospitalizations from 2010 county level Kentucky data.  Explanatory factors include PSE sales (in grams), number of clandestine lab incidents reported, USDA urban/rural indicator, methamphetamine-related arrests, number of controlled substance (CS) prescriptions dispensed, and population. Data sources include the Kentucky All Schedule Prescription Electronic Reporting Program, the Kentucky Inpatient Discharge Data Set, the Kentucky State Policy Crime in Kentucky Report, and Clandestine Laboratory Surveillance System. RESULTS: PSE sales were not associated with methamphetamine-related hospitalizations in this model.  The number of clandestine lab incidents reported, however, has a strong positive impact on methamphetamine-related hospitalizations (P<0.001).  Methamphetamine-related arrests also have a strong positive relationship to hospitalization (P<0.001).  Finally, use of controlled substances has a small but negative impact on methamphetamine-related hospitalization (P<0.05).  CONCLUSIONS: PSE sales data alone cannot be used to predict methamphetamine use as evidenced by methamphetamine-related hospitalizations.  The number of clandestine lab incidents, however, reported is strongly associated with methamphetamine-related hospitalizations. These findings suggest that policies aimed at reducing clandestine labs may have a significant impact on indicators of methamphetamine use.