Context for readers from countries where this isn't an issue, or anyone who hasn't followed decongestant news: one of the most effective decongestants is called pseudoephedrine.
In the past this was easily available, with the most popular brand being Sudafed. My parents always told me that one should take Sudafed when flying after having had a cold, in order to avoid severe ear pain from the pressure changes, but people would also obviously take it when not flying, just in order to reduce the discomfort of the congestion itself.
Pseudoephedrine is very effective. It is also used to synthesize the somewhat related illegal drug methamphetamine ("meth"). Historically, meth manufacturers would hire people to buy large amounts of pseudoephedrine pills at pharmacies and supermarkets, then grind them up and synthesize meth from them.
In order to deter this, authorities in the U.S. restricted the availability of pseudoephedrine, while not making it prescription-only, by limiting the amount that people could buy, and requiring buyers to show ID and be put on a registry (which law enforcement could use in investigations). I think this is the only drug that is treated this way. Some people stopped buying pseudoephedrine entirely, either because they were offended by these rules or because they were afraid that they could wrongly be implicated in meth investigations if they appeared to buy it too often.
The pharmaceutical industry produced an alternative called phenylephrine, the substance that this proceeding relates to. Most manufacturers of pseudoephedrine-based drugs, including Sudafed, formulated alternative decongestants using phenylephrine. There are no legal restrictions on phenylephrine drugs; one can buy them anonymously and in any quantity. Customers have complained for years that these are much less effective than the original formulations.
A couple of years ago this regulatory authority started looking into the question of whether phenylephrine is actually completely useless as a decongestant (rather than just much worse than pseudoephedrine). Their preliminary review of studies suggested that it is probably, in fact, useless. This proceeding is now proposing to ban it on the grounds that it's ineffective and so people should not be encouraged to buy and use it as a medicine for purposes for which it doesn't actually work.
(There doesn't seem to be much corresponding initiative to remove or reduce the restrictions on pseudoephedrine.)
The restrictions on purchasing pseudeophedrine should be repealed. Their imposition led methamphetamine manufacturers to switch to a more efficient process based on different ingredients. Purity and production volume increased substantially.
A repeal won't turn back the clock on that of course, but it will make life easier for people with congestion.
It was a real win/win. Tens of millions of people lost access to an effective drug in order to penalize maybe a few thousand that were using it as a precursor to making mamp.
Only certain documents are accepted: photo documents issued by a US state and certain federal documents. There are some exceptions in the initial act text, but in practice, nobody is going to accept your nursery school record.
There are certainly 10s of millions of people who don't have direct access to this drug.
And if they require a drivers license but their system is based on an electronic reader and that reader is broken, then you are out of luck. No sudafed for you.
Pretty sure I've even commented here before about this, but I was refused at an LA Walgreens pharmacy when I presented both a NY ID and a US passport. Would only accept CA ID.
You honestly think there are 10s of millions of people wanting a decongestant in the United States without ID? This is ridiculous and I agree with the other commenter, a bit hyperbolic.
Wow I was surprised by this figure, so I tried to find the source everyone quotes. It appears to be a 2006 telephone survey of 987 randomly-selected voting age citizens that were then weighted for an underrepresentation of race (so perhaps not that accurate). Anecdotally, I work in a safety net hospital and it is really rare for someone to come in without ID, which is why those numbers seemed so surprising to me...
Pretending that government IDs are super duper hard to give out is a time-honored American tradition.
After all, imagine if the government had a database with every person's name in it! You'd have like 300 million rows? Nobody's built a computing machine that could do that. And then how would you get the cards to people? You'd have to send out horses and buggies to every corner of the nation. And where would you find enough coachmen to do that, and roads to drive the coaches on???
No, clearly it's unpossible.
So we have to reserve the use of government IDs for really important things, like checking if you can buy cold medicine, and voting must remain insecure.
Government IDs are not a solved problem, and you don't seem to have even tried to consider the issues involved. The key distinction between voting and cold medicine is that you have a right to vote, but not to buy cold medicine. So if you lost your ID, or it's expired, it is not an option to just say "that sucks, I guess you can't vote now".
In fact, as a rule, ID is reserved for things that aren't important, because it is a point of failure.
The point of India requiring identification for benefits is to prevent waste and fraud. And given the number of poor people in India, and the limited amount of money they have to help them, it seems like quite a good thing to do so.
Identifying people is not hard, even for the poorest countries, and it's quite easy to do with modern technology. There is no good-faith reason to oppose it, any more than there is to oppose driver's licenses.
Did you read the article I linked? You keep saying this is an easy thing to do, but don't seem to acknowledge any of the problems it causes. It is not easy to identify people. It is easy to identify people with 99% accuracy. If the remaining 1% are unable to access society, that is an unacceptable risk.
Consider for instance the people who currently exist, don't have government ID, and don't have an accurate record of their birth. Such people exist. Should they just die, or something?
I think these basic facts should be taught in school. Yes, millions don't have ID.
It seems trite to someone in the middle class, but it genuinely is not a priority to certain demographics, given the challenge of getting it. That challenge may seem trivial to a frequenter of Hacker News, but we're a diverse society.
The only barrier to getting a decongestant should be: having the money to pay for it.
No, but why the hell should someone else’s misbehavior cost me time and inconvenience?
The cost of these regulations is millions, perhaps billions of dollars in extra effort, bookkeeping and security by tens of thousands of businesses, not to mention lost productivity and frustration on the part of everyone else evolved, and moats of the costs and inconvenience is borne by people outside the government, who are not committing a crime.
It’s bat shit crazy that bureaucrats are allowed to steal this much productivity from the economy.
I honestly think it's on that order, yes. Anyone who has had a respiratory infection, a sinus headache, or seasonal allergies. Anyone who would take NyQuil. Over the course of 18 years. Why is that so hard to believe? In fact, now that I think about it more, it's probably a lot more.
I wouldn't be surprised if that's actually an underestimate, because this saga has had a knock on effect on decongestant formulations sold outside the US as well. I don't know exactly why this has happened but my guess is it may be due to economies of scale in manufacturing or licencing overheads.
It's hard to find a pharmacy which even sells pseudoephedrine based decongestant if you're in the UK, for example.
Boots (a large UK pharmacy chain) sells it, but it's "behind the counter" so you have to ask for it. They will also only sell you one pack of 12 per visit
It's the same for codeine-mixed products. Recently I got denied a simultaneous purchase of pseudoephedrine and ibuprofen/codeine - I was I was only allowed one.
I'm not sure if it's policy, law or I just looked suspicious.
Is that true? I honestly don't know. I thought it went away entirely. I guess that's what hiding it behind the counter does to those who aren't in the know.
No. Fentanyl has become a huge thing in illegal opiates (either used instead of drugs like heroin, or mixed in with heroin to make it seem stronger though more dangerous).
But, while there have been some instances of accidental fentanyl poisoning from use of other classes of drug (eg if a careless dealer/distributor is mixing fentanyl into heroin and doesn't clean the surface before moving on to weigh out bags of cocaine, or whatever) absolutely nobody is choosing to use fentanyl as a replacement for stimulants like meth (which is the drug being discussed above) or cocaine. They're complete opposites.
Of course, there are also trends over years/decades as drugs become more or less popular, either as part of societal trends (eg Ketamine in the UK, having spent a decade or two being forgotten about by the majority of recreational drug users, has apparently made a comeback and is very big in the party scene now especially among younger people), or because of the reasons people take drugs (eg the more people going to nightclubs/raves, the more people will use drugs like cocaine and MDMA; while more people getting depressed and not going out will lead to more people using drugs like opiates, eg heroin/fentanyl, to take away their mental pain - and some drugs, like Ketamine, are actually popular for both those examples, it's a popular party drug and it's often used alone by people wanting to bury their feelings).
So it's possible that the state or the world has led to more people choosing opiates than stimulants, and in the US fentanyl is all over the illegal supply of opiates. But I'm not aware of any logic that would say the increase in fentanyl has or would lead to meth users making the switch.
Side note that I think worth mentioning considering the topic: by FAR the most dangerous aspect of using these illegal drugs is the fact that they are illegal, not the fact that they are drugs. The majority of fentanyl users in the US are either trying to buy heroin but being sold fentanyl (or heroin+fentanyl mixes), and the majority of people actively choosing to use fentanyl illegally are doing it not because it's a nicer drug to use than heroin, but because the supply chain logistics lead to it being significantly cheaper (which is also why it's dangerously used by dealers to make their heroin batches seem stronger).
Heroin itself can of course be life ruining, but if taken on its own (not at the same time as other CNS depressants such as alcohol and benzodiazepines) then it's actually extremely unlikely to cause accidental fatal overdoses, and when it does cause overdoses (with or without whatever drugs being involved) it's 90% because the user didn't know how strong it was and expected it to be similar in purity to what they had been using before, and 10% because of lack of harm reduction education about how much to use to be safe, what drugs to avoid mixing it with, etc. (90/10% are just my ballpark guesstimates). Because we spend all the money interesting and locking drug uses up, rather than educating and supporting them in minimising risk while they do use and offering as much support as needed to those ready and wanting to beat their addiction.
If illegal drugs were, instead of being criminalised, treated like tobacco - highly taxed (but not so high that more than a few percent of people choose to buy from illegal sources), made by professional companies (more like other pharmaceuticals in this case than like tobacco m), and therefore possible to buy knowing both that the drugs are pure and knowing their precise doses - then the combination of taxes raised and money saved on the law enforcement side (everything from policing to court costs to prisons) could both fund huge amounts of mental health & addiction treatment and support options, not just for existing drug users but also as a preventative measure to reduce the number of people turning to drugs due to problems in their life or in their mind, AND leave a huge amount more money to be spent in other areas for the good of society. (Sorry for the long sentences, I'm too lazy to properly edit my comment right now).
> ...but it will make life easier for people with congestion
I haven't purchased pseudeophedrine, but my understanding was that you just walked up to the counter and had to sign your name at the pharmacy. Is that not the case? Doesn't seem like a big pain if that's the case.
It's a big pain. The prescription line at my pharmacy is never shorter than 15 minutes. Thus the drug is $11/month but costs me $60 in time to wait in that line. Meanwhile, other drugs are just mailed to me, including my prescriptions.
The prescription line is always fun. I remember some dude coughing on everyone, picking up his cell phone, "oh it was positive? great, I'm in line to get the medication" referring to COVID. In my opinion, the easiest place to get sick is waiting in the prescription line. Yet another tax on congestion sufferers.
Having said all that, your doctor can write you a prescription and all the restrictions go away, including the ID check. It has always delayed my fills even further so we don't bother anymore.
The most positive outcome from buying pseudoephedrine in line was being told "hey, your ID expires tomorrow" which was a good catch. I wasn't paying any attention to that. (I don't drive, so it's just a piece of plastic with my name. But necessary for paying taxes online in NYS.)
This is a complete tangent, but FWIW: you can pay taxes in NY with an expired license.
Source: I've been paying taxes in NY with a learner's permit that's been expired for well over a decade.
Edit: I've also used said expired permit to buy pseudoephedrine. In my experience, they get frustrated and put random garbage into the tracking system when the card doesn't verify, demonstrating that it's all theater. It did take a while, though, so your point about this being a waste of time holds.
> Thus the drug is $11/month but costs me $60 in time to wait in that line
In what reality? You were not being paid $60 to grocery shop or whatever else you might have done with that 15 minutes. Nor did it actually reduce your bank account by $60 to wait 15 minutes. If you applied this logic to everything in life, reading this very comment probably "cost" you a dozen bucks too. What a fun way to live?
> Meanwhile, other drugs are just mailed to me, including my prescriptions.
How often are your anticipating needing pseudoephedrine? For most people it's a once a year, at most, thing.
You're kidding, right? For people with allergies and/or chronic sinusitis, it's a thing they're taking for about a quarter of the year off and on. ...and they _will_ practically "cut you off" if you buy enough to be taking it for 45 days straight, no matter how you buy it.
That phenylephrine (which everyone with sinuses knows doesn't do a damn thing) was perpetually being touted as a substitute was just adding insult to injury.
Btw I got septum surgery and turbinate reduction and it was life-changing. Previously used antihistamines and nasal steroids every day. Even when my nose produces mucus, its doesn’t clog now. Procedure cost me $100 through Kaiser (cost them probably $75k if you believe all the various documents they sent me).
No, that's the inflated list price that's only paid by people with an emergency while out of network or similar unfortunates -- not insurance companies.
You can't take pseudoephedrine every day. Nor is pseudoephedrine used for allergies - it is a decongestant, not an antihistamine. Nor does immunotherapy "solve" allergies.
A simple google search before posting would have made your fictitious scenario a little bit more believable.
Guess what people take for allergies - drugs that actually prevent reactions. Allergic reactions that effect the nose are almost always going to result in discharge, aka. a runny nose. It's the body's natural way of removing the allergen. Pseudoephedrine doesn't help with this at all.
The side affects of prolonged pseudoephedrine use (usually defined as more than 7 days, btw) are far more serious than a stuffy nose.
You cannot even purchase enough pseudoephedrine to use every day over a full month. The government restricts maximum grammage per month - and no doctor is going to prescribe long-term use of pseudoephedrine to "help with allergies".
That is to say I don't believe your story at all. But I get it - googling these things before you posted would have "cost" you approximately $24 or something something something...
Sudafed (the working version) was one of the go-tos for seasonal allergies, alongside Claritin. Not everyone reacts to allergens the same way. You'd take Claritin daily for the month or so, then Sudafed for a day or two when it got bad.
Guess what happens when people take antihistamines... Lovely, lovely side effects. Side effects which are generally equally as annoying as the original problem.
If one can treat the symptoms just as easily as the cause and pseudoephedrine doesn't make them feel like a drugged-out zombie, just guess which drug people are going to take...
...and yes, doctors actually will write prescriptions for pseudoephidrine because they're generally pretty sure their patients aren't using it to make meth. I know three people who've gotten such prescriptions, and I've been tempted to do the same thing myself.
It means you have to go to the pharmacy when it's open. That's a significant hurdle if you're sick, especially if you have something contagious and you're trying not to expose people to it, or if you work weird hours, or if you don't have reliable transportation, or if you're the primary caregiver for young children, etc....
It also means you can't get it delivered, can't stock up, might have trouble sending someone else to get it, etc.... It's a big pain for some people, and particularly for people who already have a harder life than average.
I suffer from seasonal allergies that last anywhere from 2-4 months out of the year. During the height of allergy season, I take Claritin-D – a mixture of loratadine and pseudoephedrine.
Claritin-D 24-hour caplets come in boxes of 10.
You need 3 boxes to get a full month's supply.
Each caplet has 240mg of pseudoephedrine – 2.4g per box.
In my state, individuals can purchase up to 9g of pseduoephedrine per month, but only up to 3.6g per day.
So, while I can technically purchase a full month's supply of Claritin-D, I can't buy more than one box at a time.
These sorts of rules are minor inconveniences for an individual compared to the rest of life's challenges, but they exist in a special category of stupid that make them all the more frustrating.
But, here's a thought: what if I had children who needed the same medication? Who's going without?
Tangent; you reminded me about the Robitussin liquid (Dextromethorphan) in my pantry. It prescribes 20 mL doses but the bottle contains 118 mL total. Really grinds my gears this is legal.
> Some people stopped buying pseudoephedrine entirely, either because they were offended by these rules or because they were afraid that they could wrongly be implicated in meth investigations if they appeared to buy it too often.
This has actually happened [0], and I seem to remember more instances (at least when the law was first passed). I know I have also gone to buy it in a headache-induced fog and found that I've forgotten my ID, and on at least one occasion the national drug whatever system was down and they refused to sell it. Because it has to be run through the specific national database, it has to be run through one department and I have been unable to purchase because that department has closed for the day.
These are just what comes to mind when I think about purchasing pseudoephedrine over the years; it's just generally become a pain to get. It makes me wonder if it'd be quicker and easier to just buy meth and reintroduce the hydroxyl group to get my cold medicine.
Just crazy, isn't it? Nothing could be better proof that drug laws are both ill conceived and ineffective than when otherwise lawful people are forced to consider converting easily available but highly illicit meth into a medicine that's much needed by millions because it's essentially unavailable through stupidity.
If aliens were to visit they'd likely bypass contact on grounds that the planet's inhabitants are low-IQ nut cases.
"…and easier to just buy meth and reintroduce the hydroxyl group to get my cold medicine."
Damn stupid isn't it? I'd be funny if it weren't serious.
What's more most of these sympathomimetic amines are both simple organic molecules, and in numbers/types they're a dime-a-dozen so to speak—there are hundreds of them. Any number of which can be altered or 'metamorphosed' into others that have different physiological and psychological effects by almost any competent chemist.
I'm certainly not advocating the use of meth but it's clear to me that the regulations that control the distribution and use of these amines are not working. Essentially, all these brute-force/unsophisticated laws have done is to inconvenience legitimate users and have drug barons streamline the production of more efficient precursors such as phenylacetone (P2P).
We really do need a better way of approaching the problem. For instance, many drug users turn to illicit amines and other street drugs to overcome medical and psychological problems. It would make sense to have these people identified and then be treated by the health system before they turn to the street to 'help' them. Moreover, I'd reckon it'd be much cheaper than the millions now spent on enforcement.
Trouble is moral panic and an almost complete lack of understanding by both lawmakers and law enforcement of the problem and its underlying causes is significantly impeding progress.
It's also out of stock now a lot more than before. Especially in larger (read: cheaper per dose) boxes. I assume but have not confirmed this is simply done by overworked pharmacy staff not re-ordering as often as they otherwise would to avoid the extra workload induced by having to run your ID through the database/etc. I've talked to pharmacy techs that do this for other drugs that induce extra workload at national chains, so I don't see why this wouldn't hold true here as well.
That happened 15 years ago, just a couple years after the policy is created. A more compelling example of a spurious prosecution would be one more recent, say, after 2016. We can probably find some! The last time people looked, we found a pretty interesting story.
I did not know that pseudeophendrine could be bought without a prescription until last year I think. I was deterred from buying it not because I fear putting my name down, but because I wrongly assumed I needed a prescription and thus a doctors visit to go purchase it.
There aren't exactly signs that say "Hey, the good stuff is behind the counter and you don't need a prescription to get it".
Depends on the state; at least some have made it prescription-only.
It's much less convenient than going to the nearest 24-hour store and grabbing it off the shelf. And I'm a doctor married to a doctor; I don't have to get an appointment to get a prescription for a non-scheduled drug, but I do have to go during pharmacy hours and wait to pick it up.
The downstream effects in other countries are pretty annoying.
Because of US restrictions on pseudo, bizarrely other countries have followed suit - it’s next to impossible to find a decongestant with pseudo here in Ireland, they will sell you the useless phenylephrine shit instead, and the packaging is almost indistinguishable unless you spend a while looking and arguing with a pharmacist who is convinced phenylephrine works just as good.
It's a huge pain if the pharmacy is closed or has a long line. A pointless, purposeless pain. Another sacrifice the the always-ineffective yet never underfunded drug war gods.
You can't get it delivered using standard delivery apps (you can get phenylephrine, or medications containing it such as DayQuil, delivered using uber eats or doordash). That is an issue when you're sick.
It's still a pain in the ass you can't just go to the gas station and get some, etc... There shouldn't be a need to go to a pharmacy for what should be an over the counter drug that's far more effective than synephrine ever was. The difference between the 2 is night and day, probably because one actually works and the other maybe kinda sorta barely does.
You can can do this or your doctor can write you a prescription. I've never stopped using pseudoephedrine and depending on how congested I am sometimes it's the little red 4 hour pills or sometimes it's the big monster 12 hour version - but your doctor can write a generic prescription for pseudoephedrine and the quantity and amount and you can buy a box that way via cash or insurance too.
According to my friend who suffers when there is pollen/smoke in the air, it is typically sold out when he needs it, because other people breathe the same contaminated air.
So he has to drive around to ~5 pharmacies to occasionally score a a box.
He does try to stock up during low season, but it's hard to do.
Some years ago I was very frustrated, as a UK citizen visiting the States and suffering from congestion, that I was completely unable to buy it because I wasn't carrying suitable ID that the pharmacy would recognize.
Restrictions on pseudoephedrine did nothing to curtail the manufacture, sale or use of amphetamines in this country. It didn't even raise the price. If anything, speed of all kinds is easier to get today.
The restrictions centralized production though. Now almost all meth is being made in a lab that can import Phenylacetone from china. That's safer than someone next door setting up an explosive cookhouse.
I'm just as annoyed with the hurdles to buying real pseudoephedrine as anyone else, but let's not make the production of bathtub meth any easier. It is not worth it.
Given the prevalence of P2P meth and apparent inability of governments to do anything about it, this does not seem like a rational position to me. If there was any reason to believe that large scale production will ever be substantially curbed, there might be a case for it.
Yes, P2p meth is rampant and cheap. However I look at it like this: Meth addicts will absolutely decide to become chefs if the ingredients are readily available, even if there's a McDonalds down the street. You're approaching this rationally, which is not what meth addicts are going to do.
If it is readily available down the street, it looks to me that people cooking their own is a superior outcome for society in every single way than they buying it down-street.
Even more if the professional labs close down due to lack of customers.
A buddy of mine worked his way through college cleaning out meth labs in homes and motels after they had (typically) blown themselves up. They are toxic nightmares. He was especially shaken when he'd find the family photos indicating that the labs were operating while children were in the home.
The professional labs would absolutely not close down due to lack of customers, there would just be even more meth available, more contaminated, with the bonus of hazmat sites peppering communities.
That seems to track pretty well with the rise of P2P meth. It's unlikely many people would return to setting up small labs using pseudoephedrine because large scale operations using P2P have driven the price down to the point that it wouldn't be profitable.
There might be an increase in people making tiny batches for personal use if pseudoephedrine became easier to get, but nothing on the scale of 20 years ago.
P2P is phenyl-2-propanone, an ingredient in some methods of synthesizing methamphetamine. In supply chain terms, it is much harder to restrict than the previously-popular ephedrine and pseudoephedrine because it can be synthesized from many common chemicals.
The need to show an ID to purchase real pseudoephedrine (feels like an oxymoron to write that) can be a legitimate PITA. I am American who lives abroad but is frequently back in the U.S. for family reasons. I suffer from sinus problems, so I periodically need to purchase pseudoephedrine-based products. Because I have no state ID, the show-ID-based workflow essentially fails. For whatever reason, the pharmacies won't take a U.S. passport (or foreign ID card), so they end up spending 15 minutes futzing with the data entry software, only to resign to entering garbage into the system.
And as OP points out: Phenylephrine is 100% useless.
Phenylephrine is useless. As an extra added bonus, it will still spike your blood pressure, so it isn't just useless, it's dangerous to people with high blood pressure.
Nasal irrigation is the way to go for sinus trouble. It's more work and takes a little getting used to, but no ID needed to buy saline and baking soda packets, and it actually works.
I was 17 for my first few months of college and got horribly sick and congested. The school pharmacy wouldn't sell me the real Sudafed because of my age... not sure if that was part of the nationwide Patriot Act restrictions on Sudafed or a specific state law. I thought about getting someone of age to buy it for me but I was too much of a goody two shoes to go through with it.
I ended up going to the doctor and getting sent home with a bottle of opioid cough syrup. Fortunately didn't end up addicted or anything, but it was very frustrating at the time.
Stores around me stopped selling it altogether because they got tired of dealing with both the registry itself and the customers who get irate when told they're going on a list for buying cold medicine. It sucks but I can't say I blame them.
So at least here in Germany, we pretty much all use nasal spray with xylometazoline, and it's very effective as it also binds to adrenergic receptors. It does not seem to be available in the US, and at least from a cursory search I cannot find out why...?
EDIT: After looking a bit more, the simple answer seems to be that it's not FDA approved for nasal congestion, and since there's not much money to be made, there's simply no incentive to go through the costly approval process..
They have oxymetazoline but I think the problem with this class of decongestants is that it is ineffective and dependency is basically guaranteed if used for more than a couple of days
Oxymetazoline is different from Xylometazoline, although it was derived from it. Xylometazoline is pretty harmless for adults when not used over extended periods (it is advised to not use it longer than 6 days, but that will cover your typical cold). It is true that if you take it regularly over extended periods, you will have a rebound effect and your nose will get congested when not taking it, so in that way, you develop a "physical dependency", but that's obviously much more harmless than other medication dependencies. Getting off a Xylometazoline dependence means that you'll have to deal with a congested nose for a few weeks...
I don't see from your comment how the risk from congested nose for a few weeks deems it "harmless" for you. Two fully congested nostrils is hell for one night alone, imagine a few weeks of that. A few weeks of terrible sleep, if any. It's torture.
It can also cause permanently enlarged turbinates with chronic use.
I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos. Even here in tightly regulated Germany, Xylometazoline can be bought without a prescription. It is very effective and, compared to other drugs, pretty harmless.
Look, there are always extreme cases. Just look up how many people need a liver transplant or even die each year from misusing paracetamol. So should we make it a prescription drug? Maybe, I don't know, it's always a trade-off.
Is there any basis to think xylo- is better than the similar oxymetazoline available in the US? Both the efficacy and downsides seem similar from discussion so far.
> I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos.
I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin.
I mean, I quit smoking, hardest thing I've ever done, and the physical withdrawal effects were insignificant compared to that.
It's funny; looking back, I quit smoking exactly BECAUSE I was suffering from crazy congestion, and after a week of Afrin and poor sleep I thought quitting smoking altogether would help me regain my sanity.
> I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin.
Let me assure you that there's (yet?) no Xylometazoline epidemic ravaging though Europe, with tens of thousands of people dying each year, destroying families and communities, in effect causing endless grief for people and huge profits for pharma companies. There's also no black market for Xylometazoline, with people overdosing because there's nasal spray on the street that is contaminated with a much more potent derivative than can kill pretty much instantly. I've also never heard of babies born with congested noses that spend their first weeks of life going through a Xylometazoline withdrawal.
So to summarize, I think my initial statement that a physical dependence on Xylometazoline is less harmful than a dependence on opioids is probably correct.
OK, this is getting ridiculous, but stop putting words in my mouth. So for the third time: less harmful than a dependence on pain killers. How this could be even a controversial statement is completely beyond me, but HN never stops to surprise me.
Many medicines pose some risk to some people who would abuse it for too long. Xylometazoline just is crazy effective (instantly eliminates congestion and running nose completely in most cases) and completely harmless in what looks like 99% cases of usage - nearly-everyone here in the EU uses it happily and has no problems. I would really dread a cold without it and never travel without having it with me. Just try to not over-use habitually. The sense of measure is always a key to healthy and happy living.
That’s why if you developed a dependence you don’t quit cold turkey.
The strategy I’ve heard is purchasing a normal bottle, and refilling it with boiled cool water when it’s ½ empty. Then refilling it again when it’s ¾ empty.
Xylometazoline is an absolute godsend, and has even more efficacy in a dual-action spray with saline water.
It feels nothing short of magical to do one spray per nostril, and be completely uncontested in less than 10 minutes.
Worse, the symptoms gets worse after you stop using it, see rhinitis medicamentosa.
Many people have used decongestants so much they cannot quit them or will have to suffer weeks of nasal congestion. I risked going through that; later I swore I will never touch one ever again.
Kind of funny to see a medication that's super common in Germany, widely recommended by doctors, given to children, etc. to be discussed in those terms.
This isn’t that strange in the context that all medicines, while generally safe in OTC form, can have negative side effects if used for too long or at the wrong dose or in the wrong circumstance.
My wife has one kidney and as such is told to avoid NSAIDs as a class of medicine. She’s realistically fine taking it every so often but her doctors are asking her to avoid using kidney capacity that could hypothetically be needed to filter and excrete something else.
Acetaminophen/Paracetamol is great alternative for her since it’s processed in the liver. However if you’re a frequent drinker, have a liver deficiency, or have to take some other drug straining your liver, it’s contraindicated.
For most of us most of the time you’re completely correct though.
In the case of these nasal spray decongestants I had a case of rebound congestion due to over-reliance on them while surviving some family bringing really bad colds into the house and my son starting daycare. It was really bad. I then managed by switching to an alternating schedule of pseudoephedrine and the nasal spray so I could reduce the physical dependency on the latter and get a good night’s sleep.
My doctor eventually cleared me to take an allergy spray medication (Fluticasone propionate) that is safer for long term use but generally not used for colds because it inhibits immune response and mask the symptoms which can cause new infections and hurt your ability to heal. Yet another case of the mundane medicine that is contraindicated. While seemingly being the wrong thing to be put on while fighting off infections it worked out great.
After four months I had seen enough child germs and no adult has brought their own plague or food poisoning (it was a very bad summer for me) and I finally became healthy again.
> Acetaminophen/Paracetamol is great alternative for her since it’s processed in the liver. However if you’re a frequent drinker, have a liver deficiency, or have to take some other drug straining your liver, it’s contraindicated.
What many people don't know: Overdosing on paracetamol is the leading cause of acute liver failure. It's also contraindicated for people with Gilbert's syndrome, which is actually pretty common (~5% of people in the US) and most people don't even know they have it, as it's harmless and usually only found accidentally through high bilirubin levels in the blood.
I've been through this and sucked hard. Never will I use a decongestant nasal spray again.
If there was a way to somehow sum up all of the suffering caused by these sprays from dependency (which lasts weeks, months, years even) and compare that with the suffering alleviated from a cold (which lasts a fews days), my bet is these cause more harm than good.
The best thing I ever did for decongestion was to get outside and start wearing a mask during the winter. The air entering my nose is clearer and warmer, which causes less mucus production. The mucus that is produced is more likely to drain, rather than sit around thickening and waiting to be blown out. I wish I'd thought to wear a mask while out when I was younger; could have saved myself much suffering waiting at the bus stop and during the subsequent schoolday.
It's not a dependence like mental addiction. Your body becomes dependent on it. Your sinuses "rebound" and all but completely block in absence of the spray. I had a cold that blocked my nose up so bad I couldn't sleep because I was afraid of suffocating so I tried one of the sprays and it opens you up like magic, super effective. But about an hour after use if would completely block up again where you literally can't inhale through your nose at all. That's how it is even after you get over the cold/illness. You have to continue to use the spray to keep your airway open until you suffer through breaking the "addiction" by not using it for however long that takes. It really does immediately open your airway, but I won't EVER use it again because it's really scary to be completely blocked like that and have to get a dose in every 30mins-hour just to breath.
Of course it can. You take drug A for 5 days to get rid of symptom X. The symptom X does not go away. It is ineffective! You stop taking drug A and immediately experience brutal migraines that go away when you start taking drug A again. Ergo, you have become dependent on drug A for normal functioning, even though it is ineffective at ridding you of symptom X.
I’ve wondered this also. As an American who lived in Germany and found this while living there, I can attest that it’s quite effective for me. There are other quite useful and safe drugs that are not available in the US.
It's actually slightly more selective for a1 receptors than the German alternative. They both have the same dependence potential and rebound liability.
There are nasal sprays in the US - and yes they are more targeted and better in general than pills. But Americans love their pills ... almost as much as Germans love their homeopathic remedies :-)
Additional context on why phenylephrine was ever approved to begin with—apparently it is effective if you use it as a spray, but apparently nobody bothered to check what happens when consumed orally, and it turns out your digestive system degrades it quickly and it doesn’t even make it into the bloodstream.
This is a perennial topic on HN, which is generally inhospitable to drug prohibition to begin with; it's possible to lay out the schematics of the counterargument:
* While there can't be any defense for the marketing of phenylephrine as a pseudoephedrine replacement, restrictions on pseudoephedrine are not irrational (that doesn't make them right, though I think they are).
* Pseudoephedrine by itself practically is methamphetamine, just in an unproductive chemical configuration. It is extraordinarily simple (though: not safe) to convert pseudoephedrine into meth.
* Pseudoephedrine is widely, practically universally available in the US without a prescription. It's a "behind the counter" drug, and, because of rampant abuse, access requires ID, like alcohol. Further, because the point of restricting pseudoephedrine is effectively a "rate limit" (to prevent people from acquiring enough Sudafed to make meth production practicable), Sudafed purchases are tracked.
* We've hashed out on HN the argument about whether that tracking results in spurious prosecutions. The one case I've seen us come up with, the arrest and prosecution of William Fousse, concerned someone who had a pseudoephedrine addiction (he was using it to come up from habitual alcohol benders).
* Restriction of pseudoephedrine does basically zero to staunch the flow of high-quality methamphetamine, which is produced at industrial scale with more sophisticated chemistry in Mexico and Asia.
* But restriction of pseudoephedrine might reduce the incidence of garage meth labs, which pose their own distinctive dangers to communities.
The argument in favor of continued pseudoephedrine restriction would be that the cost of the policy is relatively low (it inconveniences allergy sufferers, but most of those sufferers only marginally) vs. the public safety benefit (which is also probably low, but also probably nonzero).
Not like alcohol. I know you know, but to spell it out for those that dont: there is a universal registry. Each purchase is tracked and tallied by name and residential address. Best case scenario is you are denied access, but you could also be raided.
It doesn't just require any old ID. Many, if not most, will not accept military ID. No foreign ID is accepted. Essentially, if your ID isn't a recent scannable ID issued by a US state, you don't get it. And I can't go a week without hearing that ID is a kind of ism.
None that I have on hand, no. Not in the US, at least. But do you agree that it's possible? The registry afford that capability. There are raids for far less.
I'm not trying to needle you. It's just nothing like alcohol, tobacco, etc. It's not even really like opioids.
Anyway, I think your conclusion is reasonable, even if we come to different conclusions. Mine is based on common benefit. I think the benefit that comes from the drug far surpasses the detriment.
> Police also can look for people who might have purchased pseudoephedrine around the same time as the suspect, as a way to identify friends and conspirators.
This appears to be a story about a guy who hit the limit in his state, with a reporter talking to an enforcement agent explaining why he looked nothing like an offender, followed by a story about a busted meth lab and their purchasing patterns in the database. It doesn't look like anybody narrowly avoided anything, and it's from 2013.
I object to the government pulling a medication report containing the name, date of birth, address, and ID number for me and the people in the pharmacy around the same time as me, and then setting a "watch" on me.
from the article:
> he showed up one day early to purchase his two-week supply.
Good thing he didn't show up in the next county one day early. Maybe that would've been enough for Goff to act.
The article also points out that pse remains non-prescription because if it were to become rx-only, the government would be prohibited from monitoring it. Here I was just thinking that prescription exists for the health and safety of the patient...
This issue is symptomatic of an underlying problem for me: we do not regularly re-evaluate laws to see if they are having the intended effect.
American politics might have bigger problems at the moment, but under normal circumstances, I consider this pretty important. I'm not sure what the solution is, but an expiration date on nearly all laws comes to mind as a start to an interesting discussion on the matter.
It would be great if laws worked like software deployments:
1. Roll out law to 2%, look for any obvious unintended effects (like we check for crashes)
2. Roll out law to 50%, study for effectiveness. Is the intended positive effect happening in the experiment population? Any effect on the control population?
3. Finally, roll out law to 100% and keep monitoring.
4. Be ready to roll back to 0% if failures seen at any stage.
5. Be ready to apply a zero day patch after it's at 100% if edge cases are found.
But, we don't do any of this! Lawmakers make a law and yolo it into production on a fixed date, and it's often impossible to roll it back or modify it.
We do sort of do that, with state laws. Different states try out different laws, and copy laws from other states. Ideally a state will repeal laws that don't work well, and copy laws from other states when they work well. In practice it's all a mess of course.
> This issue is symptomatic of an underlying problem for me: we do not regularly re-evaluate laws to see if they are having the intended effect.
Even the Constitution. It was intended to be revisited for appropriateness and currency every 20 years.
Instead, a significant number of people, including some on the Supreme Court, believe that the Founding Fathers[1] could speak no wrong words and that the Constitution is the perfect document, to be taken at its word, with no deviation, until the end of time.
[1] Pop Quiz: "How old were the Founding Fathers when they signed the Declaration of Independence and crafted the Constitution?" You'd be forgiven for thinking they were world-weary, wizened old men. In fact, the majority were under forty. Indeed, it was also signed by a sixteen-year-old, a 21-year-old, two 26-year-olds, a 27-year-old, and a 29-year-old.
Only thing I'd quibble with is the reason most consumers switched off of pseudoephedrine. The manufacturers knew that the inconvenience of having to go to the counter would reduce sales so they just replaced it in the aisle with an identically branded product with a different active ingredient. Most people made no affirmative choice at all; they're just buying "Sudafed", but now it's a placebo.
I’ve had two doctors and two NPs tell me to stop using sudafed. It dries out the mucus membranes and allows infections to start. If you’ve had sinus infections before, they suck and you don’t want them again. Give the Sudafed away.
(It also gives me horrible insomnia if I take it at night so it wasn’t a huge hardship).
Guaifenesin thins the mucus instead, makes it more watery so it drains down the throat with no further complications like sore throat and coughing. And the extra volume helps flush bacteria out of the sinuses.
The two aren't mutually exclusive. I take pseudophedrine whenever I have a serious sinus infection or blocked eustachian tubes because it's the only thing that promotes drainage. I also take guaifenesin for its mucosal thinning effects as a matter of course. I supplement these with nasal irrigation, DXM (if the cough is impacting my sleep), and diphenhydramine in lieu of the pseudo (again for sleep).
These drugs all have different mechanisms of action and specialties and should be used only as needed, i.e. if a symptom abates then you should stop taking whatever it is that treats it. The problem is that people are too used to combination formulations or, even worse, treating all of these drugs interchangeably. A chest cold has a different OTC treatment regimen than a sinus infection.
Everyone's body and ailments are different. For some people in some situations, the benefits of pseudoephedrine outweigh the side effects. For others, it doesn't. Drugs should be used on an individualized basis.
The insomnia effect is no joke! It’s an amphetamine.
I used to take 24-hour allergy medicine with pseudoephedrine, and it took me years to realize it was the thing that was giving me insomnia during allergy season—for years I thought I just had periodic bouts of intense insomnia.
I stopped taking pretty much any OTC meds about 10 years ago. My sinuses seem much healthier. I hardly ever get congestion or runny nose anymore. Not sure there's a correlation here but for me, they don't seem to have any benefit.
In general, things like medicine/drugs (even caffeine!) should be used as sparingly as possible, so they're maximally powerful when you do need them.
If you pop OTC meds at the first sign of anything, your body gets used to it and it becomes a baseline; whereas before it would blow all the symptoms away, now you need it just not to get significantly worse.
An interesting tidbit to add, for working in the industry:
The restricted process around buying pseudoephedrine is imposed by state governments and not the federal government. A number of the states coordinate their policies, so it looks like nation-wide action but really isn't (in a legal sense).
FDA doesn't have the legal authority to put medications "behind the counter" like you would see in Europe or Canada. So untangled this is a weird mess of overlapping jurisdictions.
> The restricted process around buying pseudoephedrine is imposed by state governments and not the federal government. [...] FDA doesn't have the legal authority to put medications "behind the counter" like you would see in Europe or Canada.
Someone should tell the FDA, because they seem to think that the “locked cabinet or behind the counter” rule, the per person per month quantitative limit, the photo ID requirement, and the requirement for retailers to track personal information of buyers are all federal rules either directly in or imposed by the FDA under the authority of the Combat Methamphetamine Epidemic Act of 2005.
Good summary. To add to what you've said, Sudafed (as an example brand name) opens your eustachian tubes which are passages from your inner ear to your throat. If you think you might be getting an ear infection, Sudafed increases draining and potentially helps prevent a worse infection. As mentioned, it helps air equalize to the atmosphere via these tubes. If you make a yawning motion now and hear your ears crackle, that's the air moving through your eustachian tubes. You'll notice that crackling decrease when an ear infection may be imminent. I tried the useless alternative and discovered on my own that it was, indeed, useless. And it was quite expensive, with great marketing on the box.
In my experience phenylephrine is worse than useless. Not only does it do nothing for congestion, but it makes me feel wired in a bad way and unable to sleep for at least 24 hours. I hate phenylephrine.
I read this and was puzzled, until I realized that you are talking about the pills. The nasal spray is effective, although probably not more effective than a saline solution.
> although probably not more effective than a saline solution
I guess saline is a baseline against which effectiveness should be measured here, especially since nasal sprays are usually saline plus something. (I guess? Not sure about Sudafed specifically.)
I'd argue that saline should be the panacea here. I doubt very many people do at-home saline rinses with filtered, sterilized water and a simple mixture of salt and baking soda.
Do people really want to spray PFAS water directly into their mucus lining?
I bought an Arm and Hammer Saline spray out of curiosity. It smelled awful, and the BPS lined can had an awful smell despite the ingredients being: water, salt, baking soda, and no suspicious preservatives.
True except it is definitely more effective than saline. Phenylephrine nasal spray is not as effective or long-lasting as oxymetazoline, but it's also not as dependency-inducing.
The efficacy of the nasal sprays had already been demonstrated when they introduced the pills. Surprisingly, the efficacy of the pills was never properly demonstrated, and now that it's being investigated, they're pulling it from the shelves.
Why not just use xylometazoline (aka Otrivin) at least as a nasal (spray) decongestant — or isn't it available in the U.S?
Xylometazoline is very effective. Sure that doesn't solve the oral/body-wide absorption of a decongestant but it's a good start.
From my personal experience phenylephrine (as a nasal spray) does work but it's one step off being useless. I've occasionally had to use it as a fallback when I haven't been able to get
xylometazoline (where I am xylometazoline is only available in pharmacies whereas phenylephrine is also available in supermarkets and elsewhere).
It's interesting to note that the bans and restrictions on pseudoephedrine have had large negative consequences. Not only have ordinary users missed out on a good decongestant but it seems drug cartels have largely overcome the shortage of pseudoephedrine by substituting the precursor phenylacetone (P2P). Not only that but they've even managed to separate the chiral components of the final drugs which makes them indistinguishable from medical pharmaceuticals.
Incidentally, I prefer not to use pseudoephedrine as a decongestant, whilst I receive no mental stimulation from it, it nevertheless has stimulating properties that make me feel queasy. It's why my first choice is xylometazoline. There's also the related decongestant oxymetazoline, which I've found effective but it's not as good as xylometazoline (for me at least) but it's still vastly superior to the near-useless phenylephrine.
It's not the only drug treated this way. You can go to any pharmacy and see a ton of things on the shelves that are just cards you have to take to the counter, and then see what's actually behind the counter. Insulin needles, for instance, even though you can also just buy those in bulk on Amazon. I'm not sure what does and does not get tracked in a statewide database, but at minimum, regular Ephedrine, typically sold under the brand name Bronkaid, is tracked this way, because it can also be used to manufacture meth. I don't even think in this case there is an alternative formulation like there is with Sudafed and generic equivalents.
The monthly purchase limits on these tend to be ludicrously high, though. I think they're state by state, but in Texas, you can purchase up to 9 grams a month.
Lots of what you described is very location-store specific. That's why you can buy a lifetime supply of clean needles on amazon, but buying any in CVS is requires waiting in line longer than it take for amazon to deliver.
But think about all the jobs the government by created running that registry, prompting the drug makers to formulate and manufacture bogus decongestants and then eventually studying that those bogus decongestants were in fact bogus.
(in case it wasn't obvious, this is broken windows fallacy)
The "registry" is signing your name on a sheet of paper on a clipboard - less than 1% more work for the pharmacy employee's overall job, approximately 0 new jobs created.
I went to the doctor recently. I usually take what I am taking so they can see it. I was taking Sudafed and had just purchased it. She took it out of my hand and told me basically all that and threw it in the trash.
Great summary. It's a classic case of government action ending up a net negative for society. Everything would've been great if they'd just minded their own business.
It is darkly amusing to me that it took the FDA well over a decade to conclude what was immediately obvious to anyone who has ever tried phenylephrine: that it is not worth taking
This reminds me when EU banned some eye drops with the product name Proculin which have been very effective. The replacement Berberil is useless, literally no effect.
Proculin made your eyes white white constricting the blood vessels for hours. All the stoners had it in their pockets.
Since it constricted blood vessels one could use it also to reduce the local inflammation on pimples, which was a neat off label usage.
yes, well, the other part of the story
you would not know it maybe unless you frequent among addicts or psych wards where the practice is done
indeed there is a third such nasal decongestion / meth class drug known as BENZEDREX
it is a OTC decongestant .. an inhaler.. okay, fine.
but what drug addicts, and in my experience for whatever reason, people with hard psych illnesses like to do is pop the inhaler open. inside is a benzedrex-laden ball of cotton which is then chewed upon for the high
Also true of aspirin, ibuprofen, acetaminophen, dextromethorphan, melatonin, vitamins, supplements, and practically every other over-the-counter drug that is not homeopathic.
ESPECIALLY acetaminophen aka paracetamol aka Tylenol aka Panadol. This is the single drug with the smallest ratio between the effective does and the lethal dose, and it would not be approved today because of that. Oh, and you'll be fully conscious while you're dying and there's no known antidote.
My Googling says 7.5g-10g is a lethal (acute) dose for an adult. The extra strength Tylenol pills come in 500mg, and they recommend two of those at a time. Not saying it's wrong that the gap between "effective" and "lethal" is small, but at the same time it's hard to accidentally take 15-20 pills at a time.
Even doses as low as 1g taken daily for a week or two will show significant changes in liver chemistry. Consider that many other medicines, especially cold medicines, often include it as well, and it's not hard to see how someone that is suffering from a strong cold could end up taking more like 2-3g per day for extended periods of time. That will definitely cause some damage to the liver, which can be recovered from, but should probably be avoided. At least in the US though, many people have already compromised liver function due to chronic metabolic diseases, and for many, the damage might end up being permanent.
Now consider people with memory issues such as dementia where they might have a headache, take 2 pills, then 10 minutes later think 'I have a headache...'
if we're talking about people with dementia and/or memory issues - almost everything becomes dangerous. Not an argument. Doors aren't dangerous, but now imagine a small child being hit with one.
Water allergy is a skin condition triggered by contact with water. I don't think that applies to swallowing water.
If someone's actually allergic to water, they're going to be reacting all the time since they're mostly water and have to drink regularly to stay alive.
Homeopathic pills are usually literally sugar pills, essentially small crummy candy, so not really any water, despite the purported basis of the "technology".
If you give me six lines written in a material safety datasheet for the most chemically inert of materials, I will find something in them that could cause some human, in some situation, to die.
After a little bit of googling, it seems that sugar allergy from ingestion doesn't exist. Intolerance is not allergies.
I did find that there's apparently one case of anaphylaxis caused by injection of fructose, though it wasn't the normal reaction referred to as allergies.
Before Sudafed was common in pills, they had the small disposable inhalers where the pseudoephedrine was not in crystal form but was dissolved in vaporous liquids like menthol. Inside the inhaler there is a cotton piece soaked with the pleasant-smelling liquid. The aroma vapors are drawn right up into the sinuses along with the active ingredient.
The inhaler itself was first marketed during World War II by the well-established 19th century Vicks company, already very successful for decades with it's earlier VapoRub aromatic topical OTC formulations. People are probably aware that this is one of the companies that is older than the US FDA. Older than the Fed & income taxes too, for those who are keeping score ;)
Natural products like ephedrine have long been the inspiration for medicinal chemists to synthesize similar compounds for potential screening as new drugs, so a number of new experimental relatives such as pseudoephedrine were produced eventually.
As the name implies, people did not always know what the real difference was between ephedrine and pseudoephedrine, since both molecules have the same molecular weight, naturally because both have the same number of carbons, hydrogens, oxygen, and nitrogen content.
Only a slight difference in chemical structure between the two, which got figured out soon enough.
Some of the less-similar new drug candidates were ordinary amphetamines. They are the ones that really got popular fast, especially in wartime :\
Now when the unique inhalers were born, it was a bit of the new synthetic ingredient along with the traditional aromatic mixture that Vicks was famous for, and the Vicks Inhaler was deemed safe & effective as recommended for OTC use. People loved it. Nobody had ever had anything as effective as that.
IIRC it was 50 milligrams per inhaler soaked into a few hundred milligrams of aromatic essential oil mixture. As expected they were a lot stronger when you first started smelling one.
That's because it was 50 mg of meth-amphetamine in the Vicks inhalers.
Parents would buy them for their kids, because they were so "safe", for self medication naturally, even at times when they would not consider dosing them up with cough syrup.
There was never any FDA-approved prescription for methamphetamine in any other form, only this one OTC product.
I would think the inhalers themselves were patent encumbered until the 1960's (remind you of an Epipen?) and by the 1970's other companies like Sudafed offered their own version, only not containing meth, give me a break.
The meth version of amphetamine became recognized as a dangerous drug in the after-war years when the negative effects became apparent with soldiers who had been given it in pill form habitually as stimulants, often when facing the most serious combat.
No other company ever was able to put meth in their inhalers, but Vicks slipped in under the wire and couldn't even be stopped for decades until some time after the DEA came into being. Everybody else was using pseudoephedrine from the start. By this time crystal meth was just beginning to emerge, which people were trying to avoid when they saw what it was like, at the same time different people started seeking meth more intently. Orders of magnitude more out-of-hand now.
The way Vicks stayed under the radar the whole time with meth in it, was hiding in plain sight.
Right there on the inhaler in fine print where it always was, active ingredient desoxyephedrine 50 mg.
Simply a less-common alternative chemical name for meth, and desoxyephedrine had become a very uncommon rapidly deprecated name quite early. Way before any amphetamines were commercialized, they were instead marketed using the well-known convention based on the Alpha-MethylPHenylEThylAMINE type nomenclature.
Anyway, back in the 1970's when it was first becoming known that shady operators were cooking meth by starting with inhalers, I looked at one of them and sure enough, 50 mg meth per Vicks inhaler. Who knew?
For a while there I figured they must be starting with way over 20 inhalers and probably would not extract nearly a gram of meth but it sounded feasible. I wasn't going to be the one to do it, my first job out of college was working for a company that was a real pharmaceutical manufacturer. So I wasn't going to tell anybody either. There was already talk among law enforcement about cracking down on this kind of thing. Suspicion of inhalers was beginning to barely arise, it was thin but widespread among anybody who had heard anything about this.
Eventually I figured out that the clandestine cookers were synthesizing their meth by using the pseudoephedrine in non-Vicks inhalers as starting material for their reactions ! Well, what do you know? Was I wrong the whole time?
I "guessed" so.
With not-so-blurry 20/20 hindsight, I would estimate that before I got around to figuring this out, a clandestine chemist had come along way before I knew a thing and had started out extracting grams of meth directly from Vicks inhalers. And the meth heads loved it, found out it was coming from inhalers and the word got around among them.
Some other chemist picks up the inexact word-of-mouth and by this time Vicks inhalers are outnumbered, sharing shelf space with numerous alternative brands, all of them containing pseudoephedrine as expected, and cheaper too. If they look at Vicks, it's the odd ball out, that doesn't look like the same kind of "ephedrine" as everything else. So they figured out how to do some home made reactions starting with Sudafed. And this is what was just starting to go through the roof.
This was before the Sudafed pills really took over, once they showed up they flew off the shelf way faster than the inhalers because there were more milligrams.
One day in the '70's I was in Walgreens and there was somebody buying over a dozen Sudafed inhalers so I knew what they were up to.
I went over to the aisle and looked at the then-current Vicks Inhaler, which I hadn't checked in a while, sure enough 50 mg of desoxyephedrine, active ingredient, same as ever.
The poor Sudafed buyer wasn't the least bit aware that real meth was right there on the shelf next to it.
And I wasn't going to say a thing :)
Most doctors and pharmacists didn't even have a clue.
Within a few years Vicks stated putting in pseudoephedrine themselves instead of meth.
Until it got way too far out of hand and the pseudoephedrine became tightly controlled, much more tightly than the meth was, as can be seen.
Edit:
"And now you know the rest of the story"
- Paul Harvey
PSA: Kroger and Kroger-owned supermarkets require ID to purchase any "cold medication" including those only containing phenylephrine. It's a stupid policy.
Buy your cold medication at Walgreens. Good luck finding a non-Kroger grocer.
> Their preliminary review of studies suggested that it is probably, in fact, useless. This proceeding is now proposing to ban it on the grounds that it's ineffective
Is ineffectiveness really a good reason to ban a substance? Why not just ban labeling it as a medicine instead?
If you read the article title it is not a ban on the drug.
> Ending Use of Oral Phenylephrine as OTC Monograph Nasal Decongestant Active Ingredient
It is a ban on marketing/listing this as an active ingredient on those products. If you read further into the article this is only for oral use and they're requesting comments for nasal use, which would be unaffected by this.
No worries, "Meth" was largely unknown in my area, until you guys exported "Breaking Bad". Roughly a year or two later, it started to be available here as well. Thanks for that, media industry, that was a wonderful move! /s
One of my favorite papers is "A simple and convenient synthesis of pseudoephedrine from N-methylamphetamine" [1].
This is a satirical paper. Because pseudoephedrine (i.e. the good decongestant) is very difficult to obtain due to restrictions, but "N-methylamphetamine can be procured at almost any time on short notice", the paper describes how to synthesize pseudoephedrine from meth with a procedure that looks valid.
I found out recently that you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from, because apparently each state administers its own database. If you run out and have a persistent cough (weakened immune system from not licking doorknobs the last few years of covid, or so do the doctor says) from a common cold while on vacation, you're shit out of luck unless you go back home or you and an accomplice are willing to procure your cough medicine with their license.
> you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from
The FDA rule on this [1] doesn't appear to be quite that strict: it says the ID can be "a photo identification card issued by the State or the Federal Government or a document that is considered acceptable by the seller". It doesn't explicitly say it has to be from the same state as the one in which you are buying the medication, and it leaves the seller some latitude in what to accept.
Possibly some states have more restrictive rules. Or particular sellers might be more leery about what they are willing to accept.
The FDA rule doesn't restrict the IDs but the phrase "that is considered acceptable by the seller" lets the pharmacy put any restrictions in place they want. They can tell you it has to be hot pink and glow-in-the-dark and you've got no choice but to deal with it.
While true as long as they're in compliance with the law, wouldn't they want to sell all the Sudafed they can? They can deny service to anyone for pretty much any reason. No shirt, no shoes, no Sudafed or anything else. So yeah, but in reality it isn't aligned with their interests and if they don't want to serve you they can always find a different justification.
Maybe they want that, maybe they don't. Retail drug stores in the US are an oligopoly, that industry may not be a monopoly (yet) but they don't function under perfect competition. Maybe if you're the management or the shareholders of a retail drug chain you're just kind of shrugging your shoulders and working on the next merger at this point since the fewer competitors you have, the less hard you have to work for the customer's dollar.
The “acceptable by the seller” wording only applies if the ID is not issued by “the State” or “the Federal Government”. Wouldn’t the latter option mean that a US passport, a green card, a Global Entry card, or a NEXUS card must be accepted as suitable ID by any seller in any state? All of those are issued by the feds.
States like MA legally only accept MA IDs and federal govt IDs for age verification. That’s why a lot of bars and packies will turn people away or ask for additional proof like CC’s. You’re more likely to be held liable for misconduct if the license you accepted is out of state.
The wallet-sized passport card is a great solution for that case then. It’s much cheaper than the regular passport book (and you are allowed to have both at once), doesn’t invalidate your regular passport book if it gets lost or stolen, and is also usable to go between the US and Canada by land or sea without having to bring the passport book with you. For people with a Global Entry or NEXUS card, that card also works for every case where the passport card does (and more).
Green card holders also have a convenient wallet size for their green card, and they’re legally required to carry it with them at all times while in the US anyway.
Here in Vietnam it's completely impossible to get pseudoephedrine at all and I think it's the same in all Asian countries. I even resorted to trying to buy some ephedra tea (Chinese medicinal herb from which ephedrine was first discovered). I ordered a box of tea bags from Shopee.vn and rather amusingly received an envelope with the amount I had paid including shipping in cash and an apology letter saying they could no longer sell this herb and please don't leave a bad review.
However, a few months earlier due to a Google translate mixup where I thought I was ordering peppermint oil, I got 100ml of sassafras oil [0]. It's a precursor to MDMA and at least as restricted as pseudoephedrine.
It's readily available in Thailand and Indonesia. You can get it mixed with paracetamol OTC in Singapore, but almost everything in Singapore requires a prescription (even e.g. throat lozenges) so find a doctor if you're staying for a while. In Malaysia you need a prescription.
Refused sale of Sudafed because my license was expired. Apparently I accidentally tossed my new license and kept the old one. Doh! However they happily refilled my schedule III meds with the expired license.
Once again, big thanks to paranoid "mark of the beast" conspiracy theorists with funny ideas about federal government IDs and digital IDs.
We have the technology. "Behind the counter" could just mean a vending machine with good ID tech instead of queuing up for an overworked pharmacist behind a dozen people.
Adderall is a 3:1 dextroamphetamine/levoamphetamine mix.
Methamphetamine is a whole other level of stimulant.
> amphetamine habits in kids that have trouble focusing in school.
1) Do you have evidence that Adderall at therapeutic dosages is anywhere near as addictive as methamphetamine at recreational dosages?
2) Yeah, ADHD makes it real hard to focus at school. I never graduated from high school, and I dropped out of university as an adult student without even completing one year, thanks to untreated ADHD. Not to mention the impulsive behaviour, the inability to stick at boring things etc. etc. It's not great in our society.
You're implicitly minimising the very real impact of ADHD, that's not super great.
In fact, one of the biggest issues for people finally being treated for ADHD as adults is the grieving process around "What my life could've been if my parents hadn't believed that ADHD wasn't real and my issues in school and my 'disruptiveness' was solely due to 'food intolerances', because my Mom read a magazine article about it once, then paid a quack to stick a probe in my ear, one on my finger, and then rub food on my skin while looking at a galvanometer making 'hmmm' noises sagely."
3) You know there's been Adderall shortages in the USA recently due to DEA manufacturing limitations right? So it's not like they're just throwing out to kids like it's a lolly scramble.
Anyway, it's about as ironic as 10,000 spoons when all you need a knife. That is, not at all.
> Methamphetamine is a whole other level of stimulant.
The extra methyl group that differentiates it from regular amphetamine salts mainly serves the purpose of crossing the blood-brain barrier quicker. However, during this process it loses that extra methyl group. So whether you're taking meth or adderal, the chemical that actually reaches your brain is ultimately the same
In fact, methamphetamine is available as a prescription ADHD medicine under the brand name "Desoxyn"
I thought that (1) meth (e.g. methylphenidate a.k.a. ritalin) blocks reuptake of dopamine, and (2) amphetamine (e.g. dextroamphetamine) stimulates production of dopamine, and (3) methamphetamine (a.k.a. desoxyn) does both. Is that understanding accurate?
“Meth” is methamphetamine, not methylphenidate. Ritalin isn’t the same thing as Meth. Not sure about how Ritalin vs Adderall act different on dopamine.
~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
_Edit: I am told I'm wrong on this front, and I stand corrected_
The fact that doctors are prescribing them too freely is definitely worth looking into.
But severely restricting medication that is used to effectively treat disease because it has abuse potential only harms legitimate users. But definitely worth auditing prescriptions to ensure that they're being issued for valid diagnoses.
But as for illegitimate users? You ban it, they'll find something else.
And as someone who needs ADHD meds to do things like "remember I have a todo list, remember where I left it, and remember to use it", I very much resent the people who abuse the meds I need to function in our society to pass their law degrees easier.
I resent the meth addicts who try to get an ADHD diagnosis for their kids so they can abuse (or sell...) their children's ADHD meds when they can't afford meth, because it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
(My country uses methylphenidate / Ritalin / Concerta (the slow release form) as the first treatment for ADHD, Adderall is not prescribed here that much, if ever, but it is possible to be prescribed dexamphetamine if you're bad enough).
But I really do object to glibly implying that every child who is prescribed a treatment for ADHD is actually a case of pharmacists gleefully overmedicating, it's naïve, unsympathetic, and, tbh, rather unfair to pharmacists.
As for what schedule a drug is... ...is the harm of Adderall abuse the same as the harm of fentanyl abuse?
Drug schedules aren't a good way to determine harm, IMO. They're a good way to discern moral panics though.
E.g., in my country, Class A, the drugs that attract the highest penalties, include magic mushrooms, mescaline, DMT, and that one you get from licking toads, bufotentine or something, alongside classics like heroin and cocaine.
Fentanyl is Class B, alongside opium, morphine, amphetamine, methylphenidate, MDMA, and one that always amuses me, hashish.
* There's probably some dumb-ass rules around declining to dispense abortifacients because of religious beliefs, I'm sure.
> I very much resent the people who abuse the meds I need to function ... I resent the meth addicts ... it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
It's important to remember that no addict did this to you. An addict doesn't force Kaiser to charge me $20 when they demand I piss in a cup in order to receive my legally prescribed medication. It's fucking Kaiser, and the DEA, and the mad cap conservative politicians and their shitty fucking values. Drug addicts are suffering from a health problem, just like you and I are with our ADHD. None of us have the power to influence the massive engine of carceral drug policy and the promotion of mass moral panic about people taking medication that helps them.
It's important to point the anger at the right people.
Using telemedicine in New Hampshire, I don't have to take any drug tests for mine, just self-report my blood pressure and pulse on zoom every 3 months.
> Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.
This is not true. Pharmacists have the right to not fill a prescription for a number of reasons, and in fact can be held liable for not doing so.
If they feel the use of the drug is medically inappropriate they can decide not to fill it. If they feel the patient is taking it for a non-medical reason (abuse) they can choose not to fill it.
Pharmacists are medical professionals who are expected to use their judgement to make sure medicines are not used inappropriately.
> ~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
As others said, it's not true. Pharmacists are also trained to spot any possible adverse drug interactions with other medications that you might be taking.
It more often happens in the clinical setting, rather than at retail pharmacies, but it still is a possibility.
> I think the parent post is more likely alluding to the abuse of the medication, particularly in higher learning institutions.
It's kind of weird that people are calling this "abuse" when it's apparently using the drug in the same context and dosage as it's prescribed therapeutically, plausibly by people who actually have ADHD but don't have the time or insurance to get a prescription.
It's an interesting case study in what would happen if it was more widely available in a pharmaceutical form with a known dose and purity. What percentage of these college students are actually getting addicted to amphetamine vs. just taking a therapeutic dose here and there?
Damn, if Schedule II drugs are that bad, Schedule I drugs must be terrible. Let me go see:
> Some examples of Schedule I drugs are: lysergic acid diethylamide (LSD), marijuana (cannabis)
Oh damn, marijuana is worse than this drug? I hope they arrest anyone selling marijuana. What’s that you say? Legal? In California? Oh, in lots of states?
Schedule I "merely" means:
The drug or other substance has a high potential for abuse.
The drug or other substance has no currently accepted medical use in treatment in the United States.
There is a lack of accepted safety for use of the drug or other substance under medical supervision.
The more interesting take for me is that these meds work roughly the same way and almost as well in people without ADHD (a symptom cluster, not a single disease per se, like everything else in the DSM). As we give them to people with ADHD why not let anyone get a scrip?
People without ADHD already get more than enough benefit from just coffee. Stimulants might be able to benefit them further, but if you let anyone take them, eventually it'd become expected of everyone due to their increased productivity, and the potential consequences of abuse are much higher than coffee.
Chronic use of caffeine blunts the effects, it doesn't do much to regular drinkers. You develop tolerance very quickly. I can drink several cups and get basically no effect. Apparently your body just increases the quantity of adenosine receptors in the brain to offset the caffeine.
I didn't say it's not real. A doctor prescribed me Adderall at 18 after talking to me for 5 minutes because I was having trouble sleeping. It did more harm than good.
Something can have therapeutic uses and still be over-prescribed.
I don’t know why you are being downvoted, adhd medication is insanely overprescribed. Turns out, kids get antsy and hard to control after cramming them into overcrowded rooms for 8-9 hours a day doing slop work. Some schools are now forgoing any form of recess at all. Modern public education is inhuman and dystopian.
It is absolutely not the job of a pharmacist to make decisions about which drugs are being overprescribed, and IMHO it's a dangerous thing to suggest. The pharmacist should assess for drug interactions, but we can't burden pharmacists with knowing the details that went into a prescription, and we shouldn't have them second guessing the diagnosis of a doctor. Down that road lies madness.
I get where you're coming from but pharmacists have the right to refuse to fill a prescription and in fact can be held liable for not doing so. Pharmacists are trained medical professionals and are expected to use their judgement
It's one thing to use their judgement to refuse somebody who is going to get a bad drug interaction, and another for a pharmacist to say "I've given out too many of X prescriptions, I'm going to start cutting off people from their prescription based on my judgement of them," and this latter one is what was under discussion and the one that I'm rejecting.
Another thing is, do you get an actual trained and knowledgeable pharmacist, or a technician?
In Poland, pharmacies are required by law to have a MSc in pharmacy present during operating hours - that is, no less than one pharmacist with a Masters degree. One is enough. Which means that's all you get. You may not even see them unless you're buying ADHD meds, which need MSc to sign off on them. Otherwise, you're almost always dealing with a pharmacy technician. Some are pretty knowledgeable[0], others could be replaced by GPT-3.5[1] with net benefit to the customer. The latter type, if they're going to notice anything about you, it's whether you're likely to buy some useless supplement or homeopathic product.
--
[0] - Probably on their way to MSc in Pharmacy, which is a mistake if they're looking for a pharmacy job - pharmacies don't want people with MSc, there's enough of them around already; they want the cheap technician labor.
Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
Pseudoephedrine should be easy and plentiful to obtain. I don't care if people use it to make meth. What they do in their private time doesn't concern me. Not being able to get Sudafed when I'm sick kills me. It's not like those people won't be able to get meth some other way.
We let people buy cars and cause 43,000 automobile deaths a year. People should be able to live life without stuffy noses. Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
And don't get me started on ADHD medication and their shortages.
Edit: and there are 178,000 alcohol related deaths per year in the US. If you're going to allow that without prohibition, then please let us unstuff our noses.
I'm tired of living in a nanny state when we let people buy and own guns and swords and flamethrowers. Simply hiking on a mountain can kill you. Must we install guardrails on all the high places?
It's not that bad of a negative externality. Honestly. Not relative to all the other ones we've deemed acceptable. This is weird picking and choosing that doesn't make sense.
> Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
What's even worse, modern pseudoephedrine is produced in a form that makes meth synthesis from it extremely tedious and generally impossible in home conditions: https://pmc.ncbi.nlm.nih.gov/articles/PMC3793278/
99% of pseudoephedrine sold is not this form and this specific product has already been debunked years ago with Mississippi's complete ban (and their refusal to allow it.)
I remember the video of the pharma rep or cop or whoever trying to make meth out of the new pills and the product getting squishy. Months later, a different video was published, where some household solvent was used to easily pull the very-dissolvable pseudoephedrine salts from the paste.
Addictive is the argument in favor of making it over the counter. Addicts will do whatever it takes to get their fix, so if there isn't a legal path, they buy on the street, creating a funding source for organized crime and spurring gang violence.
Then, because the black market is already in violation of the law, there are no purity standards. The customer who thinks they're getting Adderall or codeine is actually getting fentanyl because fentanyl's much higher potency makes it easier to smuggle, but for the same reason makes it much more prone to addiction and overdose, especially when careless street dealers get their proportions wrong. All of which is avoided if you just let them buy it from the pharmacy.
Notice that there is no thriving black market for antibiotics propping up international drug cartels, because they're not addictive.
Strongly agreed, with one correction: black markets are driven by shortage. The role of addiction is in creating demand, and at the same time making authorities restrict access.
There is no thriving black market for antibiotics, because they are accessible when you need them (and most people need them very infrequently for a short duration). In contrast, I believe there is a black market for insulin in the US, and that's because of how ridiculously expensive it is. Exuberant pricing is a form of restricting access, too.
> Addictive is the argument in favor of making it over the counter
You want to control the general population’s access to physically-addictive substances to control addiction. Managing addicts is not a pharmaceutical matter.
We don't control access to alcohol, paints/volatiles, aerosols, and so many other things people abuse.
Just yesterday on Reddit there was a thread that went viral for "cutter" reviews on Shein razor blades, with cutesy language like "beautiful beans for my followers" (referring to subcutaneous dermal appearance when deeply cut open). Every product can be abused in horrible ways. It's the nature of the stochastic bubble we're in. People will find every nook and cranny of the human experience.
You can't stop this stuff from happening. So at least let the normal use cases that benefit society through. Don't put everyone else in the same straight jacket. We don't deserve to be punished for the bad gradients some people fall into.
It is a bit silly to ban a useful drug like pseudoephedrine while large parts of the US is in an opioid crisis. Kind of like how lawn darts have disappeared from stores but you can still buy all sorts of weapons. That said, a lot of laws are based on established traditions. Alcohol use goes back thousands of years, and the other things you mentioned such as vehicles and weapons are tools going back even longer. They are dangerous tools, to be sure, and often employed unnecessarily in this society, but tools nonetheless. Once upon a time most people depended on their weapons and vehicles to survive, and differences in the quality and quantity of weapons and transportation technology have historically led to the rise and fall of entire civilizations.
> Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
I sympathize with your broader point, but... how is that better? "Sorry, you were buying too much nasal decongestant a decade ago, so no cancer medication for you"?
I understood your parent comment in a specific drug way: you can buy pseudo until your license to buy that specific compound, or maybe a group or related chemicals, is revoked. But you can still get any other compound.
Not that different from current situation: we have all our "license" to buy scheduled compounds revoked, but we still can get a lot of other compounds.
I read a study here in Australia a little while ago that showed that removal of easily accessible pseudoephedrine had done nothing to either stop the proliferation of clandestine labs, nor curtail the availability of crystal meth. They just switched to different syntheses, and there are still large-scale imports that sometimes get caught, sometimes don't.
People were still trying to claim the program was a success because they had stopped gangs getting pseudo as a precursor.
But so what? it's done literally nothing to stop criminals profiting, nor to stop people getting addicted to meth, with all the associated public health and petty-criminal consequences of that. And now it's harder for ordinary people to get effective decongestant.
It just seems that nobody is willing to admit the whole thing was pointless.
Same in New Zealand, we removed pseudoephedrine as an option unless you had a special dispensation from the Ministry of Health - mainly due to pharmacies being ram-raided for the pseudo.
The end result? The gangs just started importing pseudo, before later just switching to importing methamphetamine directly (something that Australia's deportation policies really helped with as the "501s" as we call them that were deported back to NZ often had existing connections that could facilitate the direct importation of meth).
It's a really interesting supply chain that involves organised crime groups in multiple countries, often starts in India for the precursors, then clandestine labs in Laos/Vietnam/Thailand overseen by Chinese groups in conjunction with local groups, then smuggled via the Pacific Islands, notably Fiji and Samoa where the Chinese groups have established transshipment facilities, before being smuggled into Australia and NZ by local groups who then distribute and supply it.
A new development has been the Central American cartels branching out from cocaine to meth so there's been a bunch of meth coming directly from the Americas.
The car stat is a good example of trying new policies to lower car deaths! They are the greatest risk to my children's lives and I find it terrifying that we let them roll around everywhere so close to people, like we do in parking lots.
>Maybe license people to buy meds and take it away if they abuse it?
I'm a bit confused, because you can buy it already with an ID, correct? You don't even need a purchasing license, just a drivers license or other government ID.
You can only buy from a pharmacist (behind the counter) and you need to provide your national ID number. Your purchase is put in a database that any pharmacist can see.
Fun fact, there (was?) is a isomer of methamphetamine that is actually over the counter, levomethamphetamine was often found in Vicks brand inhalers, though they appear to be discontinued, being replaced with a ‘non-medicated’ version. There are apparently generic inhalers that still do contain it though.
"simple and convenient" does a lot of heavy lifting in this paper - n-BuLi, chromium hexacarbonyl and MoOPH (had to look that one up!) is not something you find outside of a well equipped lab and shouldn't be touched by anyone who isn't highly experienced.
> Other side effects may include violent urges or, similarly, the urge to be successful in business or finance.
...
> We expect that the simultaneous trends of restricting pseudoephedrine sales while N-methylamphetamine becomes less expensive and of higher purity will make the methods presented here increasingly attractive.
The problem I found was that nobody wanted to deal with the database after a certain time in the evening. Odds are good you don’t admit you’re coming down with something until after work. Or at least admit to yourself that medicine would be helpful. So by the time you see you’re out of Sudafed or can’t find the old pack, it’s often too late to go to the store to get a new one before morning.
I remember complaining to my friends about how frustrating it was to hear that a medicine I frequently used turned out to be placebo, exactly one year ago today. Opened this article up, I'm currently taking the _exact same_ one in the article photo - it's what I had lying around and I had forgotten the name of the "bad" sudafed (it's sudafed PE). They need to take it off the shelves quicker. Every day is tens of thousands of more people who are scammed.
Putting my money where my mouth is and leaving a comment on the FDA proposal...
I remember when the law first went into place. I bought some meds and the next day was back at the store because the new stuff didn’t work. For me it was even more obvious because pseudoephedrine works so well for me.
If you're referring to Zicam, there's actually evidence that zinc gluconate helps reduce the length and severity of colds... and it's actually present in more than trace amounts in Zicam. They market it as "homeopathic" in order to get around FDA regulations, and they've gotten in trouble because zinc in your nose can knock out your sense of smell, perhaps permanently. (The lozenges don't appear to have this issue.)
How can you believe you've been taking a placebo for years? Phenylephrine is used for the illicit synthesis of methamphetamine, so there's an inherent bias towards anything that gets it off the shelves. Cherry picking studies that say it's ineffective is more velvet glove than using only the iron fist to ban the stuff. But make no mistake that the iron fist is taking your meds away either way.
Pseudoephedrine is the one that is both proven to be effective and is the precursor to meth. Phenylephrine is the useless placebo that they put in the tablets on the shelf only because it can’t be used to make meth. It should be torn off the shelves because it’s useless.
The only reason the ‘PE’ (marketing term for the ineffective phenylephrine) tablets might be helpful is because they usually also have paracetamol (acetaminophen) in them which is probably the only bit that works. They don’t work as a decongestant for most people like pseudoephedrine does though.
I believe that it doesn’t work wholeheartedly, because every time I try it, it is ineffective - but my sinus problems are rarely bad enough to warrant medication (it’s been one year) and by then I’ve forgotten what works and what doesn’t.
Also, I suspect you’re mixing up your drugs. Phenylephrine (the drug in this article) lacks the methyl structure to be used for the synthesis of methamphetamines. In fact, that’s why it was popularized - pseudoephedrine, the truly effective sibling, was becoming too good for meth production, so they created a less potent alternative, phenylephrine, that lacks the ingredients necessary. They then locked pseudoephedrine behind the counter. Turns out the oral form of phenylephrine is less than “weaker” - it’s largely useless - so they pumped out enough of this crap to the tune of $1.7B that the American public spent every year for 18 years after they knew.
> so they created a less potent alternative, phenylephrine,
Just to be clear, phenylephrine is not a “creation” or necessarily less potent. It’s an even older drug and a very effective vaso/venoconstrictor.
The problem is it has poor oral absorption (bioavailability) as you note, so it doesn’t do much taken by mouth, but anything it does do is mostly deleterious. And thank god for that, because if it had the effect orally that it does via IV it would be killing a lot of people.
I think you're confusing Pseudoephedrine (which works and is used to produce meth) with Phenylephrine (which doesn't work and cannot be used to produce meth).
This article is about removing phenylephrine (sudafed PE) from shelves. Studies have pretty thoroughly showed it is completely ineffective for what it is marketed for
Way overdue. I wonder if the purveyors of this fraud have ever been sued.
One refrain I got tired of hearing was that it "wasn't a safety issue." WRONG. Anyone who has ever had a ruptured eardrum can tell you that it is 100% a safety issue.
If you're about to take a flight with any congestion, you're relying on decongestant to save your ears. I've had ruptured eardrums; it's probably the worst pain I've experienced. I had to take a flight a couple years ago with only this crap, and must have come extremely close to rupturing them again. It was EXCRUCIATING.
For example here in France tap water is disinfected with chlorine and hot water must be heated to at least 50°C which is enough to kill the microorganism.
On the other hand, depending how the distilled water is sourced (container bought in a supermarket...) & used (opened/closed daily...), it can actually create a much riskier source of infection.
Infection with Naegleria fowleri is incredibly rare.
A run-of-the-mill bacterial infection is much more common. There's more than one type of infection you can give yourself by putting water into your sinuses.
You're correct that it does require a source of the pathogen, be it the water, a poorly cleaned neti pot, or the interior of your nostril.
I tried this once when I was a teenager. As far as I remember, I took the precautions of sterilized water, getting the right salt, etc.
Guess I didn’t know how to properly use it, since I gave myself an awful sinus infection and was bedridden for next two weeks. To this day it’s the worst I’ve ever felt. Never touching a neti pot since then :/
It works wonders on me and family members. Except we just always go for the Neil Med bottles from Costco or Target. They are also easy to disinfect in the microwave.
Always distilled water, though. It’s not worth waiting to boil the water, let it cool down, and then manage the dish used after. It’s also easy to get just the right temperature using distilled water in the microwave.
I would strongly advise against broadly recommending this across the board, because while rinsing your sinuses can help with some infections, it can make the situation considerably worse if you're working with e.g. inflammation instead. For a lot of people the difference isn't easy to tell and they end up making their own situation worse. As always, ask a medical professional, even your pharmacist can tell you what to do or not to do once you describe the symptoms.
Total anecdata, but when I was college age I would get bronchitis about annually that usually started from something that would have at least 1 nostril completely blocked for a week or so. I read about neti pots, bought a pharmacy "sinus rinse" and started using it daily.
I'm 58 now and I haven't had bronchitis like I used to since.
My theory is that it not only washes out stuff that might lead to infection, but also keeps your membranes from drying out and cracking, opening a vector for them.
If you're worried about the possible infection or don't want to mix it yourself, check out Arm & Hammer Simply Saline. It can be used like a neti pot for sinus rinse.
You can still get pseudoephedrine containing Sudafed in UK sometimes, I've had difficulties finding it, but they package it almost identically to the phenylephrine containing placebo.
To me this has always seemed like obvious fraud.
We don't have class actions in the UK, but perhaps in USA there's a chance of punishing this sort of behaviour going forward?
Basically they took the active ingredient out, added a similarly sounding chemical, continued to sell the new known-ineffective chemical in the virtually the same packet, under the same trade dress and branding...
Pseudo was really effective for me. When I first bought Sudafed after they took the active ingredient out (of the easy to find product) I thought I'd misremembered, took a couple of illnesses before I twigged, then some very careful analysis of packaging to make sure to get the actual medicine.
In the US everywhere has it, but it’s behind the counter and you have to show ID so they can track how much buy. It’s ridiculous, but it’s not hard to get, and has never stopped an illegal drug chemist from making crystal meth, but regular folks pay the price in inconvenience
Perhaps if you pay cash in UK they have to get ID, if you don't (or you use a discount card) then they're already tracking you so extra checks probably aren't needed.
Interesting. I was just in the UK (Scotland), and picked up a cold on the plane. I was unable to locate any pseudoephedrine.
My search was far from comprehensive, so it might merely have required looking harder. But I gave up early, on the assumption that the UK was similarly restrictive to the US.
Maybe it has, but last time we bought it was within the last year - branded Sinutab (actually clearly marked, unlike Sudafed), from Tesco Pharmacy I think. It's always with paracetamol; which I assumed made it difficult/useless for meth makers.
I was denied this the last time I tried to buy it and the pharmacist couldn't even tell me why aside from "the system won't let me". I went to a different chain a half mile away and walked out with a month's supply of the stuff. Hilariously incompetently-designed regulation.
Meanwhile meth making is more efficient, cheaper, and delivers purer-grade glass than ever.
Most worthless law. Now i have to wait in line for 10 minutes to get it and yet meth is still widely available and usage actually increased. Did nothing except shift manufacturing to outside of the US.
Pseudoephedrine should be unrestricted, there’s no way to compete on price with meth cooked in an industrial lab in Mexico by using pseudoephedrine as a precursor. Keep it behind the counter (to prevent theft) but let adults buy as much as they want.
And I can't stockpile it for allergy season (which is about 9 months out of the year for me). I have to make regularly scheduled trips to the pharmacy every two weeks which is a huge pain in the ass
My life on an ADHD med, a mental health med, and 3 other meds for transgender stuff.
I am very lucky to have a backlog of estradiol, my main HRT drug, because I was purposely "playing under speed" for most of a year, otherwise all 5 drugs would be randomly running out at 5 different times throughout the month. Almost nothing gets assigned to 90-day fills for some stupid fucking reason.
So from personal experience you can often just ask docs for a longer prescription if something isn't particularly restricted (like stimulant-type ADHD medications).
From friends, I know that some therapists and endocrinologists are willing to give 6 mo or even 1 yr scripts of hormones, though some will only do so under certain conditions. You might want to find a different doc. I know one person who gets a 3 mo supply of estradiol from a telehealth provider.
I once actually got denied and had to buy a smaller box (for the same price). What the hell happens to families with multiple teens who all get sick at the same time?
Corticosteroids are powerful substances, and have lots of potential adverse effects - and long-term usage can wreak havoc. The physiological side-effects of corticosteroid withdrawal can be quite awful. They are amazing, necessary, drugs for society. But, when something as safe and effective as pseudoephedrine can do the trick (it really is quite safe, and even has less potential interactions with things than plenty of OTC drugs do), there is literally no reason for anything else.
When I get a cold, (pseudo)ephedrine is the only medication that actually really helps. I don't need it often, I just try to remember to buy some once in a blue moon when I'm already at the pharmacy so that when I need some, it will be there. But for people with allergies or those who get sick a lot, the current process is yet another completely pointless annoyance.
Corticosteroid nasal spray does not have the same effects as when it is administered in other ways and is safe even for long-time use as three different doctors in my country told me.
I just spent dug in to this and, wow, I was wrong!
Most all the negatives that occur with parenteral and oral routes appear to be absent in the intranasal form. And there is quite a lot of research to back that up.
Thank you for correcting me. And likely sending me down another rabbit hole.
They make twelve hour extended release versions now. There are twelve per box and you can get three boxes at a time. That's 18 days but only if you take them twice a day, which you probably shouldn't if you like sleeping. If you take one a day, that's a whole month's worth.
I've only had to buy it in three states, but generally my experience has been that you can buy a "30 day supply" per month. How often are you sick that you need more than 30 days of the stuff every month? If we run out I'll buy a 30 day supply and that generally lasts the whole family a year or more.
You definitely don't have anyone in your family who gets severe congestion from allergies then. The "funnest" form it takes for me is when I start going partially blind in one eye due the the sinus pressure
I could do it with less effort and cost than OTC. Online message my PCP, prescription sent to pharmacy, mailed to me at my house, cost $0 since it's just a generic. And I have a cheap as shit high deductible plan with a steep out of pocket maximum, not some cadillac plan.
OTC would be faster, but if I have a chronic need for large amounts of pseudoephedrine I'm not waiting until it hurts before I run to the store. I'm getting my doc to make sure I have a hell of a good stash (and I checked, just to be sure -- the limits don't exist if it's prescription; at least not in Oregon, which is famously restrictive on pseudoephedrine).
Would it be better to relax the restrictions that now seem pointless on the OTC version? Yep. But if someone is bitching on HN about how they can barely get what they desperately need, I'd say it's time to stop being idealistic and go get the damn drugs already.
> Unfortunately there is an absurdly low limit on purchasing amount in the US.
The maximum safe dose for an adult is 240 mg in a 24 hour period. Current guidelines allow for getting a 10 day supply (the average cold lasts 7-10 days) in a single visit, and basically a limitless supply with a few visits (37 days worth every 30 days).
If you are running into purchasing limits, you are either making meth or blowing out your liver.
Edit: Math is hard. The 30 day limit is 7.5 grams (a 31 day supply), or 3.6 grams per trip (a 15 day supply).
I seem to only be able to buy 10 days of Sudafed 24 Hour every 14 days. That doesn't work if you have allergies.
Presumably because places like Walgreen's can't adjust compliance per state and places like Alaska have "No person may purchase or possess more than 6 g of PSE, EPH or PPA per 30 days unless dispensed pursuant to a prescription"
Note that 6g / .240g = 25. So I can only buy 25 days worth of pills every 30 days. Or 12.5 pills every 15 days which is suspiciously close to that 10 every 14 days number.
Aren’t there better things to take longer term for allergies? Pseudoephedrine is amazing for colds etc. but I’ve always seen warnings not to take it for more than a few days at a time…
What's 10 days/4 people? like... a family that lives together? Who will almost inevitably get each other sick? If the average cold lasts 7-10 days, one of them's going shopping for more while sick.
Sounds like great public health and safety policy there.
I've noticed that in the UK all phenylephrine based OTC medications also contain paracetamol (acetaminophen) and often caffine. They are just an expensive way to buy two very cheap compounds with an added bit of placebo effect from the flashy packaging.
I can't take pseudoephedrine due to high blood pressure and I've found that the most effective thing for me, especially at night, is paracetamol, a blast from a nasal spray, and one of those nasal strips that help keep your nostrels open a bit more. It's not quite up there with the real Sudafed, but it's generally enough to get me a good night's sleep.
>I can't take pseudoephedrine due to high blood pressure
I really miss being able to take pseudoephedrine. I mentioned to my doctor that it seemed to affect my blood pressure and he looked scandalized and told me I should never take it again. Apparently someone should have told me when I was diagnosed with high blood pressure. The only real information I got was a handout for a DASH diet.
Yeah, I don't think it was mentioned when I was diagnosed, but the pharmacist asked about it when I next went to buy some more. That was a very sad day.
I miss being able to take Night Nurse and then sleep like a baby.
Phenylephrine does increase blood pressure when delivered by IV at doses that work. The oral 10mg dose just isn't enough to get absorbed and do anything.
It's not that phenylephrine is ineffective, it's that it's underdosed in the oral formulation.
There was some article about it on HN a while ago. If I remember right the problem was that its bioavailability is super low. You can take all you want, but only a tiny percent makes it through to get absorbed. In theory you could increase the the dose a lot but I imagine that might have other issues.
I believe the problem is that the oral route causes most of it to be broken down in the digestive system. Nasal spray seems to be more effective because it has a chance to directly enter the blood stream rather than go through the gut.
Finally. I hope this reaches Australia and the rest of the world. Phenylephrine doesn't work, it never worked, it's obvious that it doesn't work, it's a literal scam, and the companies selling it are fraudulent.
Half the products in chemist warehouse are pretty blatant scams. It's insane how effective, important pharmaceuticals are sold side by side with products known to be ineffective and that exist purely to strip uneducated customers of their money.
I remember, many years ago, that I got some Antihistamine tables with Pseudoephedrine to take in 'light' emergencies for my allergies, cat hair in my case. I wasn't going to fall over like other people but have trouble breathing and a runny nose, so every time I visited people with cats, I could take one and everything was fine. When they banned it and my supply was used up, I got something with Phenylephrine and it just did... nothing. Then 5min of online research told me just as much.
My anecdata is that, though it's not as effective as pseudoephedrine, phenylephrine actually is effective in an inhaler, and a helluva lot better at clearing up a stuffy nose than "scents and essential oils". Of course, a cylindrical inhaler with a wick inside it doesn't go near my digestive tract... Now I'll have to look around for a replacement inhaler, something quick enough to avert choking-panic. Thanks, CVS.
It's only the oral version which has no effect and is thus being pulled. The inhaled version has more evidence that it works and will remain available.
I can't pronounce either one of the Sudafed substances. One time, an old lady asked me which Sudafed work for her as she pointed to a shelf full of Sudafed plus other decongestant drugs. I told her just buy the one that you need to take the flyer and bring it to the pharmacist to get it. Others are just scam. The real one is used to make meth so they put it behind the counter.
She was surprised that the US gov would allow fake decongestant to be sold.
Ambroxol is not a decongestant, it's an expectorant. If you take Ambroxol expecting to clear your sinus pressure like pseudoephedrine, you're going to be disappointed.
I've used it. I thought it was going to be better than guaifenesin (equivalent available in the US). In my experience, it was not.
That entire blog post appears to be based on a second-hand report from someone who went on vacation in France and was told something by the person at the pharmacist selling them Ambroxol. I don't understand why rationalist bloggers are so keen to rely on anecdotes and hearsay when it supports a point they're trying to make.
Am I taking crazy pills, because I've been taking PE for years and it works just fine? Like yes the behind the counter stuff is stronger but it also comes with more annoying side effects.
I use it to sleep during allergy season and I can tell when I don't take it when I mouth breathe the whole night. I might try some experiments to see if I can tell but I didn't think you could placebo while sleeping.
For most of my adult life, I was "addicted" to sudafed (pseudoephedrine, not phenylephrine). I had absolutely horrific sinus problems. Could never breathe, tons of sinus infections, etc etc. Things like sinus rinses (not a netipot which is gravity driven, but a positive pressure squeeze bottle) helped, but it was still a major inhibitor in life.
I got a new ENT, and I started getting a quarterly "chemical nasal cautery". It has ABSOLUTELY changed my life. I can breathe sooo much easier, and I couldn't recommend it enough to anyone with persistent sinus issues. It is super easy. It doesn't even kind of hurt, the most mild of stings if anything at all. Doc will spray a lot of afrin up your nose, then lidocaine, then carbolic acid which kills a bunch of your immune cells (so they can't overreact to tree pollen and make you miserable). You get it done once a month for three months, then once every 3 months thereafter.
Everyone in the pharma and regulatory world has known this stuff is worthless for years. I feel like the pharma industry should be severely fined for knowingly perpetrating a fraud on the public. Sadly, they would likely be able to defend themselves on the grounds that the FDA allowed it.
A faculty member clued me in when I worked for a college of pharmacy 20 years ago! FDA should be embarrassed. This shouldn't even have been hard. How many drugs have been p-hacked into efficacy and would need expensive trials to disprove? Oral PE is metabolized too quickly make it to the bloodstream and can't be more than a placebo.
Thanks to the Administrative Procedures Act, and per the release from the FDA, the proposal will take some time. Comments are accepted until May 7, 2025. If the government moved with all legal alacrity, the order might get finalized by this time next year, that's if there are no lawsuits, petitions, etc.
I mention this because I can't help but feel the APA takes too long when an agency is doing something proactive for the public good. This should take sixty days, not years, because it's not a removal of a product for safety reasons, that's often done via the FTC.
There is a hole between FDA's authority to create and amend regulations, order the removal of products due to safety, and what should be a more routine streamlining of the FDA cleaning up..
Next I hope they do cough medicines, I looked a few years ago when I had a cough and it seems like literally none of the OTC ones are more effective than placebo.
Dextromethorphan (DM or DXM) is the OTC cough suppressant. Marketed as Delsym comes in an orange box, or you can find it in various combo formulations, and it works
Delsym is dextromethorphan-polistirex, a long-acting formulation of DXM that is supposed to last 12 hours. DXM is available in almost all cough syrups.
The 12 hour formula is the only way you can get it OTC by itself. That’s because it’s a recreational drug that is commonly abused (“robo tripping”) and extended release prevents that. Otherwise you have to get it in a combo drug like NyQuil, which I don’t prefer because I can’t manage distinct symptoms and dosages independently with a combo
Dextromethorphan is the only otc cough medicine that works and pretty much the only prescription stuff that works is opiate based. Of course both are regulated.
Because you and your neighbors think you can interfere with people through your voting decisions. Government has grown so out of line, 'crime' has no meaning anymore beyond "doing that which some group of humans with guns and cages says, who nobody really consented to or contracted with (they've always been there bullying everyone into paying taxes and obeying edicts)." It certainly doesn't mean what it used to mean anymore!
We as a people need to become even more ungovernable, we need to be the opposite of German and be the most annoying red blooded American caricatures we can be.
Don't join the beehives, they're not worth it! My corollary to Franklin: those who would give up essential sovereignty to gain inclusion into a society deserve and shall receive neither.
Not sure if it's still possible, but in eastern europe back in 2010s you could buy bottles of liquid ephedrine nose drops without a prescription. The pharmacists would get raw ephedrine and mix it in the back, filling the generic nose drop bottles. Tho they'd only give you 1 a month or so, looking at you suspiciously if you came multiple times in a row.
Back when I was obsessed with sports and being the peak athlete I can be, I'd go to the different pharmacies around town and buy a bunch of nose drops. These would get mixed in with coffee to get a dumb version of EC stack. Not sure if it was worth it, but it definitely had me wired to the gills.
I had a student once from Sofia (capital and largest city of Bulgaria), she told me her mother mailed her all sort of antibiotics because they were not available here (western Europe) and "what if she'd catch a cold or the flu?" (Both are viruses so antibiotics don't even do anything other than kill the useful bacteria in your body!)
Many of the eastern-european markets around here have a little mini pharmacy where you can buy stuff that's either stronger than what you can find in the US, or can't be found at all. Especially various topicals, they tend to have versions with 2-5% of the active ingredient whereas most of the equivalents I can find in the US are 1%; Obviously nothing that's controlled/scheduled.
So a useless drug has made billions and took 30 years to be taken off the market . And who knows what damage it’s done ? Can we go back to being suspicious of pharmaceutical companies and the fda ?
This is why sovereign immunity needs to be rescinded: bad law should get politicians incarcerated for long periods of time and their assets stripped to help pay back the treasury for the piles of money it should be printing and handing its victims. It should also be legal to lie to police while they're barred from lying to you (again, at threat of incarceration). We are supposed to be sovereign, not them!
>Preventing people from getting real medical care due to fraud is absolutely damage.
Sure, but I don't think you could reliably charge that, at least in the US, where homeopathic medicines with absolutely no effect are allowed to be sold. We're talking about over the counter remedies for temporary sinus congestion often caused by pollen allergies, not prescription medicines that treat actual serious conditions.
Giving you the benefit of the doubt, I think you mean mean that everything has side effects, not that everything has actual ill effects. But even then, not everything has measurable side effects. There is a common saying of "the dose makes the poison" for a reason. I'll leave it up to you to think up some examples, they are innumerable.
It would require the whole scientist communities and the sanctioning organisations to work together in order to validate a drug that is basically infective. Because you see before a drug is out on the market there are a lot of testing on animals, then humans and they have control group to measure how effective (or not) it is.
Things like that CANT happen.
Obviously I'm being sarcastic, that's the usual argument: you can't possibly have all scientist and federal organisation work together on malicious drugs.
The truth is that it happens, see that drug or the oxycontin. It just requires some shity people and the rest of scientist community to not care.
Some of us were suspicious all along. Especially of Pfizer.
But such suspicions became socially dangerous right around the time that Pfizer stood to make multiple billions selling a novel treatment for a recent pandemic.
Let's be honest about this: the reasons people were skeptical of COVID-19 vaccines had nothing to do with the actual corruption in the pharmaceutical industry, and everything to do with the corruption stories told by people who profit when more people die.
It's rather annoying that the only actually effective nasal decongestants are amphetamines or otherwise closely related compounds. Sudafed is great for daytime relief, but there really is no good sleep time decongestant. Sure Nyquil is a thing, but it just relies on the antihistamine to produce drowsiness without any actual decongestant effect. And Dextromethorphan is arguably even more useless than Phenylephrine since at least the latter could conceivably be effective if you shot it up.
I do find it amusing reading hundred year old stories where characters walk into a pharmacy to buy a pint of whiskey, a sandwich, and a vial of cocaine and it’s just an everyday normal thing.
Clearly placebo for me, I guess? It's wild how many people are saying phenylephrine is completely ineffective. It saved my ass during a really long COVID stint. It was impossible to find by itself but when we finally found it we bought 2 boxes because we use it and, for us, it works wonders... Hope they release something else better I guess.
The better thing is the original: psuedoephedrine. It was never impossible to buy, it just required going to the pharmacy counter and showing ID. I knew about this when it happened in the 2000's because my dad needed Sudafed often, but the changeover was almost certainly invisible to most people given that the packaging is essentially identical between the two versions of the product.
I have tried many nasal sprays, but what is really effective is a salt in water solution (slightly salty to taste) and a 10 ml syringe. Simply inject it into each nostril so that the water comes out through the mouth, a couple of times a day. Cleans out all the garbage really well.
Among the medications, Flonase spray is effective, but saltwater is enough most of the time.
Does anyone else feel like dayquil is an effective decongestant? I do. I can literally feel the gunk running down from my sinuses to the back of my throat when I take it. Confusing to me cause it's phenylephrine, which is what the article states is ineffective. I've had this experience after reading these reports about a year ago.
> Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication taken by mouth and marketed as an aid to eliminate sputum from the respiratory tract.
> ...
> Guaifenesin is used to try to help with coughing up thick mucus, and is sometimes combined with the antitussive (cough suppressant) dextromethorphan, such as in Mucinex DM or Robitussin DM.
---
> Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines.
> ...
> The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), or from inhaled particle irritants, as well as chronic cough at a higher dosage.
---
The combination of the two is designed to reduce coughing and when you do cough, it is much more productive with the expectorant and cough suppression. It isn't a decongestant, but it has (personal anecdotal take) a good effect on getting rid of the secondary effects of congestion.
I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?), although I can't find it again, and I may have read it when I was congested and only had PE.
My lived experince with PE is it never works most of the time. But if I realise I need psuedoephedrine and I'm not somewhere or sometime where I can access it, I'll get PE and hope. Sometimes hope works, but it usually doesn't clear my sinuses very effectively. But if I have sinus congestion related to flying, I might also have soreness related to flying and take PE (because you can get it at the airport) and ibuprofen together, and maybe it works.
But also some people are more sensitive to some drugs, so it could work for you, while not being very effective in general.
> I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?)
Oh yeah combine with Tylenol and increase the dose if you want to experience adverse cardiac events. The oral form of PE is really only good for jacking up blood pressure, it doesn't help with congestion more than placebo: https://pmc.ncbi.nlm.nih.gov/articles/PMC4500855/
Phenylephrine doesn't work though. It never did. It was "pushed" as an alternative to pseudoephedrine which can be used to synthesize meth, but afaik every single study done on this shows that phenylephrine does absolutely nothing, it's a placebo drug. The faster it's phased out the better.
It was approved back in the 70s after there being some studies that showed it was somewhat effective against congestion. I suspect it was no better than a placebo, but once it gets over the hurdle of being shown to be safe to use it probably didn't take much to get it approved. I don't think it was ever a popular product until the government starting making pseudoephedrine, which is highly effective, hard to buy.
People bought sudafed / they earned a lot of money from it, and they wanted to continue to earn money off of it. That's basically it. But they will point the blame at legislation I'm sure, both for making the effective stuff more difficult to get, and for being OK with the ineffective stuff being sold.
Phenylephrine worked great for clearing my mucus overproduction. Unfortunately, this has little to do with allergy relief, so I can see why many here hold that it's ineffective. I can imagine how frustrating it must be to have actual allergy issues and be prescribed something that doesn't solve the problem.
Didn't see any one talk about it but French health agency recommended all pharmacists and doctors to stop issuing Pseudoephedrine for colds as there is supposedly increased risk of heart attacks and strokes. It was only for people with high BP but seems like it's now for general population too.
Just as a reminder, you are completely allowed to buy pseudoephedrine without a prescription, you just have to ask your pharmacist. My local pharmacy keeps it behind the counter already pre-compounded, and it's cheap and effective. One of those little things that I never used to purchase because I was somehow not certain if I could actually get it. Yes, you can.
What country are you in? In the US, pseudoephedrine has to be requested at the pharmacy counter, but it's not a compounded medication. Instead it's sold as pills in the usual "blister pack" format.
I live in the US. You're right, it's not compounded by my pharmacy, I was confused because of the branding on the package — it's manufactured somewhere else and just repackaged by my pharmacy:
It's not repackaged by your pharmacy, Good Neighbor Pharmacy is a generic drug brand for pharmacies and supermarkets that don't have their own generic brand.
Ohm Laboratories appears to be a subsidiary of Sun Pharma which is one of the largest generic drug manufacturers in the world. This looks like a pretty standard generic drug with store branding package to me.
My local pharmacies keep it behind the counter, but the counter has shorter hours than the rest of the store. And you've got to submit your license to be entered into their system (and who knows what happens with that data).
In Belgium it's no longer available without prescription since this month. Reasoning is that it can trigger cardiac issues, neurological issues, and even psychiatric issues in some people.
Lots of versions of Alka Seltzer use aspirin instead of acetaminophen, and aspirin in combination with phenylephrine is documented to reduce congestion more than either alone.
Note - avoid the cold & flu versions (the ones with orange bottoms) and the day & night versions (orange and green bottoms), because they're not aspirin, they're acetaminophen. The traditional blue bottom "Alka Seltzer Severe Cold" is the one with aspirin and phenylephrine.
Good to know thanks. Considering it does work it would be weird to pull ALL phenylephrine in that case. I remember the last time PE came up they were just pulling medicines that were only PE like the fake Sudafed.
It's been definitiely shown since at least 2010 that phenylephrine is useless for this purpose. How in the world did the FDA let the decongestant industry push this drug for 15 years before coming down on it?
whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism.
in the 90s and 2000s when meth first began to spike, the rural economy was changing. Jobs weren't paying as well or were going away altogether. Meth found a niche as a kind of performance enhancement drug for people working long hours at physically demanding jobs. journalist Nick Reding found this in the pork industry in Iowa, and anthropologist Jason Pine found in general in Missouri.
neoliberalisms solution was a ham fisted market based restriction that turned a normal cold drug into a rarity. we didnt start working to treat methamphetamine addiction as a disease until it began to spread into more affluent white-collar neighborhoods.
this could have been avoided with competent market reforms and regulation, as well as stronger labor protections and minimum wage law.
I blame Progressivism™ and the expansion of the role of government. Laissez Faire is the ideal policy for a force-monopolist to perform by. It is better to have a weak government precisely because it's way easier to fell a badge-less gangster than a badged one.
Neoliberals believe in free market and deregulation, not market restrictions.
Nixon was the one that started the war on drugs and also enacted price controls. I would not call him a neoliberal. He also primarily interested in foreign policy and not the economy.
Also, Sudafed was only banned from being purchased easily in 2006. The bill was introduced by a random congressman from Indiana, a congressman was also easily offended by an offensive joke written on someone’s else cake.
And it's much more profitable to scrape every ounce of working life out of the poor, then use them as slave labor in a prison once their addictions get them into a critical situation or farm them out to a rehabilitation facility that pays councilors 20 bucks an hour and gets a large chunk of it's funding from taxpayer subsidies. If there's any issue, blame the overworked poor for turning to drugs, then sell them energy drinks.
I’ve hearing great things about this new drug called placebo. You can apparently prescribe it for anything and in many cases it’s just as good as existing medications.
For the record, with regard to treatment, ivermectin was understood to benefit anyone who had a co-occurring worm infection (targeted by ivermectin) while also having Covid. This just rules out most people in the US as they typically don't have the corresponding worm infections. I myself tried two brands of ivermectin while having Covid, with no luck.
Better to have taken it when (and if) you knew you were exposed. It was always considered to be a prophylactic more so than a treatment. And in that capacity it did seem to work for me. (Having never tested positive for COVID, despite numerous tests, numerous exposures and no shots)
I also suspect that the much maligned "fish tank cleaner" hydroxychloroquine remains effective-as-ever for many issues, which "more targeted" in-patent drugs are on the market for.
It's very interesting to see such skin issues treated with ivermectin, although they are fundamentally a cleanliness issue of skin, clothes, and carpet.
Regarding HCQ, do I have a story to tell. Early in the Covid years, I had its symptoms twice. This was before any vaccine or tests. The first time was from a coworker, and the second time from a stairwell while unmasked. Both times, nothing would fix it, but pure CQ did. This was no fish tank cleaned. It was a proper CQ medicine at 250 mg/day for two days, then repeated again after a week for another two days. The only side effects were very minor visual blurriness which resolved on its own within 3 months, and cardiac arrhythmia which resolved using atenolol. The cardiac arrhythmia could just have been an effect of Covid itself for all I know. Note that I do take quercetin which is one of the few agents that is necessary to get CQ or HCQ to do its magic, failing which it could not work for Covid. Later strains of Covid became weaker and the vaccine also protected, so I didn't need it for future reinfections.
In your opinion, should any government agency monitor truth of claims, or is this all outsourced to private things like consumer reports? Is it class action lawsuits?
And in the case of drug effectiveness, isn't this a very expensive endeavor, where the primary source of funding would be the companies themselves biasing results?
In this case we had companies happily selling us ineffective drugs, not because the FDA wanted it, but because they did not reject it. In a world without the FDA, what entity rejects?
>I bet you think people should trust you even though I also bet you were wrong about something once.
Is there anything I've been wrong about which has been significant for a couple of decades?
Pseudoephedrine left OTC in about 2006, phenylephrine has been the main decongestant available and there's been solid evidence out there for a long time that it didn't do anything.
I don't hear anything that shows that this mistake is part of the majority or minority.
How long ago it was made is insignificant.
I have no reason to think that you do not have a similar 20 year old ongoing error unless you are physically not yet 20 years old. I'm sure I probably do. I'm sure everyone does. It's not a remarkable thing.
They are also right now self-correcting this error, while I still have mine whatever they are.
Regardless, it still doesn't answer the question of exception vs rule. No matter how bad or long-running this error is, it doesn't matter, what matters is, is it representative of most of their policies and actions? It might be, but you have not shown that it is and I have not shown that it's not.
Companies lie to the public and sell products that contain a useless drug that does nothing, the FDA wants the products with the useless drug removed because the companies selling them are just ripping people off, and your conclusion is that the FDA is the problem?
It makes me wonder if it has anything to do with Trump winning the election.
> What else is the FDA wrong about
Too much. For one, numerous harmful additives are freely allowed. These additives may not cause immediate damage, but over the long term they really inflame the gut. They serve no good purpose in the medicines. Examples include: propylene glycol, sodium lauryl sulfate, titanium dioxide, talc, ammonium hydroxide, monoethanolamine, n-butyl alcohol.
Context for readers from countries where this isn't an issue, or anyone who hasn't followed decongestant news: one of the most effective decongestants is called pseudoephedrine.
https://en.wikipedia.org/wiki/Pseudoephedrine
In the past this was easily available, with the most popular brand being Sudafed. My parents always told me that one should take Sudafed when flying after having had a cold, in order to avoid severe ear pain from the pressure changes, but people would also obviously take it when not flying, just in order to reduce the discomfort of the congestion itself.
Pseudoephedrine is very effective. It is also used to synthesize the somewhat related illegal drug methamphetamine ("meth"). Historically, meth manufacturers would hire people to buy large amounts of pseudoephedrine pills at pharmacies and supermarkets, then grind them up and synthesize meth from them.
In order to deter this, authorities in the U.S. restricted the availability of pseudoephedrine, while not making it prescription-only, by limiting the amount that people could buy, and requiring buyers to show ID and be put on a registry (which law enforcement could use in investigations). I think this is the only drug that is treated this way. Some people stopped buying pseudoephedrine entirely, either because they were offended by these rules or because they were afraid that they could wrongly be implicated in meth investigations if they appeared to buy it too often.
The pharmaceutical industry produced an alternative called phenylephrine, the substance that this proceeding relates to. Most manufacturers of pseudoephedrine-based drugs, including Sudafed, formulated alternative decongestants using phenylephrine. There are no legal restrictions on phenylephrine drugs; one can buy them anonymously and in any quantity. Customers have complained for years that these are much less effective than the original formulations.
A couple of years ago this regulatory authority started looking into the question of whether phenylephrine is actually completely useless as a decongestant (rather than just much worse than pseudoephedrine). Their preliminary review of studies suggested that it is probably, in fact, useless. This proceeding is now proposing to ban it on the grounds that it's ineffective and so people should not be encouraged to buy and use it as a medicine for purposes for which it doesn't actually work.
(There doesn't seem to be much corresponding initiative to remove or reduce the restrictions on pseudoephedrine.)
The restrictions on purchasing pseudeophedrine should be repealed. Their imposition led methamphetamine manufacturers to switch to a more efficient process based on different ingredients. Purity and production volume increased substantially.
A repeal won't turn back the clock on that of course, but it will make life easier for people with congestion.
https://dynomight.net/p2p-meth/
It was a real win/win. Tens of millions of people lost access to an effective drug in order to penalize maybe a few thousand that were using it as a precursor to making mamp.
But, hey, we beat street meth, right?
> Tens of millions of people lost access
This is a bit hyperbolic. You just have to ask for it at the counter and show ID.
Only certain documents are accepted: photo documents issued by a US state and certain federal documents. There are some exceptions in the initial act text, but in practice, nobody is going to accept your nursery school record.
There are certainly 10s of millions of people who don't have direct access to this drug.
And if they require a drivers license but their system is based on an electronic reader and that reader is broken, then you are out of luck. No sudafed for you.
Pretty sure I've even commented here before about this, but I was refused at an LA Walgreens pharmacy when I presented both a NY ID and a US passport. Would only accept CA ID.
You honestly think there are 10s of millions of people wanting a decongestant in the United States without ID? This is ridiculous and I agree with the other commenter, a bit hyperbolic.
26 million Americans lack valid government-issued IDs, and of this 26m, minority groups comprise the vast majority.
https://bluenotary.us/how-many-american-citizens-don-t-have-...
Wow I was surprised by this figure, so I tried to find the source everyone quotes. It appears to be a 2006 telephone survey of 987 randomly-selected voting age citizens that were then weighted for an underrepresentation of race (so perhaps not that accurate). Anecdotally, I work in a safety net hospital and it is really rare for someone to come in without ID, which is why those numbers seemed so surprising to me...
https://www.brennancenter.org/media/6697/download
I could easily have missed a better or more recent study, so if anyone has one please post it!
The answer here is to make getting a government issued ID a straightforward matter and a national priority.
I cannot think of another significant country that hasn't had this figured out for decades.
Pretending that government IDs are super duper hard to give out is a time-honored American tradition.
After all, imagine if the government had a database with every person's name in it! You'd have like 300 million rows? Nobody's built a computing machine that could do that. And then how would you get the cards to people? You'd have to send out horses and buggies to every corner of the nation. And where would you find enough coachmen to do that, and roads to drive the coaches on???
No, clearly it's unpossible.
So we have to reserve the use of government IDs for really important things, like checking if you can buy cold medicine, and voting must remain insecure.
Government IDs are not a solved problem, and you don't seem to have even tried to consider the issues involved. The key distinction between voting and cold medicine is that you have a right to vote, but not to buy cold medicine. So if you lost your ID, or it's expired, it is not an option to just say "that sucks, I guess you can't vote now".
In fact, as a rule, ID is reserved for things that aren't important, because it is a point of failure.
Yes, only advanced countries like India can give everyone an ID. The US is too poor and backwards to give everyone a plastic card.
Do you think citizens of India experience no problems as a consequence of this, or is it just too exciting to be sarcastic on the internet?
Oh, wait, it must be the latter, because finding problems with India's government ID scheme takes five seconds: https://www.theguardian.com/global-development/2017/mar/21/n...
The point of India requiring identification for benefits is to prevent waste and fraud. And given the number of poor people in India, and the limited amount of money they have to help them, it seems like quite a good thing to do so.
Identifying people is not hard, even for the poorest countries, and it's quite easy to do with modern technology. There is no good-faith reason to oppose it, any more than there is to oppose driver's licenses.
Did you read the article I linked? You keep saying this is an easy thing to do, but don't seem to acknowledge any of the problems it causes. It is not easy to identify people. It is easy to identify people with 99% accuracy. If the remaining 1% are unable to access society, that is an unacceptable risk.
Consider for instance the people who currently exist, don't have government ID, and don't have an accurate record of their birth. Such people exist. Should they just die, or something?
I think these basic facts should be taught in school. Yes, millions don't have ID.
It seems trite to someone in the middle class, but it genuinely is not a priority to certain demographics, given the challenge of getting it. That challenge may seem trivial to a frequenter of Hacker News, but we're a diverse society.
The only barrier to getting a decongestant should be: having the money to pay for it.
No, but why the hell should someone else’s misbehavior cost me time and inconvenience?
The cost of these regulations is millions, perhaps billions of dollars in extra effort, bookkeeping and security by tens of thousands of businesses, not to mention lost productivity and frustration on the part of everyone else evolved, and moats of the costs and inconvenience is borne by people outside the government, who are not committing a crime.
It’s bat shit crazy that bureaucrats are allowed to steal this much productivity from the economy.
I honestly think it's on that order, yes. Anyone who has had a respiratory infection, a sinus headache, or seasonal allergies. Anyone who would take NyQuil. Over the course of 18 years. Why is that so hard to believe? In fact, now that I think about it more, it's probably a lot more.
Yes - I often lose my wallet/ID and I don’t think I’m in in the 0.1%ile. Even if 1% are like me, thats 30 million Americans.
I wouldn't be surprised if that's actually an underestimate, because this saga has had a knock on effect on decongestant formulations sold outside the US as well. I don't know exactly why this has happened but my guess is it may be due to economies of scale in manufacturing or licencing overheads.
It's hard to find a pharmacy which even sells pseudoephedrine based decongestant if you're in the UK, for example.
Boots (a large UK pharmacy chain) sells it, but it's "behind the counter" so you have to ask for it. They will also only sell you one pack of 12 per visit
It's the same for codeine-mixed products. Recently I got denied a simultaneous purchase of pseudoephedrine and ibuprofen/codeine - I was I was only allowed one.
I'm not sure if it's policy, law or I just looked suspicious.
Thanks. Looks like the buying limits are a legal requirement: https://www.gov.uk/drug-safety-update/pseudoephedrine-and-ep... ) Seems like it was also classified as Pharmacy only (behind the counter) or prescription instead of just OTC.
Is that true? I honestly don't know. I thought it went away entirely. I guess that's what hiding it behind the counter does to those who aren't in the know.
Yes.
> But, hey, we beat street meth, right?
It’s all fentanyl now so in a weird way, maybe?
No. Fentanyl has become a huge thing in illegal opiates (either used instead of drugs like heroin, or mixed in with heroin to make it seem stronger though more dangerous).
But, while there have been some instances of accidental fentanyl poisoning from use of other classes of drug (eg if a careless dealer/distributor is mixing fentanyl into heroin and doesn't clean the surface before moving on to weigh out bags of cocaine, or whatever) absolutely nobody is choosing to use fentanyl as a replacement for stimulants like meth (which is the drug being discussed above) or cocaine. They're complete opposites.
Of course, there are also trends over years/decades as drugs become more or less popular, either as part of societal trends (eg Ketamine in the UK, having spent a decade or two being forgotten about by the majority of recreational drug users, has apparently made a comeback and is very big in the party scene now especially among younger people), or because of the reasons people take drugs (eg the more people going to nightclubs/raves, the more people will use drugs like cocaine and MDMA; while more people getting depressed and not going out will lead to more people using drugs like opiates, eg heroin/fentanyl, to take away their mental pain - and some drugs, like Ketamine, are actually popular for both those examples, it's a popular party drug and it's often used alone by people wanting to bury their feelings).
So it's possible that the state or the world has led to more people choosing opiates than stimulants, and in the US fentanyl is all over the illegal supply of opiates. But I'm not aware of any logic that would say the increase in fentanyl has or would lead to meth users making the switch.
Side note that I think worth mentioning considering the topic: by FAR the most dangerous aspect of using these illegal drugs is the fact that they are illegal, not the fact that they are drugs. The majority of fentanyl users in the US are either trying to buy heroin but being sold fentanyl (or heroin+fentanyl mixes), and the majority of people actively choosing to use fentanyl illegally are doing it not because it's a nicer drug to use than heroin, but because the supply chain logistics lead to it being significantly cheaper (which is also why it's dangerously used by dealers to make their heroin batches seem stronger).
Heroin itself can of course be life ruining, but if taken on its own (not at the same time as other CNS depressants such as alcohol and benzodiazepines) then it's actually extremely unlikely to cause accidental fatal overdoses, and when it does cause overdoses (with or without whatever drugs being involved) it's 90% because the user didn't know how strong it was and expected it to be similar in purity to what they had been using before, and 10% because of lack of harm reduction education about how much to use to be safe, what drugs to avoid mixing it with, etc. (90/10% are just my ballpark guesstimates). Because we spend all the money interesting and locking drug uses up, rather than educating and supporting them in minimising risk while they do use and offering as much support as needed to those ready and wanting to beat their addiction.
If illegal drugs were, instead of being criminalised, treated like tobacco - highly taxed (but not so high that more than a few percent of people choose to buy from illegal sources), made by professional companies (more like other pharmaceuticals in this case than like tobacco m), and therefore possible to buy knowing both that the drugs are pure and knowing their precise doses - then the combination of taxes raised and money saved on the law enforcement side (everything from policing to court costs to prisons) could both fund huge amounts of mental health & addiction treatment and support options, not just for existing drug users but also as a preventative measure to reduce the number of people turning to drugs due to problems in their life or in their mind, AND leave a huge amount more money to be spent in other areas for the good of society. (Sorry for the long sentences, I'm too lazy to properly edit my comment right now).
Wasn't that literally the plot of Breaking Bad? Walt's meth was p2p meth.
Yes. Jesse couldn't score enough product via his smurfs, so they had to find an alternate industrial method for quantity purposes - in the show.
> ...but it will make life easier for people with congestion
I haven't purchased pseudeophedrine, but my understanding was that you just walked up to the counter and had to sign your name at the pharmacy. Is that not the case? Doesn't seem like a big pain if that's the case.
It's a big pain. The prescription line at my pharmacy is never shorter than 15 minutes. Thus the drug is $11/month but costs me $60 in time to wait in that line. Meanwhile, other drugs are just mailed to me, including my prescriptions.
The prescription line is always fun. I remember some dude coughing on everyone, picking up his cell phone, "oh it was positive? great, I'm in line to get the medication" referring to COVID. In my opinion, the easiest place to get sick is waiting in the prescription line. Yet another tax on congestion sufferers.
Having said all that, your doctor can write you a prescription and all the restrictions go away, including the ID check. It has always delayed my fills even further so we don't bother anymore.
The most positive outcome from buying pseudoephedrine in line was being told "hey, your ID expires tomorrow" which was a good catch. I wasn't paying any attention to that. (I don't drive, so it's just a piece of plastic with my name. But necessary for paying taxes online in NYS.)
This is a complete tangent, but FWIW: you can pay taxes in NY with an expired license.
Source: I've been paying taxes in NY with a learner's permit that's been expired for well over a decade.
Edit: I've also used said expired permit to buy pseudoephedrine. In my experience, they get frustrated and put random garbage into the tracking system when the card doesn't verify, demonstrating that it's all theater. It did take a while, though, so your point about this being a waste of time holds.
> Thus the drug is $11/month but costs me $60 in time to wait in that line
In what reality? You were not being paid $60 to grocery shop or whatever else you might have done with that 15 minutes. Nor did it actually reduce your bank account by $60 to wait 15 minutes. If you applied this logic to everything in life, reading this very comment probably "cost" you a dozen bucks too. What a fun way to live?
> Meanwhile, other drugs are just mailed to me, including my prescriptions.
How often are your anticipating needing pseudoephedrine? For most people it's a once a year, at most, thing.
You're kidding, right? For people with allergies and/or chronic sinusitis, it's a thing they're taking for about a quarter of the year off and on. ...and they _will_ practically "cut you off" if you buy enough to be taking it for 45 days straight, no matter how you buy it.
That phenylephrine (which everyone with sinuses knows doesn't do a damn thing) was perpetually being touted as a substitute was just adding insult to injury.
Why don't they just get meth? It works just as well as psuedo and it has a much longer duration.
I take it every day; deviated septum and allergic to everything even after decades of immunotherapy. Maybe I should get surgery. But this is easier.
Btw I got septum surgery and turbinate reduction and it was life-changing. Previously used antihistamines and nasal steroids every day. Even when my nose produces mucus, its doesn’t clog now. Procedure cost me $100 through Kaiser (cost them probably $75k if you believe all the various documents they sent me).
> cost them probably $75k
No, that's the inflated list price that's only paid by people with an emergency while out of network or similar unfortunates -- not insurance companies.
[dead]
You can't take pseudoephedrine every day. Nor is pseudoephedrine used for allergies - it is a decongestant, not an antihistamine. Nor does immunotherapy "solve" allergies.
A simple google search before posting would have made your fictitious scenario a little bit more believable.
> Nor is pseudoephedrine used for allergies
Technically true but it is often paired with loratadine in, e.g., Claritin-D. Many allergy sufferers also get congested sinuses.
Guess what happens when allergens irritate the inside of your nose? You get congested.
Guess what people take for allergies - drugs that actually prevent reactions. Allergic reactions that effect the nose are almost always going to result in discharge, aka. a runny nose. It's the body's natural way of removing the allergen. Pseudoephedrine doesn't help with this at all.
The side affects of prolonged pseudoephedrine use (usually defined as more than 7 days, btw) are far more serious than a stuffy nose.
You cannot even purchase enough pseudoephedrine to use every day over a full month. The government restricts maximum grammage per month - and no doctor is going to prescribe long-term use of pseudoephedrine to "help with allergies".
That is to say I don't believe your story at all. But I get it - googling these things before you posted would have "cost" you approximately $24 or something something something...
Sudafed (the working version) was one of the go-tos for seasonal allergies, alongside Claritin. Not everyone reacts to allergens the same way. You'd take Claritin daily for the month or so, then Sudafed for a day or two when it got bad.
Guess what happens when people take antihistamines... Lovely, lovely side effects. Side effects which are generally equally as annoying as the original problem.
If one can treat the symptoms just as easily as the cause and pseudoephedrine doesn't make them feel like a drugged-out zombie, just guess which drug people are going to take...
...and yes, doctors actually will write prescriptions for pseudoephidrine because they're generally pretty sure their patients aren't using it to make meth. I know three people who've gotten such prescriptions, and I've been tempted to do the same thing myself.
It means you have to go to the pharmacy when it's open. That's a significant hurdle if you're sick, especially if you have something contagious and you're trying not to expose people to it, or if you work weird hours, or if you don't have reliable transportation, or if you're the primary caregiver for young children, etc....
It also means you can't get it delivered, can't stock up, might have trouble sending someone else to get it, etc.... It's a big pain for some people, and particularly for people who already have a harder life than average.
I suffer from seasonal allergies that last anywhere from 2-4 months out of the year. During the height of allergy season, I take Claritin-D – a mixture of loratadine and pseudoephedrine.
Claritin-D 24-hour caplets come in boxes of 10. You need 3 boxes to get a full month's supply. Each caplet has 240mg of pseudoephedrine – 2.4g per box.
In my state, individuals can purchase up to 9g of pseduoephedrine per month, but only up to 3.6g per day.
So, while I can technically purchase a full month's supply of Claritin-D, I can't buy more than one box at a time.
These sorts of rules are minor inconveniences for an individual compared to the rest of life's challenges, but they exist in a special category of stupid that make them all the more frustrating.
But, here's a thought: what if I had children who needed the same medication? Who's going without?
Tangent; you reminded me about the Robitussin liquid (Dextromethorphan) in my pantry. It prescribes 20 mL doses but the bottle contains 118 mL total. Really grinds my gears this is legal.
GP said:
> Some people stopped buying pseudoephedrine entirely, either because they were offended by these rules or because they were afraid that they could wrongly be implicated in meth investigations if they appeared to buy it too often.
This has actually happened [0], and I seem to remember more instances (at least when the law was first passed). I know I have also gone to buy it in a headache-induced fog and found that I've forgotten my ID, and on at least one occasion the national drug whatever system was down and they refused to sell it. Because it has to be run through the specific national database, it has to be run through one department and I have been unable to purchase because that department has closed for the day.
These are just what comes to mind when I think about purchasing pseudoephedrine over the years; it's just generally become a pain to get. It makes me wonder if it'd be quicker and easier to just buy meth and reintroduce the hydroxyl group to get my cold medicine.
[0] https://reason.com/2009/09/28/hoosier-grandmother-arrested-f...
> It makes me wonder if it'd be quicker and easier to just buy meth and reintroduce the hydroxyl group to get my cold medicine.
Relevant: “A Simple and Convenient Synthesis of Pseudoephedrine from Meth” https://news.ycombinator.com/item?id=33444852 https://maggiemcneill.com/wp-content/uploads/2012/03/synthes...
Just crazy, isn't it? Nothing could be better proof that drug laws are both ill conceived and ineffective than when otherwise lawful people are forced to consider converting easily available but highly illicit meth into a medicine that's much needed by millions because it's essentially unavailable through stupidity.
If aliens were to visit they'd likely bypass contact on grounds that the planet's inhabitants are low-IQ nut cases.
"…and easier to just buy meth and reintroduce the hydroxyl group to get my cold medicine."
Damn stupid isn't it? I'd be funny if it weren't serious.
What's more most of these sympathomimetic amines are both simple organic molecules, and in numbers/types they're a dime-a-dozen so to speak—there are hundreds of them. Any number of which can be altered or 'metamorphosed' into others that have different physiological and psychological effects by almost any competent chemist.
I'm certainly not advocating the use of meth but it's clear to me that the regulations that control the distribution and use of these amines are not working. Essentially, all these brute-force/unsophisticated laws have done is to inconvenience legitimate users and have drug barons streamline the production of more efficient precursors such as phenylacetone (P2P).
We really do need a better way of approaching the problem. For instance, many drug users turn to illicit amines and other street drugs to overcome medical and psychological problems. It would make sense to have these people identified and then be treated by the health system before they turn to the street to 'help' them. Moreover, I'd reckon it'd be much cheaper than the millions now spent on enforcement.
Trouble is moral panic and an almost complete lack of understanding by both lawmakers and law enforcement of the problem and its underlying causes is significantly impeding progress.
It's also out of stock now a lot more than before. Especially in larger (read: cheaper per dose) boxes. I assume but have not confirmed this is simply done by overworked pharmacy staff not re-ordering as often as they otherwise would to avoid the extra workload induced by having to run your ID through the database/etc. I've talked to pharmacy techs that do this for other drugs that induce extra workload at national chains, so I don't see why this wouldn't hold true here as well.
That happened 15 years ago, just a couple years after the policy is created. A more compelling example of a spurious prosecution would be one more recent, say, after 2016. We can probably find some! The last time people looked, we found a pretty interesting story.
I did not know that pseudeophendrine could be bought without a prescription until last year I think. I was deterred from buying it not because I fear putting my name down, but because I wrongly assumed I needed a prescription and thus a doctors visit to go purchase it.
There aren't exactly signs that say "Hey, the good stuff is behind the counter and you don't need a prescription to get it".
Depends on the state; at least some have made it prescription-only.
It's much less convenient than going to the nearest 24-hour store and grabbing it off the shelf. And I'm a doctor married to a doctor; I don't have to get an appointment to get a prescription for a non-scheduled drug, but I do have to go during pharmacy hours and wait to pick it up.
The downstream effects in other countries are pretty annoying.
Because of US restrictions on pseudo, bizarrely other countries have followed suit - it’s next to impossible to find a decongestant with pseudo here in Ireland, they will sell you the useless phenylephrine shit instead, and the packaging is almost indistinguishable unless you spend a while looking and arguing with a pharmacist who is convinced phenylephrine works just as good.
> Because of US restrictions on pseudo, bizarrely other countries have followed suit
Replace pseudo with cannabis and the statement remains true.
It's a huge pain if the pharmacy is closed or has a long line. A pointless, purposeless pain. Another sacrifice the the always-ineffective yet never underfunded drug war gods.
You can't get it delivered using standard delivery apps (you can get phenylephrine, or medications containing it such as DayQuil, delivered using uber eats or doordash). That is an issue when you're sick.
I was refused purchase because I had an out of state driver's license. Despite very visibly and audibly suffering from severe nasal congestion.
It's still a pain in the ass you can't just go to the gas station and get some, etc... There shouldn't be a need to go to a pharmacy for what should be an over the counter drug that's far more effective than synephrine ever was. The difference between the 2 is night and day, probably because one actually works and the other maybe kinda sorta barely does.
You can can do this or your doctor can write you a prescription. I've never stopped using pseudoephedrine and depending on how congested I am sometimes it's the little red 4 hour pills or sometimes it's the big monster 12 hour version - but your doctor can write a generic prescription for pseudoephedrine and the quantity and amount and you can buy a box that way via cash or insurance too.
According to my friend who suffers when there is pollen/smoke in the air, it is typically sold out when he needs it, because other people breathe the same contaminated air.
So he has to drive around to ~5 pharmacies to occasionally score a a box.
He does try to stock up during low season, but it's hard to do.
Some years ago I was very frustrated, as a UK citizen visiting the States and suffering from congestion, that I was completely unable to buy it because I wasn't carrying suitable ID that the pharmacy would recognize.
have to produce a government id also
Right, but would reopen the door to your random tweakers setting up shit labs in squats/rental properties and destroying property values.
That stuff's toxic AF even if the labs don't blow up.
Restrictions on pseudoephedrine did nothing to curtail the manufacture, sale or use of amphetamines in this country. It didn't even raise the price. If anything, speed of all kinds is easier to get today.
The restrictions centralized production though. Now almost all meth is being made in a lab that can import Phenylacetone from china. That's safer than someone next door setting up an explosive cookhouse.
Even safer if they sold it at Walmart.
meth production didn't stop, in fact it switched to far more efficient ingdidient and made meth much worse than it was before.
It's cheaper and pure than it was ever been since the ban.
I'm just as annoyed with the hurdles to buying real pseudoephedrine as anyone else, but let's not make the production of bathtub meth any easier. It is not worth it.
Given the prevalence of P2P meth and apparent inability of governments to do anything about it, this does not seem like a rational position to me. If there was any reason to believe that large scale production will ever be substantially curbed, there might be a case for it.
Yes, P2p meth is rampant and cheap. However I look at it like this: Meth addicts will absolutely decide to become chefs if the ingredients are readily available, even if there's a McDonalds down the street. You're approaching this rationally, which is not what meth addicts are going to do.
If it is readily available down the street, it looks to me that people cooking their own is a superior outcome for society in every single way than they buying it down-street.
Even more if the professional labs close down due to lack of customers.
A buddy of mine worked his way through college cleaning out meth labs in homes and motels after they had (typically) blown themselves up. They are toxic nightmares. He was especially shaken when he'd find the family photos indicating that the labs were operating while children were in the home.
The professional labs would absolutely not close down due to lack of customers, there would just be even more meth available, more contaminated, with the bonus of hazmat sites peppering communities.
Why? Do you believe it made any dent in meth manufacturing what so ever? It's just drug war theatre.
It seemed to decrease the number of exploding meth labs in the country: https://www.statista.com/statistics/942043/laboratory-incide...
That seems to track pretty well with the rise of P2P meth. It's unlikely many people would return to setting up small labs using pseudoephedrine because large scale operations using P2P have driven the price down to the point that it wouldn't be profitable.
There might be an increase in people making tiny batches for personal use if pseudoephedrine became easier to get, but nothing on the scale of 20 years ago.
What is P2P meth? I always think peer to peer.
P2P is phenyl-2-propanone, an ingredient in some methods of synthesizing methamphetamine. In supply chain terms, it is much harder to restrict than the previously-popular ephedrine and pseudoephedrine because it can be synthesized from many common chemicals.
The need to show an ID to purchase real pseudoephedrine (feels like an oxymoron to write that) can be a legitimate PITA. I am American who lives abroad but is frequently back in the U.S. for family reasons. I suffer from sinus problems, so I periodically need to purchase pseudoephedrine-based products. Because I have no state ID, the show-ID-based workflow essentially fails. For whatever reason, the pharmacies won't take a U.S. passport (or foreign ID card), so they end up spending 15 minutes futzing with the data entry software, only to resign to entering garbage into the system.
And as OP points out: Phenylephrine is 100% useless.
Phenylephrine is useless. As an extra added bonus, it will still spike your blood pressure, so it isn't just useless, it's dangerous to people with high blood pressure.
Nasal irrigation is the way to go for sinus trouble. It's more work and takes a little getting used to, but no ID needed to buy saline and baking soda packets, and it actually works.
ORAL phenylephrine is useless, Nasal is not.
I was 17 for my first few months of college and got horribly sick and congested. The school pharmacy wouldn't sell me the real Sudafed because of my age... not sure if that was part of the nationwide Patriot Act restrictions on Sudafed or a specific state law. I thought about getting someone of age to buy it for me but I was too much of a goody two shoes to go through with it.
I ended up going to the doctor and getting sent home with a bottle of opioid cough syrup. Fortunately didn't end up addicted or anything, but it was very frustrating at the time.
Stores around me stopped selling it altogether because they got tired of dealing with both the registry itself and the customers who get irate when told they're going on a list for buying cold medicine. It sucks but I can't say I blame them.
So at least here in Germany, we pretty much all use nasal spray with xylometazoline, and it's very effective as it also binds to adrenergic receptors. It does not seem to be available in the US, and at least from a cursory search I cannot find out why...?
EDIT: After looking a bit more, the simple answer seems to be that it's not FDA approved for nasal congestion, and since there's not much money to be made, there's simply no incentive to go through the costly approval process..
They have oxymetazoline but I think the problem with this class of decongestants is that it is ineffective and dependency is basically guaranteed if used for more than a couple of days
Oxymetazoline is different from Xylometazoline, although it was derived from it. Xylometazoline is pretty harmless for adults when not used over extended periods (it is advised to not use it longer than 6 days, but that will cover your typical cold). It is true that if you take it regularly over extended periods, you will have a rebound effect and your nose will get congested when not taking it, so in that way, you develop a "physical dependency", but that's obviously much more harmless than other medication dependencies. Getting off a Xylometazoline dependence means that you'll have to deal with a congested nose for a few weeks...
I don't see from your comment how the risk from congested nose for a few weeks deems it "harmless" for you. Two fully congested nostrils is hell for one night alone, imagine a few weeks of that. A few weeks of terrible sleep, if any. It's torture.
It can also cause permanently enlarged turbinates with chronic use.
I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos. Even here in tightly regulated Germany, Xylometazoline can be bought without a prescription. It is very effective and, compared to other drugs, pretty harmless.
Look, there are always extreme cases. Just look up how many people need a liver transplant or even die each year from misusing paracetamol. So should we make it a prescription drug? Maybe, I don't know, it's always a trade-off.
Is there any basis to think xylo- is better than the similar oxymetazoline available in the US? Both the efficacy and downsides seem similar from discussion so far.
> I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos.
I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin.
I mean, I quit smoking, hardest thing I've ever done, and the physical withdrawal effects were insignificant compared to that.
It's funny; looking back, I quit smoking exactly BECAUSE I was suffering from crazy congestion, and after a week of Afrin and poor sleep I thought quitting smoking altogether would help me regain my sanity.
> I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin.
Let me assure you that there's (yet?) no Xylometazoline epidemic ravaging though Europe, with tens of thousands of people dying each year, destroying families and communities, in effect causing endless grief for people and huge profits for pharma companies. There's also no black market for Xylometazoline, with people overdosing because there's nasal spray on the street that is contaminated with a much more potent derivative than can kill pretty much instantly. I've also never heard of babies born with congested noses that spend their first weeks of life going through a Xylometazoline withdrawal.
So to summarize, I think my initial statement that a physical dependence on Xylometazoline is less harmful than a dependence on opioids is probably correct.
Not very harmful on an absolute scale != harmless. There is a whole spectrum between harmless and bloody heroin.
OK, this is getting ridiculous, but stop putting words in my mouth. So for the third time: less harmful than a dependence on pain killers. How this could be even a controversial statement is completely beyond me, but HN never stops to surprise me.
Many medicines pose some risk to some people who would abuse it for too long. Xylometazoline just is crazy effective (instantly eliminates congestion and running nose completely in most cases) and completely harmless in what looks like 99% cases of usage - nearly-everyone here in the EU uses it happily and has no problems. I would really dread a cold without it and never travel without having it with me. Just try to not over-use habitually. The sense of measure is always a key to healthy and happy living.
That’s why if you developed a dependence you don’t quit cold turkey.
The strategy I’ve heard is purchasing a normal bottle, and refilling it with boiled cool water when it’s ½ empty. Then refilling it again when it’s ¾ empty.
Xylometazoline is an absolute godsend, and has even more efficacy in a dual-action spray with saline water.
It feels nothing short of magical to do one spray per nostril, and be completely uncontested in less than 10 minutes.
In my experience oxymetazoline has similar fast-action - even "10 minutes" seems a bit on the long side.
Worse, the symptoms gets worse after you stop using it, see rhinitis medicamentosa.
Many people have used decongestants so much they cannot quit them or will have to suffer weeks of nasal congestion. I risked going through that; later I swore I will never touch one ever again.
> Worse, the symptoms gets worse after you stop using it,
Very tangentially, "iatrogenic" is a nice niche vocabulary word: Something unintentionally caused by a medical activity, usually undesirable.
Kind of funny to see a medication that's super common in Germany, widely recommended by doctors, given to children, etc. to be discussed in those terms.
This isn’t that strange in the context that all medicines, while generally safe in OTC form, can have negative side effects if used for too long or at the wrong dose or in the wrong circumstance.
My wife has one kidney and as such is told to avoid NSAIDs as a class of medicine. She’s realistically fine taking it every so often but her doctors are asking her to avoid using kidney capacity that could hypothetically be needed to filter and excrete something else.
Acetaminophen/Paracetamol is great alternative for her since it’s processed in the liver. However if you’re a frequent drinker, have a liver deficiency, or have to take some other drug straining your liver, it’s contraindicated.
For most of us most of the time you’re completely correct though.
In the case of these nasal spray decongestants I had a case of rebound congestion due to over-reliance on them while surviving some family bringing really bad colds into the house and my son starting daycare. It was really bad. I then managed by switching to an alternating schedule of pseudoephedrine and the nasal spray so I could reduce the physical dependency on the latter and get a good night’s sleep.
My doctor eventually cleared me to take an allergy spray medication (Fluticasone propionate) that is safer for long term use but generally not used for colds because it inhibits immune response and mask the symptoms which can cause new infections and hurt your ability to heal. Yet another case of the mundane medicine that is contraindicated. While seemingly being the wrong thing to be put on while fighting off infections it worked out great.
After four months I had seen enough child germs and no adult has brought their own plague or food poisoning (it was a very bad summer for me) and I finally became healthy again.
> Acetaminophen/Paracetamol is great alternative for her since it’s processed in the liver. However if you’re a frequent drinker, have a liver deficiency, or have to take some other drug straining your liver, it’s contraindicated.
What many people don't know: Overdosing on paracetamol is the leading cause of acute liver failure. It's also contraindicated for people with Gilbert's syndrome, which is actually pretty common (~5% of people in the US) and most people don't even know they have it, as it's harmless and usually only found accidentally through high bilirubin levels in the blood.
What is very common is hepatosteatosis, or fatty liver syndrome. Something like 1/3rd of American adults have it.
Go read the side-effects and restrictions of commonly used medicine some day, it's unsettling.
I've been through this and sucked hard. Never will I use a decongestant nasal spray again.
If there was a way to somehow sum up all of the suffering caused by these sprays from dependency (which lasts weeks, months, years even) and compare that with the suffering alleviated from a cold (which lasts a fews days), my bet is these cause more harm than good.
The best thing I ever did for decongestion was to get outside and start wearing a mask during the winter. The air entering my nose is clearer and warmer, which causes less mucus production. The mucus that is produced is more likely to drain, rather than sit around thickening and waiting to be blown out. I wish I'd thought to wear a mask while out when I was younger; could have saved myself much suffering waiting at the bus stop and during the subsequent schoolday.
Back when I was a kid, scarfs were more popular and served a similar purpose.
Did you really develop such heavy dependence after using it a few days at a time? I don't get that at all.
It's not a dependence like mental addiction. Your body becomes dependent on it. Your sinuses "rebound" and all but completely block in absence of the spray. I had a cold that blocked my nose up so bad I couldn't sleep because I was afraid of suffocating so I tried one of the sprays and it opens you up like magic, super effective. But about an hour after use if would completely block up again where you literally can't inhale through your nose at all. That's how it is even after you get over the cold/illness. You have to continue to use the spray to keep your airway open until you suffer through breaking the "addiction" by not using it for however long that takes. It really does immediately open your airway, but I won't EVER use it again because it's really scary to be completely blocked like that and have to get a dose in every 30mins-hour just to breath.
Don't use more than 3x a day, and not longer than 7 days. At least those are the recommendations over here.
[dead]
Same. I’d rather start and quit smoking again than this.
Oxymetazoline is an extremely effective nasal decongestant. It works almost instantly and it lasts 24 hours.
It also creates dependency. A drug that is ineffective cannot cause dependency.
Of course it can. You take drug A for 5 days to get rid of symptom X. The symptom X does not go away. It is ineffective! You stop taking drug A and immediately experience brutal migraines that go away when you start taking drug A again. Ergo, you have become dependent on drug A for normal functioning, even though it is ineffective at ridding you of symptom X.
I’ve wondered this also. As an American who lived in Germany and found this while living there, I can attest that it’s quite effective for me. There are other quite useful and safe drugs that are not available in the US.
The US equivalent is oxymetazoline https://en.wikipedia.org/wiki/Oxymetazoline
It's actually slightly more selective for a1 receptors than the German alternative. They both have the same dependence potential and rebound liability.
There are nasal sprays in the US - and yes they are more targeted and better in general than pills. But Americans love their pills ... almost as much as Germans love their homeopathic remedies :-)
Additional context on why phenylephrine was ever approved to begin with—apparently it is effective if you use it as a spray, but apparently nobody bothered to check what happens when consumed orally, and it turns out your digestive system degrades it quickly and it doesn’t even make it into the bloodstream.
This is a perennial topic on HN, which is generally inhospitable to drug prohibition to begin with; it's possible to lay out the schematics of the counterargument:
* While there can't be any defense for the marketing of phenylephrine as a pseudoephedrine replacement, restrictions on pseudoephedrine are not irrational (that doesn't make them right, though I think they are).
* Pseudoephedrine by itself practically is methamphetamine, just in an unproductive chemical configuration. It is extraordinarily simple (though: not safe) to convert pseudoephedrine into meth.
* Pseudoephedrine is widely, practically universally available in the US without a prescription. It's a "behind the counter" drug, and, because of rampant abuse, access requires ID, like alcohol. Further, because the point of restricting pseudoephedrine is effectively a "rate limit" (to prevent people from acquiring enough Sudafed to make meth production practicable), Sudafed purchases are tracked.
* We've hashed out on HN the argument about whether that tracking results in spurious prosecutions. The one case I've seen us come up with, the arrest and prosecution of William Fousse, concerned someone who had a pseudoephedrine addiction (he was using it to come up from habitual alcohol benders).
* Restriction of pseudoephedrine does basically zero to staunch the flow of high-quality methamphetamine, which is produced at industrial scale with more sophisticated chemistry in Mexico and Asia.
* But restriction of pseudoephedrine might reduce the incidence of garage meth labs, which pose their own distinctive dangers to communities.
The argument in favor of continued pseudoephedrine restriction would be that the cost of the policy is relatively low (it inconveniences allergy sufferers, but most of those sufferers only marginally) vs. the public safety benefit (which is also probably low, but also probably nonzero).
> access requires ID, like alcohol.
Not like alcohol. I know you know, but to spell it out for those that dont: there is a universal registry. Each purchase is tracked and tallied by name and residential address. Best case scenario is you are denied access, but you could also be raided.
It doesn't just require any old ID. Many, if not most, will not accept military ID. No foreign ID is accepted. Essentially, if your ID isn't a recent scannable ID issued by a US state, you don't get it. And I can't go a week without hearing that ID is a kind of ism.
Do we have stories about people being raided?
I’d hope people get raided or at least some police investigation. Much of the process seems pointless otherwise.
None that I have on hand, no. Not in the US, at least. But do you agree that it's possible? The registry afford that capability. There are raids for far less.
I'm not trying to needle you. It's just nothing like alcohol, tobacco, etc. It's not even really like opioids.
Anyway, I think your conclusion is reasonable, even if we come to different conclusions. Mine is based on common benefit. I think the benefit that comes from the drug far surpasses the detriment.
Literally from today's news: an alcohol raid. So I guess technically correct it's nothing like alcohol.
https://www.cbsnews.com/amp/pittsburgh/news/panther-pit-padl...
Here's a guy who narrowly avoided a raid for taking Claritin-D, so I guess your point stands: https://www.register-herald.com/news/nplex-tracking-system-h...
> Police also can look for people who might have purchased pseudoephedrine around the same time as the suspect, as a way to identify friends and conspirators.
ffs. is this what we want?
This appears to be a story about a guy who hit the limit in his state, with a reporter talking to an enforcement agent explaining why he looked nothing like an offender, followed by a story about a busted meth lab and their purchasing patterns in the database. It doesn't look like anybody narrowly avoided anything, and it's from 2013.
I object to the government pulling a medication report containing the name, date of birth, address, and ID number for me and the people in the pharmacy around the same time as me, and then setting a "watch" on me.
from the article:
> he showed up one day early to purchase his two-week supply.
Good thing he didn't show up in the next county one day early. Maybe that would've been enough for Goff to act.
The article also points out that pse remains non-prescription because if it were to become rx-only, the government would be prohibited from monitoring it. Here I was just thinking that prescription exists for the health and safety of the patient...
This whole thing is gross.
What's the significance of 2013?
"Medication report" sure does make it sound a lot scarier than an indication of whether you had allergies.
You get that there are already detailed, retained records of your actually-sensitive prescriptions, right?
This issue is symptomatic of an underlying problem for me: we do not regularly re-evaluate laws to see if they are having the intended effect.
American politics might have bigger problems at the moment, but under normal circumstances, I consider this pretty important. I'm not sure what the solution is, but an expiration date on nearly all laws comes to mind as a start to an interesting discussion on the matter.
It would be great if laws worked like software deployments:
1. Roll out law to 2%, look for any obvious unintended effects (like we check for crashes)
2. Roll out law to 50%, study for effectiveness. Is the intended positive effect happening in the experiment population? Any effect on the control population?
3. Finally, roll out law to 100% and keep monitoring.
4. Be ready to roll back to 0% if failures seen at any stage.
5. Be ready to apply a zero day patch after it's at 100% if edge cases are found.
But, we don't do any of this! Lawmakers make a law and yolo it into production on a fixed date, and it's often impossible to roll it back or modify it.
We do sort of do that, with state laws. Different states try out different laws, and copy laws from other states. Ideally a state will repeal laws that don't work well, and copy laws from other states when they work well. In practice it's all a mess of course.
California is the experimental group.
> This issue is symptomatic of an underlying problem for me: we do not regularly re-evaluate laws to see if they are having the intended effect.
Even the Constitution. It was intended to be revisited for appropriateness and currency every 20 years.
Instead, a significant number of people, including some on the Supreme Court, believe that the Founding Fathers[1] could speak no wrong words and that the Constitution is the perfect document, to be taken at its word, with no deviation, until the end of time.
[1] Pop Quiz: "How old were the Founding Fathers when they signed the Declaration of Independence and crafted the Constitution?" You'd be forgiven for thinking they were world-weary, wizened old men. In fact, the majority were under forty. Indeed, it was also signed by a sixteen-year-old, a 21-year-old, two 26-year-olds, a 27-year-old, and a 29-year-old.
Yes but the life expectancy was only 35 so in relative terms they were all senior.
Average life expectancy.
Once past your childhood, you had a good chance of making it to 60 at least.
Only thing I'd quibble with is the reason most consumers switched off of pseudoephedrine. The manufacturers knew that the inconvenience of having to go to the counter would reduce sales so they just replaced it in the aisle with an identically branded product with a different active ingredient. Most people made no affirmative choice at all; they're just buying "Sudafed", but now it's a placebo.
I’ve had two doctors and two NPs tell me to stop using sudafed. It dries out the mucus membranes and allows infections to start. If you’ve had sinus infections before, they suck and you don’t want them again. Give the Sudafed away.
(It also gives me horrible insomnia if I take it at night so it wasn’t a huge hardship).
Guaifenesin thins the mucus instead, makes it more watery so it drains down the throat with no further complications like sore throat and coughing. And the extra volume helps flush bacteria out of the sinuses.
The two aren't mutually exclusive. I take pseudophedrine whenever I have a serious sinus infection or blocked eustachian tubes because it's the only thing that promotes drainage. I also take guaifenesin for its mucosal thinning effects as a matter of course. I supplement these with nasal irrigation, DXM (if the cough is impacting my sleep), and diphenhydramine in lieu of the pseudo (again for sleep).
These drugs all have different mechanisms of action and specialties and should be used only as needed, i.e. if a symptom abates then you should stop taking whatever it is that treats it. The problem is that people are too used to combination formulations or, even worse, treating all of these drugs interchangeably. A chest cold has a different OTC treatment regimen than a sinus infection.
Everyone's body and ailments are different. For some people in some situations, the benefits of pseudoephedrine outweigh the side effects. For others, it doesn't. Drugs should be used on an individualized basis.
The insomnia effect is no joke! It’s an amphetamine.
I used to take 24-hour allergy medicine with pseudoephedrine, and it took me years to realize it was the thing that was giving me insomnia during allergy season—for years I thought I just had periodic bouts of intense insomnia.
In college I told the clinic I wanted anything but Sudafed (joke on campus was they’d give you Sudafed for a broken arm). Gave me Sudafed anyway.
First 100% sleepless night in college. And the only sleepless night that wasn’t having too much fun or stressing over a final exam. Trash can.
I forgot the worst part: Still had a sniffle the entire night. So mad.
I stopped taking pretty much any OTC meds about 10 years ago. My sinuses seem much healthier. I hardly ever get congestion or runny nose anymore. Not sure there's a correlation here but for me, they don't seem to have any benefit.
In general, things like medicine/drugs (even caffeine!) should be used as sparingly as possible, so they're maximally powerful when you do need them.
If you pop OTC meds at the first sign of anything, your body gets used to it and it becomes a baseline; whereas before it would blow all the symptoms away, now you need it just not to get significantly worse.
> your body gets used to it and it becomes a baseline
That doesn't happen for every drug. But side-effects still exist for them all, so yeah, there are several reasons to limit how much you use them.
An interesting tidbit to add, for working in the industry:
The restricted process around buying pseudoephedrine is imposed by state governments and not the federal government. A number of the states coordinate their policies, so it looks like nation-wide action but really isn't (in a legal sense).
FDA doesn't have the legal authority to put medications "behind the counter" like you would see in Europe or Canada. So untangled this is a weird mess of overlapping jurisdictions.
> The restricted process around buying pseudoephedrine is imposed by state governments and not the federal government. [...] FDA doesn't have the legal authority to put medications "behind the counter" like you would see in Europe or Canada.
Someone should tell the FDA, because they seem to think that the “locked cabinet or behind the counter” rule, the per person per month quantitative limit, the photo ID requirement, and the requirement for retailers to track personal information of buyers are all federal rules either directly in or imposed by the FDA under the authority of the Combat Methamphetamine Epidemic Act of 2005.
https://www.fda.gov/drugs/information-drug-class/legal-requi...
Good summary. To add to what you've said, Sudafed (as an example brand name) opens your eustachian tubes which are passages from your inner ear to your throat. If you think you might be getting an ear infection, Sudafed increases draining and potentially helps prevent a worse infection. As mentioned, it helps air equalize to the atmosphere via these tubes. If you make a yawning motion now and hear your ears crackle, that's the air moving through your eustachian tubes. You'll notice that crackling decrease when an ear infection may be imminent. I tried the useless alternative and discovered on my own that it was, indeed, useless. And it was quite expensive, with great marketing on the box.
In my experience phenylephrine is worse than useless. Not only does it do nothing for congestion, but it makes me feel wired in a bad way and unable to sleep for at least 24 hours. I hate phenylephrine.
I read this and was puzzled, until I realized that you are talking about the pills. The nasal spray is effective, although probably not more effective than a saline solution.
> although probably not more effective than a saline solution
I guess saline is a baseline against which effectiveness should be measured here, especially since nasal sprays are usually saline plus something. (I guess? Not sure about Sudafed specifically.)
I'd argue that saline should be the panacea here. I doubt very many people do at-home saline rinses with filtered, sterilized water and a simple mixture of salt and baking soda.
Do people really want to spray PFAS water directly into their mucus lining?
I bought an Arm and Hammer Saline spray out of curiosity. It smelled awful, and the BPS lined can had an awful smell despite the ingredients being: water, salt, baking soda, and no suspicious preservatives.
True except it is definitely more effective than saline. Phenylephrine nasal spray is not as effective or long-lasting as oxymetazoline, but it's also not as dependency-inducing.
The efficacy of the nasal sprays had already been demonstrated when they introduced the pills. Surprisingly, the efficacy of the pills was never properly demonstrated, and now that it's being investigated, they're pulling it from the shelves.
Why not just use xylometazoline (aka Otrivin) at least as a nasal (spray) decongestant — or isn't it available in the U.S?
Xylometazoline is very effective. Sure that doesn't solve the oral/body-wide absorption of a decongestant but it's a good start.
From my personal experience phenylephrine (as a nasal spray) does work but it's one step off being useless. I've occasionally had to use it as a fallback when I haven't been able to get xylometazoline (where I am xylometazoline is only available in pharmacies whereas phenylephrine is also available in supermarkets and elsewhere).
It's interesting to note that the bans and restrictions on pseudoephedrine have had large negative consequences. Not only have ordinary users missed out on a good decongestant but it seems drug cartels have largely overcome the shortage of pseudoephedrine by substituting the precursor phenylacetone (P2P). Not only that but they've even managed to separate the chiral components of the final drugs which makes them indistinguishable from medical pharmaceuticals.
Incidentally, I prefer not to use pseudoephedrine as a decongestant, whilst I receive no mental stimulation from it, it nevertheless has stimulating properties that make me feel queasy. It's why my first choice is xylometazoline. There's also the related decongestant oxymetazoline, which I've found effective but it's not as good as xylometazoline (for me at least) but it's still vastly superior to the near-useless phenylephrine.
Well, phenylephrine is ineffective when used incorrectly. You're supposed to grind the pill and snort it. Works much better ;-D
You joke, but that would actually work.
I don't joke. I'm a serious doctor :-D
It's not the only drug treated this way. You can go to any pharmacy and see a ton of things on the shelves that are just cards you have to take to the counter, and then see what's actually behind the counter. Insulin needles, for instance, even though you can also just buy those in bulk on Amazon. I'm not sure what does and does not get tracked in a statewide database, but at minimum, regular Ephedrine, typically sold under the brand name Bronkaid, is tracked this way, because it can also be used to manufacture meth. I don't even think in this case there is an alternative formulation like there is with Sudafed and generic equivalents.
The monthly purchase limits on these tend to be ludicrously high, though. I think they're state by state, but in Texas, you can purchase up to 9 grams a month.
Lots of what you described is very location-store specific. That's why you can buy a lifetime supply of clean needles on amazon, but buying any in CVS is requires waiting in line longer than it take for amazon to deliver.
But think about all the jobs the government by created running that registry, prompting the drug makers to formulate and manufacture bogus decongestants and then eventually studying that those bogus decongestants were in fact bogus.
(in case it wasn't obvious, this is broken windows fallacy)
The "registry" is signing your name on a sheet of paper on a clipboard - less than 1% more work for the pharmacy employee's overall job, approximately 0 new jobs created.
I went to the doctor recently. I usually take what I am taking so they can see it. I was taking Sudafed and had just purchased it. She took it out of my hand and told me basically all that and threw it in the trash.
Great summary. It's a classic case of government action ending up a net negative for society. Everything would've been great if they'd just minded their own business.
It is darkly amusing to me that it took the FDA well over a decade to conclude what was immediately obvious to anyone who has ever tried phenylephrine: that it is not worth taking
This reminds me when EU banned some eye drops with the product name Proculin which have been very effective. The replacement Berberil is useless, literally no effect.
Proculin made your eyes white white constricting the blood vessels for hours. All the stoners had it in their pockets.
Since it constricted blood vessels one could use it also to reduce the local inflammation on pimples, which was a neat off label usage.
yes, well, the other part of the story you would not know it maybe unless you frequent among addicts or psych wards where the practice is done indeed there is a third such nasal decongestion / meth class drug known as BENZEDREX it is a OTC decongestant .. an inhaler.. okay, fine. but what drug addicts, and in my experience for whatever reason, people with hard psych illnesses like to do is pop the inhaler open. inside is a benzedrex-laden ball of cotton which is then chewed upon for the high
FWIW phenylephrine wasn't a new drug; it was and still is used all the time in IV form to increase blood pressure in anesthesia and critical care.
But it's useless as an oral decongestant.
pseudoephedrine have serious side effects, they are rare but could be fatal
Also true of aspirin, ibuprofen, acetaminophen, dextromethorphan, melatonin, vitamins, supplements, and practically every other over-the-counter drug that is not homeopathic.
ESPECIALLY acetaminophen aka paracetamol aka Tylenol aka Panadol. This is the single drug with the smallest ratio between the effective does and the lethal dose, and it would not be approved today because of that. Oh, and you'll be fully conscious while you're dying and there's no known antidote.
My Googling says 7.5g-10g is a lethal (acute) dose for an adult. The extra strength Tylenol pills come in 500mg, and they recommend two of those at a time. Not saying it's wrong that the gap between "effective" and "lethal" is small, but at the same time it's hard to accidentally take 15-20 pills at a time.
Even doses as low as 1g taken daily for a week or two will show significant changes in liver chemistry. Consider that many other medicines, especially cold medicines, often include it as well, and it's not hard to see how someone that is suffering from a strong cold could end up taking more like 2-3g per day for extended periods of time. That will definitely cause some damage to the liver, which can be recovered from, but should probably be avoided. At least in the US though, many people have already compromised liver function due to chronic metabolic diseases, and for many, the damage might end up being permanent.
I've commonly been recommended 3-4 g per day by Physicians. I take 1 gram as my standard dose.
1 gram is the standard dose for a full-sized adult with a healthy liver who is not taking the drug in conjunction with alcohol.
As to frequency I limit myself to 2 g per day but that's just me giving my liver extra time to recover.
Now consider people with memory issues such as dementia where they might have a headache, take 2 pills, then 10 minutes later think 'I have a headache...'
if we're talking about people with dementia and/or memory issues - almost everything becomes dangerous. Not an argument. Doors aren't dangerous, but now imagine a small child being hit with one.
>and there's no known antidote.
Isn't NAC (N-acetyl-cysteine) used for that?
https://www.ncbi.nlm.nih.gov/books/NBK537183/
Homeopathic too - water allergy is a thing.
Water allergy is a skin condition triggered by contact with water. I don't think that applies to swallowing water.
If someone's actually allergic to water, they're going to be reacting all the time since they're mostly water and have to drink regularly to stay alive.
Homeopathic pills are usually literally sugar pills, essentially small crummy candy, so not really any water, despite the purported basis of the "technology".
Sure. Sugar allergy is a thing too.
If you give me six lines written in a material safety datasheet for the most chemically inert of materials, I will find something in them that could cause some human, in some situation, to die.
After a little bit of googling, it seems that sugar allergy from ingestion doesn't exist. Intolerance is not allergies.
I did find that there's apparently one case of anaphylaxis caused by injection of fructose, though it wasn't the normal reaction referred to as allergies.
I swear phenylephrine works... so I'm just falling for placebo?
Maybe you're feeling relief from the other ingredients like if there's also an inflammatory or caffeine, etc. bundled with the pill.
Only the second to last paragraph was necessary.
It comes full circle if you go back far enough.
Before Sudafed was common in pills, they had the small disposable inhalers where the pseudoephedrine was not in crystal form but was dissolved in vaporous liquids like menthol. Inside the inhaler there is a cotton piece soaked with the pleasant-smelling liquid. The aroma vapors are drawn right up into the sinuses along with the active ingredient.
The inhaler itself was first marketed during World War II by the well-established 19th century Vicks company, already very successful for decades with it's earlier VapoRub aromatic topical OTC formulations. People are probably aware that this is one of the companies that is older than the US FDA. Older than the Fed & income taxes too, for those who are keeping score ;)
Natural products like ephedrine have long been the inspiration for medicinal chemists to synthesize similar compounds for potential screening as new drugs, so a number of new experimental relatives such as pseudoephedrine were produced eventually.
As the name implies, people did not always know what the real difference was between ephedrine and pseudoephedrine, since both molecules have the same molecular weight, naturally because both have the same number of carbons, hydrogens, oxygen, and nitrogen content.
Only a slight difference in chemical structure between the two, which got figured out soon enough.
Some of the less-similar new drug candidates were ordinary amphetamines. They are the ones that really got popular fast, especially in wartime :\
Now when the unique inhalers were born, it was a bit of the new synthetic ingredient along with the traditional aromatic mixture that Vicks was famous for, and the Vicks Inhaler was deemed safe & effective as recommended for OTC use. People loved it. Nobody had ever had anything as effective as that.
IIRC it was 50 milligrams per inhaler soaked into a few hundred milligrams of aromatic essential oil mixture. As expected they were a lot stronger when you first started smelling one.
That's because it was 50 mg of meth-amphetamine in the Vicks inhalers.
Parents would buy them for their kids, because they were so "safe", for self medication naturally, even at times when they would not consider dosing them up with cough syrup.
There was never any FDA-approved prescription for methamphetamine in any other form, only this one OTC product.
I would think the inhalers themselves were patent encumbered until the 1960's (remind you of an Epipen?) and by the 1970's other companies like Sudafed offered their own version, only not containing meth, give me a break.
The meth version of amphetamine became recognized as a dangerous drug in the after-war years when the negative effects became apparent with soldiers who had been given it in pill form habitually as stimulants, often when facing the most serious combat.
No other company ever was able to put meth in their inhalers, but Vicks slipped in under the wire and couldn't even be stopped for decades until some time after the DEA came into being. Everybody else was using pseudoephedrine from the start. By this time crystal meth was just beginning to emerge, which people were trying to avoid when they saw what it was like, at the same time different people started seeking meth more intently. Orders of magnitude more out-of-hand now.
The way Vicks stayed under the radar the whole time with meth in it, was hiding in plain sight.
Right there on the inhaler in fine print where it always was, active ingredient desoxyephedrine 50 mg.
Simply a less-common alternative chemical name for meth, and desoxyephedrine had become a very uncommon rapidly deprecated name quite early. Way before any amphetamines were commercialized, they were instead marketed using the well-known convention based on the Alpha-MethylPHenylEThylAMINE type nomenclature.
Anyway, back in the 1970's when it was first becoming known that shady operators were cooking meth by starting with inhalers, I looked at one of them and sure enough, 50 mg meth per Vicks inhaler. Who knew?
For a while there I figured they must be starting with way over 20 inhalers and probably would not extract nearly a gram of meth but it sounded feasible. I wasn't going to be the one to do it, my first job out of college was working for a company that was a real pharmaceutical manufacturer. So I wasn't going to tell anybody either. There was already talk among law enforcement about cracking down on this kind of thing. Suspicion of inhalers was beginning to barely arise, it was thin but widespread among anybody who had heard anything about this.
Eventually I figured out that the clandestine cookers were synthesizing their meth by using the pseudoephedrine in non-Vicks inhalers as starting material for their reactions ! Well, what do you know? Was I wrong the whole time?
I "guessed" so.
With not-so-blurry 20/20 hindsight, I would estimate that before I got around to figuring this out, a clandestine chemist had come along way before I knew a thing and had started out extracting grams of meth directly from Vicks inhalers. And the meth heads loved it, found out it was coming from inhalers and the word got around among them.
Some other chemist picks up the inexact word-of-mouth and by this time Vicks inhalers are outnumbered, sharing shelf space with numerous alternative brands, all of them containing pseudoephedrine as expected, and cheaper too. If they look at Vicks, it's the odd ball out, that doesn't look like the same kind of "ephedrine" as everything else. So they figured out how to do some home made reactions starting with Sudafed. And this is what was just starting to go through the roof.
This was before the Sudafed pills really took over, once they showed up they flew off the shelf way faster than the inhalers because there were more milligrams.
One day in the '70's I was in Walgreens and there was somebody buying over a dozen Sudafed inhalers so I knew what they were up to.
I went over to the aisle and looked at the then-current Vicks Inhaler, which I hadn't checked in a while, sure enough 50 mg of desoxyephedrine, active ingredient, same as ever.
The poor Sudafed buyer wasn't the least bit aware that real meth was right there on the shelf next to it.
And I wasn't going to say a thing :)
Most doctors and pharmacists didn't even have a clue.
Within a few years Vicks stated putting in pseudoephedrine themselves instead of meth.
Until it got way too far out of hand and the pseudoephedrine became tightly controlled, much more tightly than the meth was, as can be seen.
Edit:
"And now you know the rest of the story" - Paul Harvey
PSA: Kroger and Kroger-owned supermarkets require ID to purchase any "cold medication" including those only containing phenylephrine. It's a stupid policy.
Buy your cold medication at Walgreens. Good luck finding a non-Kroger grocer.
> Their preliminary review of studies suggested that it is probably, in fact, useless. This proceeding is now proposing to ban it on the grounds that it's ineffective
Is ineffectiveness really a good reason to ban a substance? Why not just ban labeling it as a medicine instead?
If you read the article title it is not a ban on the drug.
> Ending Use of Oral Phenylephrine as OTC Monograph Nasal Decongestant Active Ingredient
It is a ban on marketing/listing this as an active ingredient on those products. If you read further into the article this is only for oral use and they're requesting comments for nasal use, which would be unaffected by this.
Makes sense. Thank you for clarifying.
That is actually what is happening, per the article. It's being banned as being labelled an "active ingredient" in OTC decongestant pills.
No worries, "Meth" was largely unknown in my area, until you guys exported "Breaking Bad". Roughly a year or two later, it started to be available here as well. Thanks for that, media industry, that was a wonderful move! /s
One of my favorite papers is "A simple and convenient synthesis of pseudoephedrine from N-methylamphetamine" [1].
This is a satirical paper. Because pseudoephedrine (i.e. the good decongestant) is very difficult to obtain due to restrictions, but "N-methylamphetamine can be procured at almost any time on short notice", the paper describes how to synthesize pseudoephedrine from meth with a procedure that looks valid.
[1] https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
I found out recently that you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from, because apparently each state administers its own database. If you run out and have a persistent cough (weakened immune system from not licking doorknobs the last few years of covid, or so do the doctor says) from a common cold while on vacation, you're shit out of luck unless you go back home or you and an accomplice are willing to procure your cough medicine with their license.
> you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from
The FDA rule on this [1] doesn't appear to be quite that strict: it says the ID can be "a photo identification card issued by the State or the Federal Government or a document that is considered acceptable by the seller". It doesn't explicitly say it has to be from the same state as the one in which you are buying the medication, and it leaves the seller some latitude in what to accept.
Possibly some states have more restrictive rules. Or particular sellers might be more leery about what they are willing to accept.
[1] https://www.fda.gov/drugs/information-drug-class/legal-requi...
The FDA rule doesn't restrict the IDs but the phrase "that is considered acceptable by the seller" lets the pharmacy put any restrictions in place they want. They can tell you it has to be hot pink and glow-in-the-dark and you've got no choice but to deal with it.
While true as long as they're in compliance with the law, wouldn't they want to sell all the Sudafed they can? They can deny service to anyone for pretty much any reason. No shirt, no shoes, no Sudafed or anything else. So yeah, but in reality it isn't aligned with their interests and if they don't want to serve you they can always find a different justification.
Maybe they want that, maybe they don't. Retail drug stores in the US are an oligopoly, that industry may not be a monopoly (yet) but they don't function under perfect competition. Maybe if you're the management or the shareholders of a retail drug chain you're just kind of shrugging your shoulders and working on the next merger at this point since the fewer competitors you have, the less hard you have to work for the customer's dollar.
The “acceptable by the seller” wording only applies if the ID is not issued by “the State” or “the Federal Government”. Wouldn’t the latter option mean that a US passport, a green card, a Global Entry card, or a NEXUS card must be accepted as suitable ID by any seller in any state? All of those are issued by the feds.
And the pharmacy has the state regulators breathing down their neck so being super uptight about it is the obvious choice.
Of course all of this is stupid in a world where the real junkies use fentanyl and there's other easy ways to make meth.
States like MA legally only accept MA IDs and federal govt IDs for age verification. That’s why a lot of bars and packies will turn people away or ask for additional proof like CC’s. You’re more likely to be held liable for misconduct if the license you accepted is out of state.
Any seller in any state should have to accept a federally issued ID such as a US passport, no?
Yes but then you’d have to carry that for domestic travel.
The wallet-sized passport card is a great solution for that case then. It’s much cheaper than the regular passport book (and you are allowed to have both at once), doesn’t invalidate your regular passport book if it gets lost or stolen, and is also usable to go between the US and Canada by land or sea without having to bring the passport book with you. For people with a Global Entry or NEXUS card, that card also works for every case where the passport card does (and more).
Green card holders also have a convenient wallet size for their green card, and they’re legally required to carry it with them at all times while in the US anyway.
Here in Vietnam it's completely impossible to get pseudoephedrine at all and I think it's the same in all Asian countries. I even resorted to trying to buy some ephedra tea (Chinese medicinal herb from which ephedrine was first discovered). I ordered a box of tea bags from Shopee.vn and rather amusingly received an envelope with the amount I had paid including shipping in cash and an apology letter saying they could no longer sell this herb and please don't leave a bad review.
However, a few months earlier due to a Google translate mixup where I thought I was ordering peppermint oil, I got 100ml of sassafras oil [0]. It's a precursor to MDMA and at least as restricted as pseudoephedrine.
https://en.m.wikipedia.org/wiki/Safrole
It's readily available in Thailand and Indonesia. You can get it mixed with paracetamol OTC in Singapore, but almost everything in Singapore requires a prescription (even e.g. throat lozenges) so find a doctor if you're staying for a while. In Malaysia you need a prescription.
just been banned in the UK. was the only thing that worked on my allergies.
edit: my bad, no it's codeine linctus that was banned, there was talk of making pseudoephedrine prescription only but that hasn't gone through.
Pseudoephedrine, banned? That's news to me, I bought some OTC a couple of weeks ago.
Seems like it varies by state - I’ve purchased Sudafed in at least two states other than my own.
Same here.
Me too.
My WAT.
Refused sale of Sudafed because my license was expired. Apparently I accidentally tossed my new license and kept the old one. Doh! However they happily refilled my schedule III meds with the expired license.
As I said WAT.
That's not universally applicable, as I've purchased it in Washington plenty of times with an Oregon ID.
I've purchased Sudafed in Nevada with a foreign drivers' license with no issues.
I’ve definitely purchased Sudafed in Seattle with a Virginia Drivers License.
Once again, big thanks to paranoid "mark of the beast" conspiracy theorists with funny ideas about federal government IDs and digital IDs.
We have the technology. "Behind the counter" could just mean a vending machine with good ID tech instead of queuing up for an overworked pharmacist behind a dozen people.
[flagged]
Adderall is a 3:1 dextroamphetamine/levoamphetamine mix.
Methamphetamine is a whole other level of stimulant.
> amphetamine habits in kids that have trouble focusing in school.
1) Do you have evidence that Adderall at therapeutic dosages is anywhere near as addictive as methamphetamine at recreational dosages?
2) Yeah, ADHD makes it real hard to focus at school. I never graduated from high school, and I dropped out of university as an adult student without even completing one year, thanks to untreated ADHD. Not to mention the impulsive behaviour, the inability to stick at boring things etc. etc. It's not great in our society.
You're implicitly minimising the very real impact of ADHD, that's not super great.
In fact, one of the biggest issues for people finally being treated for ADHD as adults is the grieving process around "What my life could've been if my parents hadn't believed that ADHD wasn't real and my issues in school and my 'disruptiveness' was solely due to 'food intolerances', because my Mom read a magazine article about it once, then paid a quack to stick a probe in my ear, one on my finger, and then rub food on my skin while looking at a galvanometer making 'hmmm' noises sagely."
3) You know there's been Adderall shortages in the USA recently due to DEA manufacturing limitations right? So it's not like they're just throwing out to kids like it's a lolly scramble.
Anyway, it's about as ironic as 10,000 spoons when all you need a knife. That is, not at all.
> Methamphetamine is a whole other level of stimulant.
The extra methyl group that differentiates it from regular amphetamine salts mainly serves the purpose of crossing the blood-brain barrier quicker. However, during this process it loses that extra methyl group. So whether you're taking meth or adderal, the chemical that actually reaches your brain is ultimately the same
In fact, methamphetamine is available as a prescription ADHD medicine under the brand name "Desoxyn"
I thought that (1) meth (e.g. methylphenidate a.k.a. ritalin) blocks reuptake of dopamine, and (2) amphetamine (e.g. dextroamphetamine) stimulates production of dopamine, and (3) methamphetamine (a.k.a. desoxyn) does both. Is that understanding accurate?
I have never seen "meth" taken to mean anything other than methamphetamine, and certainly not methylphenidate.
“Meth” is methamphetamine, not methylphenidate. Ritalin isn’t the same thing as Meth. Not sure about how Ritalin vs Adderall act different on dopamine.
Then why does it have meth in the name genius?
<spiderman J Jonah Jameson meme> You're kidding, right? </spidey-meme>
“Don’t call me a homo sapien! I’m not gay!”
Leave it to the peanut gallery to always assume the vulgar definition.
And you get a erdös number for taking them : https://en.wikipedia.org/wiki/Paul_Erd%C5%91s#Personality
Don’t forget to use the tweaking umlauts:ő
Yeah, precisely, that methyl group is why methamphetamine is super popular, it makes a whole lot of difference in the felt effect.
I think the parent post is more likely alluding to the abuse of the medication, particularly in higher learning institutions.
https://psych.wisc.edu/news/easy-access-pressure-on-students....
Aderrall is a Schedule II drug. This is the same category as oxycodone and fentanyl.
https://www.therecoveryvillage.com/adderall-addiction/adhd-a...
~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
_Edit: I am told I'm wrong on this front, and I stand corrected_
The fact that doctors are prescribing them too freely is definitely worth looking into.
But severely restricting medication that is used to effectively treat disease because it has abuse potential only harms legitimate users. But definitely worth auditing prescriptions to ensure that they're being issued for valid diagnoses.
But as for illegitimate users? You ban it, they'll find something else.
And as someone who needs ADHD meds to do things like "remember I have a todo list, remember where I left it, and remember to use it", I very much resent the people who abuse the meds I need to function in our society to pass their law degrees easier.
I resent the meth addicts who try to get an ADHD diagnosis for their kids so they can abuse (or sell...) their children's ADHD meds when they can't afford meth, because it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
(My country uses methylphenidate / Ritalin / Concerta (the slow release form) as the first treatment for ADHD, Adderall is not prescribed here that much, if ever, but it is possible to be prescribed dexamphetamine if you're bad enough).
But I really do object to glibly implying that every child who is prescribed a treatment for ADHD is actually a case of pharmacists gleefully overmedicating, it's naïve, unsympathetic, and, tbh, rather unfair to pharmacists.
As for what schedule a drug is... ...is the harm of Adderall abuse the same as the harm of fentanyl abuse?
Drug schedules aren't a good way to determine harm, IMO. They're a good way to discern moral panics though.
E.g., in my country, Class A, the drugs that attract the highest penalties, include magic mushrooms, mescaline, DMT, and that one you get from licking toads, bufotentine or something, alongside classics like heroin and cocaine.
Fentanyl is Class B, alongside opium, morphine, amphetamine, methylphenidate, MDMA, and one that always amuses me, hashish.
* There's probably some dumb-ass rules around declining to dispense abortifacients because of religious beliefs, I'm sure.
> I very much resent the people who abuse the meds I need to function ... I resent the meth addicts ... it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
It's important to remember that no addict did this to you. An addict doesn't force Kaiser to charge me $20 when they demand I piss in a cup in order to receive my legally prescribed medication. It's fucking Kaiser, and the DEA, and the mad cap conservative politicians and their shitty fucking values. Drug addicts are suffering from a health problem, just like you and I are with our ADHD. None of us have the power to influence the massive engine of carceral drug policy and the promotion of mass moral panic about people taking medication that helps them.
It's important to point the anger at the right people.
Fair point. Thank you for the feedback :)
Using telemedicine in New Hampshire, I don't have to take any drug tests for mine, just self-report my blood pressure and pulse on zoom every 3 months.
> Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.
This is not true. Pharmacists have the right to not fill a prescription for a number of reasons, and in fact can be held liable for not doing so.
If they feel the use of the drug is medically inappropriate they can decide not to fill it. If they feel the patient is taking it for a non-medical reason (abuse) they can choose not to fill it.
Pharmacists are medical professionals who are expected to use their judgement to make sure medicines are not used inappropriately.
Interesting, do you have any material I can read up on about this?
P.S., have edited that statement after your correction, much obliged :)
> ~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
As others said, it's not true. Pharmacists are also trained to spot any possible adverse drug interactions with other medications that you might be taking.
It more often happens in the clinical setting, rather than at retail pharmacies, but it still is a possibility.
I do believe you quoted my edit after being corrected :)
I was definitely wrong.
> I think the parent post is more likely alluding to the abuse of the medication, particularly in higher learning institutions.
It's kind of weird that people are calling this "abuse" when it's apparently using the drug in the same context and dosage as it's prescribed therapeutically, plausibly by people who actually have ADHD but don't have the time or insurance to get a prescription.
It's an interesting case study in what would happen if it was more widely available in a pharmaceutical form with a known dose and purity. What percentage of these college students are actually getting addicted to amphetamine vs. just taking a therapeutic dose here and there?
Damn, if Schedule II drugs are that bad, Schedule I drugs must be terrible. Let me go see:
> Some examples of Schedule I drugs are: lysergic acid diethylamide (LSD), marijuana (cannabis)
Oh damn, marijuana is worse than this drug? I hope they arrest anyone selling marijuana. What’s that you say? Legal? In California? Oh, in lots of states?
Schedule I "merely" means: The drug or other substance has a high potential for abuse. The drug or other substance has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use of the drug or other substance under medical supervision.
Oh good, another round of "ADHD isn't real."
The more interesting take for me is that these meds work roughly the same way and almost as well in people without ADHD (a symptom cluster, not a single disease per se, like everything else in the DSM). As we give them to people with ADHD why not let anyone get a scrip?
People without ADHD already get more than enough benefit from just coffee. Stimulants might be able to benefit them further, but if you let anyone take them, eventually it'd become expected of everyone due to their increased productivity, and the potential consequences of abuse are much higher than coffee.
Chronic use of caffeine blunts the effects, it doesn't do much to regular drinkers. You develop tolerance very quickly. I can drink several cups and get basically no effect. Apparently your body just increases the quantity of adenosine receptors in the brain to offset the caffeine.
Well, I yet to see someone without ADHD who becomes calmer and slows down after taking stimulants.
I didn't say it's not real. A doctor prescribed me Adderall at 18 after talking to me for 5 minutes because I was having trouble sleeping. It did more harm than good.
Something can have therapeutic uses and still be over-prescribed.
I don’t know why you are being downvoted, adhd medication is insanely overprescribed. Turns out, kids get antsy and hard to control after cramming them into overcrowded rooms for 8-9 hours a day doing slop work. Some schools are now forgoing any form of recess at all. Modern public education is inhuman and dystopian.
It is absolutely not the job of a pharmacist to make decisions about which drugs are being overprescribed, and IMHO it's a dangerous thing to suggest. The pharmacist should assess for drug interactions, but we can't burden pharmacists with knowing the details that went into a prescription, and we shouldn't have them second guessing the diagnosis of a doctor. Down that road lies madness.
I agree it was a poor choice of words as the decisions are largely being made by regulators and doctors.
I get where you're coming from but pharmacists have the right to refuse to fill a prescription and in fact can be held liable for not doing so. Pharmacists are trained medical professionals and are expected to use their judgement
It's one thing to use their judgement to refuse somebody who is going to get a bad drug interaction, and another for a pharmacist to say "I've given out too many of X prescriptions, I'm going to start cutting off people from their prescription based on my judgement of them," and this latter one is what was under discussion and the one that I'm rejecting.
Judgment based on what? The five-second interaction we have while they're doing twenty other things thirty feet away?
Another thing is, do you get an actual trained and knowledgeable pharmacist, or a technician?
In Poland, pharmacies are required by law to have a MSc in pharmacy present during operating hours - that is, no less than one pharmacist with a Masters degree. One is enough. Which means that's all you get. You may not even see them unless you're buying ADHD meds, which need MSc to sign off on them. Otherwise, you're almost always dealing with a pharmacy technician. Some are pretty knowledgeable[0], others could be replaced by GPT-3.5[1] with net benefit to the customer. The latter type, if they're going to notice anything about you, it's whether you're likely to buy some useless supplement or homeopathic product.
--
[0] - Probably on their way to MSc in Pharmacy, which is a mistake if they're looking for a pharmacy job - pharmacies don't want people with MSc, there's enough of them around already; they want the cheap technician labor.
[1] - Yes, not even 4.
Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
Pseudoephedrine should be easy and plentiful to obtain. I don't care if people use it to make meth. What they do in their private time doesn't concern me. Not being able to get Sudafed when I'm sick kills me. It's not like those people won't be able to get meth some other way.
We let people buy cars and cause 43,000 automobile deaths a year. People should be able to live life without stuffy noses. Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
And don't get me started on ADHD medication and their shortages.
Edit: and there are 178,000 alcohol related deaths per year in the US. If you're going to allow that without prohibition, then please let us unstuff our noses.
I'm tired of living in a nanny state when we let people buy and own guns and swords and flamethrowers. Simply hiking on a mountain can kill you. Must we install guardrails on all the high places?
It's not that bad of a negative externality. Honestly. Not relative to all the other ones we've deemed acceptable. This is weird picking and choosing that doesn't make sense.
> Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
What's even worse, modern pseudoephedrine is produced in a form that makes meth synthesis from it extremely tedious and generally impossible in home conditions: https://pmc.ncbi.nlm.nih.gov/articles/PMC3793278/
99% of pseudoephedrine sold is not this form and this specific product has already been debunked years ago with Mississippi's complete ban (and their refusal to allow it.)
I remember the video of the pharma rep or cop or whoever trying to make meth out of the new pills and the product getting squishy. Months later, a different video was published, where some household solvent was used to easily pull the very-dissolvable pseudoephedrine salts from the paste.
> Pseudoephedrine should be easy and plentiful to obtain
Anything that isn't directly physically addictive (e.g. opiates) or subject to a tragedy of the commons (e.g. antibiotics) should be over the counter.
Addictive is the argument in favor of making it over the counter. Addicts will do whatever it takes to get their fix, so if there isn't a legal path, they buy on the street, creating a funding source for organized crime and spurring gang violence.
Then, because the black market is already in violation of the law, there are no purity standards. The customer who thinks they're getting Adderall or codeine is actually getting fentanyl because fentanyl's much higher potency makes it easier to smuggle, but for the same reason makes it much more prone to addiction and overdose, especially when careless street dealers get their proportions wrong. All of which is avoided if you just let them buy it from the pharmacy.
Notice that there is no thriving black market for antibiotics propping up international drug cartels, because they're not addictive.
Strongly agreed, with one correction: black markets are driven by shortage. The role of addiction is in creating demand, and at the same time making authorities restrict access.
There is no thriving black market for antibiotics, because they are accessible when you need them (and most people need them very infrequently for a short duration). In contrast, I believe there is a black market for insulin in the US, and that's because of how ridiculously expensive it is. Exuberant pricing is a form of restricting access, too.
*Exorbitant?
> Addictive is the argument in favor of making it over the counter
You want to control the general population’s access to physically-addictive substances to control addiction. Managing addicts is not a pharmaceutical matter.
We don't control access to alcohol, paints/volatiles, aerosols, and so many other things people abuse.
Just yesterday on Reddit there was a thread that went viral for "cutter" reviews on Shein razor blades, with cutesy language like "beautiful beans for my followers" (referring to subcutaneous dermal appearance when deeply cut open). Every product can be abused in horrible ways. It's the nature of the stochastic bubble we're in. People will find every nook and cranny of the human experience.
You can't stop this stuff from happening. So at least let the normal use cases that benefit society through. Don't put everyone else in the same straight jacket. We don't deserve to be punished for the bad gradients some people fall into.
Ok, if you want to control it, than mediate access through a public health institution.
It is a bit silly to ban a useful drug like pseudoephedrine while large parts of the US is in an opioid crisis. Kind of like how lawn darts have disappeared from stores but you can still buy all sorts of weapons. That said, a lot of laws are based on established traditions. Alcohol use goes back thousands of years, and the other things you mentioned such as vehicles and weapons are tools going back even longer. They are dangerous tools, to be sure, and often employed unnecessarily in this society, but tools nonetheless. Once upon a time most people depended on their weapons and vehicles to survive, and differences in the quality and quantity of weapons and transportation technology have historically led to the rise and fall of entire civilizations.
> Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
I sympathize with your broader point, but... how is that better? "Sorry, you were buying too much nasal decongestant a decade ago, so no cancer medication for you"?
I understood your parent comment in a specific drug way: you can buy pseudo until your license to buy that specific compound, or maybe a group or related chemicals, is revoked. But you can still get any other compound.
Not that different from current situation: we have all our "license" to buy scheduled compounds revoked, but we still can get a lot of other compounds.
How is that any better than the current system which is just “no cancer medication for you”?
I think they were deliberately pointing out the absurdity by comparing it to other far more dangerous things we just waive off if you have a license.
I read a study here in Australia a little while ago that showed that removal of easily accessible pseudoephedrine had done nothing to either stop the proliferation of clandestine labs, nor curtail the availability of crystal meth. They just switched to different syntheses, and there are still large-scale imports that sometimes get caught, sometimes don't.
People were still trying to claim the program was a success because they had stopped gangs getting pseudo as a precursor.
But so what? it's done literally nothing to stop criminals profiting, nor to stop people getting addicted to meth, with all the associated public health and petty-criminal consequences of that. And now it's harder for ordinary people to get effective decongestant.
It just seems that nobody is willing to admit the whole thing was pointless.
Same in New Zealand, we removed pseudoephedrine as an option unless you had a special dispensation from the Ministry of Health - mainly due to pharmacies being ram-raided for the pseudo.
The end result? The gangs just started importing pseudo, before later just switching to importing methamphetamine directly (something that Australia's deportation policies really helped with as the "501s" as we call them that were deported back to NZ often had existing connections that could facilitate the direct importation of meth).
It's a really interesting supply chain that involves organised crime groups in multiple countries, often starts in India for the precursors, then clandestine labs in Laos/Vietnam/Thailand overseen by Chinese groups in conjunction with local groups, then smuggled via the Pacific Islands, notably Fiji and Samoa where the Chinese groups have established transshipment facilities, before being smuggled into Australia and NZ by local groups who then distribute and supply it.
A new development has been the Central American cartels branching out from cocaine to meth so there's been a bunch of meth coming directly from the Americas.
You can get it in the UK, fortunately.[0]
0: https://www.nhs.uk/medicines/pseudoephedrine/about-pseudoeph...
> I don't care if people use it to make meth. What they do in their private time doesn't concern me.
You ever seen a meth lab that blew up?
I've seen fireworks, gas stoves, portable electric heaters, peanut oil deep fried turkeys, etc.
The car stat is a good example of trying new policies to lower car deaths! They are the greatest risk to my children's lives and I find it terrifying that we let them roll around everywhere so close to people, like we do in parking lots.
>Maybe license people to buy meds and take it away if they abuse it?
I'm a bit confused, because you can buy it already with an ID, correct? You don't even need a purchasing license, just a drivers license or other government ID.
No, they mean you get a license to buy meds and that license gets revoked if you abuse them. Not that you need a _driving_ license to buy meds.
It is even easier to get in Singapore.
It's the same in Singapore.
You can only buy from a pharmacist (behind the counter) and you need to provide your national ID number. Your purchase is put in a database that any pharmacist can see.
Really? As in, in spite of how bonkers the overall import rules in Singapore are?
I just travelled there few weeks ago, and the government websites made it sound like it’s best to just not bring any pills at all (or chewing gum).
- Tool you can to use to check active ingredients and whether its allowed: https://www.hsa.gov.sg/personal-medication/check-requirement...
- Anything that might be controlled/require prescription, have to apply for permit it to bring it: https://www.hsa.gov.sg/personal-medication/submit-applicatio...
- They provide a tool to show illegal health products. Better not bring one of them: https://oscar.hsa.gov.sg/Publication/ahpdm/faces/AHPPublicat...
Fun fact, there (was?) is a isomer of methamphetamine that is actually over the counter, levomethamphetamine was often found in Vicks brand inhalers, though they appear to be discontinued, being replaced with a ‘non-medicated’ version. There are apparently generic inhalers that still do contain it though.
https://www.science.org/content/blog-post/other-methamphetam...
See also selegiline, which partially metabolizes to levoamphetamine and levomethamphetamine. Not OTC though (antidepressant).
Oh man, I have fun stories about selegiline.
Come on, you can't be vague like that and expect no one to ask. Do tell!
If you really would like to know and enjoy mortal suffering, just contact me privately.
"simple and convenient" does a lot of heavy lifting in this paper - n-BuLi, chromium hexacarbonyl and MoOPH (had to look that one up!) is not something you find outside of a well equipped lab and shouldn't be touched by anyone who isn't highly experienced.
How did I miss this article before?!? Love it!
> Other side effects may include violent urges or, similarly, the urge to be successful in business or finance. ... > We expect that the simultaneous trends of restricting pseudoephedrine sales while N-methylamphetamine becomes less expensive and of higher purity will make the methods presented here increasingly attractive.
The problem I found was that nobody wanted to deal with the database after a certain time in the evening. Odds are good you don’t admit you’re coming down with something until after work. Or at least admit to yourself that medicine would be helpful. So by the time you see you’re out of Sudafed or can’t find the old pack, it’s often too late to go to the store to get a new one before morning.
That's actually hilarious.
I remember complaining to my friends about how frustrating it was to hear that a medicine I frequently used turned out to be placebo, exactly one year ago today. Opened this article up, I'm currently taking the _exact same_ one in the article photo - it's what I had lying around and I had forgotten the name of the "bad" sudafed (it's sudafed PE). They need to take it off the shelves quicker. Every day is tens of thousands of more people who are scammed.
Putting my money where my mouth is and leaving a comment on the FDA proposal...
I remember when the law first went into place. I bought some meds and the next day was back at the store because the new stuff didn’t work. For me it was even more obvious because pseudoephedrine works so well for me.
PE = Placebo Effect
My grocery store pharmacy has homeopathic stuff next to the Sudafed too. Is literally a placebo.
At least the Sudafed has acetaminophen in it ...
If you're referring to Zicam, there's actually evidence that zinc gluconate helps reduce the length and severity of colds... and it's actually present in more than trace amounts in Zicam. They market it as "homeopathic" in order to get around FDA regulations, and they've gotten in trouble because zinc in your nose can knock out your sense of smell, perhaps permanently. (The lozenges don't appear to have this issue.)
How can you believe you've been taking a placebo for years? Phenylephrine is used for the illicit synthesis of methamphetamine, so there's an inherent bias towards anything that gets it off the shelves. Cherry picking studies that say it's ineffective is more velvet glove than using only the iron fist to ban the stuff. But make no mistake that the iron fist is taking your meds away either way.
Pseudoephedrine is the one that is both proven to be effective and is the precursor to meth. Phenylephrine is the useless placebo that they put in the tablets on the shelf only because it can’t be used to make meth. It should be torn off the shelves because it’s useless.
The only reason the ‘PE’ (marketing term for the ineffective phenylephrine) tablets might be helpful is because they usually also have paracetamol (acetaminophen) in them which is probably the only bit that works. They don’t work as a decongestant for most people like pseudoephedrine does though.
I believe that it doesn’t work wholeheartedly, because every time I try it, it is ineffective - but my sinus problems are rarely bad enough to warrant medication (it’s been one year) and by then I’ve forgotten what works and what doesn’t.
Also, I suspect you’re mixing up your drugs. Phenylephrine (the drug in this article) lacks the methyl structure to be used for the synthesis of methamphetamines. In fact, that’s why it was popularized - pseudoephedrine, the truly effective sibling, was becoming too good for meth production, so they created a less potent alternative, phenylephrine, that lacks the ingredients necessary. They then locked pseudoephedrine behind the counter. Turns out the oral form of phenylephrine is less than “weaker” - it’s largely useless - so they pumped out enough of this crap to the tune of $1.7B that the American public spent every year for 18 years after they knew.
> so they created a less potent alternative, phenylephrine,
Just to be clear, phenylephrine is not a “creation” or necessarily less potent. It’s an even older drug and a very effective vaso/venoconstrictor. The problem is it has poor oral absorption (bioavailability) as you note, so it doesn’t do much taken by mouth, but anything it does do is mostly deleterious. And thank god for that, because if it had the effect orally that it does via IV it would be killing a lot of people.
Ah gotcha. So the cynical thing I thought would happen already happened.
Glad to hear we're on a road where peak cynicism is looking behind us.
I think you're confusing Pseudoephedrine (which works and is used to produce meth) with Phenylephrine (which doesn't work and cannot be used to produce meth).
This article is about removing phenylephrine (sudafed PE) from shelves. Studies have pretty thoroughly showed it is completely ineffective for what it is marketed for
Way overdue. I wonder if the purveyors of this fraud have ever been sued.
One refrain I got tired of hearing was that it "wasn't a safety issue." WRONG. Anyone who has ever had a ruptured eardrum can tell you that it is 100% a safety issue.
If you're about to take a flight with any congestion, you're relying on decongestant to save your ears. I've had ruptured eardrums; it's probably the worst pain I've experienced. I had to take a flight a couple years ago with only this crap, and must have come extremely close to rupturing them again. It was EXCRUCIATING.
As long as we're giving decongestant advice, in my experience a neti pot (sinus rinse) really helps.
I also take pseudoephedrine when things get bad. I'm not trying to push a natural stuff only approach.
The neti pot really seems to reduce the odds that sinus congestion will spiral into a terrible sinus headache.
Do be aware of the need to use sterilized water to avoid a possible dangerous infection, though. Distilled water is the easiest way.
> Do be aware of the need to use sterilized water to avoid a possible dangerous infection, though. Distilled water is the easiest way.
It must be noted that the infection is incredibly rare and requires multiple conditions (like dysfunction of the immune system, unsafe tap water...)
- https://en.wikipedia.org/wiki/Naegleria_fowleri#Pathogenicit...
- https://charlotte.floridahealth.gov/newsroom/2023/03/DOHChar...
For example here in France tap water is disinfected with chlorine and hot water must be heated to at least 50°C which is enough to kill the microorganism.
On the other hand, depending how the distilled water is sourced (container bought in a supermarket...) & used (opened/closed daily...), it can actually create a much riskier source of infection.
Infection with Naegleria fowleri is incredibly rare.
A run-of-the-mill bacterial infection is much more common. There's more than one type of infection you can give yourself by putting water into your sinuses.
You're correct that it does require a source of the pathogen, be it the water, a poorly cleaned neti pot, or the interior of your nostril.
I tried this once when I was a teenager. As far as I remember, I took the precautions of sterilized water, getting the right salt, etc.
Guess I didn’t know how to properly use it, since I gave myself an awful sinus infection and was bedridden for next two weeks. To this day it’s the worst I’ve ever felt. Never touching a neti pot since then :/
The infection may have happened despite the neti pot, not because of it
It works wonders on me and family members. Except we just always go for the Neil Med bottles from Costco or Target. They are also easy to disinfect in the microwave.
Always distilled water, though. It’s not worth waiting to boil the water, let it cool down, and then manage the dish used after. It’s also easy to get just the right temperature using distilled water in the microwave.
I would strongly advise against broadly recommending this across the board, because while rinsing your sinuses can help with some infections, it can make the situation considerably worse if you're working with e.g. inflammation instead. For a lot of people the difference isn't easy to tell and they end up making their own situation worse. As always, ask a medical professional, even your pharmacist can tell you what to do or not to do once you describe the symptoms.
Total anecdata, but when I was college age I would get bronchitis about annually that usually started from something that would have at least 1 nostril completely blocked for a week or so. I read about neti pots, bought a pharmacy "sinus rinse" and started using it daily.
I'm 58 now and I haven't had bronchitis like I used to since.
My theory is that it not only washes out stuff that might lead to infection, but also keeps your membranes from drying out and cracking, opening a vector for them.
If you're worried about the possible infection or don't want to mix it yourself, check out Arm & Hammer Simply Saline. It can be used like a neti pot for sinus rinse.
So stupid. It was plainly obvious how ineffective it was, compared to pseudoephedrine, anytime you got sick.
You can still get pseudoephedrine containing Sudafed in UK sometimes, I've had difficulties finding it, but they package it almost identically to the phenylephrine containing placebo.
To me this has always seemed like obvious fraud.
We don't have class actions in the UK, but perhaps in USA there's a chance of punishing this sort of behaviour going forward?
Basically they took the active ingredient out, added a similarly sounding chemical, continued to sell the new known-ineffective chemical in the virtually the same packet, under the same trade dress and branding...
Pseudo was really effective for me. When I first bought Sudafed after they took the active ingredient out (of the easy to find product) I thought I'd misremembered, took a couple of illnesses before I twigged, then some very careful analysis of packaging to make sure to get the actual medicine.
In the US everywhere has it, but it’s behind the counter and you have to show ID so they can track how much buy. It’s ridiculous, but it’s not hard to get, and has never stopped an illegal drug chemist from making crystal meth, but regular folks pay the price in inconvenience
Perhaps if you pay cash in UK they have to get ID, if you don't (or you use a discount card) then they're already tracking you so extra checks probably aren't needed.
Interesting. I was just in the UK (Scotland), and picked up a cold on the plane. I was unable to locate any pseudoephedrine.
My search was far from comprehensive, so it might merely have required looking harder. But I gave up early, on the assumption that the UK was similarly restrictive to the US.
Maybe it has, but last time we bought it was within the last year - branded Sinutab (actually clearly marked, unlike Sudafed), from Tesco Pharmacy I think. It's always with paracetamol; which I assumed made it difficult/useless for meth makers.
Back to Pseudoephedrine! It's behind the counter at your local pharmacist.
I was denied this the last time I tried to buy it and the pharmacist couldn't even tell me why aside from "the system won't let me". I went to a different chain a half mile away and walked out with a month's supply of the stuff. Hilariously incompetently-designed regulation.
Meanwhile meth making is more efficient, cheaper, and delivers purer-grade glass than ever.
Most worthless law. Now i have to wait in line for 10 minutes to get it and yet meth is still widely available and usage actually increased. Did nothing except shift manufacturing to outside of the US.
Pseudoephedrine should be unrestricted, there’s no way to compete on price with meth cooked in an industrial lab in Mexico by using pseudoephedrine as a precursor. Keep it behind the counter (to prevent theft) but let adults buy as much as they want.
There was actually a push to make it rx only. Oregon and Mississippi passed laws to make it RX, luckily those laws have been rolled back.
And I can't stockpile it for allergy season (which is about 9 months out of the year for me). I have to make regularly scheduled trips to the pharmacy every two weeks which is a huge pain in the ass
My life on an ADHD med, a mental health med, and 3 other meds for transgender stuff.
I am very lucky to have a backlog of estradiol, my main HRT drug, because I was purposely "playing under speed" for most of a year, otherwise all 5 drugs would be randomly running out at 5 different times throughout the month. Almost nothing gets assigned to 90-day fills for some stupid fucking reason.
So from personal experience you can often just ask docs for a longer prescription if something isn't particularly restricted (like stimulant-type ADHD medications).
From friends, I know that some therapists and endocrinologists are willing to give 6 mo or even 1 yr scripts of hormones, though some will only do so under certain conditions. You might want to find a different doc. I know one person who gets a 3 mo supply of estradiol from a telehealth provider.
I once actually got denied and had to buy a smaller box (for the same price). What the hell happens to families with multiple teens who all get sick at the same time?
Any reason you choose to take PE rather than a corticosteroid nasal spray?
Corticosteroids are powerful substances, and have lots of potential adverse effects - and long-term usage can wreak havoc. The physiological side-effects of corticosteroid withdrawal can be quite awful. They are amazing, necessary, drugs for society. But, when something as safe and effective as pseudoephedrine can do the trick (it really is quite safe, and even has less potential interactions with things than plenty of OTC drugs do), there is literally no reason for anything else.
When I get a cold, (pseudo)ephedrine is the only medication that actually really helps. I don't need it often, I just try to remember to buy some once in a blue moon when I'm already at the pharmacy so that when I need some, it will be there. But for people with allergies or those who get sick a lot, the current process is yet another completely pointless annoyance.
Corticosteroid nasal spray does not have the same effects as when it is administered in other ways and is safe even for long-time use as three different doctors in my country told me.
I just spent dug in to this and, wow, I was wrong! Most all the negatives that occur with parenteral and oral routes appear to be absent in the intranasal form. And there is quite a lot of research to back that up.
Thank you for correcting me. And likely sending me down another rabbit hole.
Yep - I think parent poster is conflating the effects of oral corticosteroid use (which believe me, I know, and they SUCK) with topical usage.
Yes, I was. Thank you both for pointing this out.
You take 48 pills in two weeks?!
That’s pretty easy when the dose is two pills every six hours.
They make twelve hour extended release versions now. There are twelve per box and you can get three boxes at a time. That's 18 days but only if you take them twice a day, which you probably shouldn't if you like sleeping. If you take one a day, that's a whole month's worth.
You're going to have serious issues if you take that much. It's causes major problems after a few days.
I can get 15 of the 24 hour generic Claritins every 2 weeks. Works out to about 1 a day
Bring back domestic manufacturing jobs!
Small batch, organic, artisanal, fair trade meth for the win!
[dead]
Unfortunately there is an absurdly low limit on purchasing amount in the US.
In addition, I can't seem to find the 24 hour versions anywhere right now. I could probably buy meth more conveniently. :(
Cue: "A Simple and Convenient Synthesis of Pseudoephedrine From N-Methylamphetamine" https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
I've only had to buy it in three states, but generally my experience has been that you can buy a "30 day supply" per month. How often are you sick that you need more than 30 days of the stuff every month? If we run out I'll buy a 30 day supply and that generally lasts the whole family a year or more.
You definitely don't have anyone in your family who gets severe congestion from allergies then. The "funnest" form it takes for me is when I start going partially blind in one eye due the the sinus pressure
When it’s that bad why wouldn’t you just get a prescription for an appropriate amount for your situation?
> When it’s that bad why wouldn’t you just get a prescription for an appropriate amount for your situation?
Prescriptions take time and money.
I could do it with less effort and cost than OTC. Online message my PCP, prescription sent to pharmacy, mailed to me at my house, cost $0 since it's just a generic. And I have a cheap as shit high deductible plan with a steep out of pocket maximum, not some cadillac plan.
OTC would be faster, but if I have a chronic need for large amounts of pseudoephedrine I'm not waiting until it hurts before I run to the store. I'm getting my doc to make sure I have a hell of a good stash (and I checked, just to be sure -- the limits don't exist if it's prescription; at least not in Oregon, which is famously restrictive on pseudoephedrine).
Would it be better to relax the restrictions that now seem pointless on the OTC version? Yep. But if someone is bitching on HN about how they can barely get what they desperately need, I'd say it's time to stop being idealistic and go get the damn drugs already.
"I don't have this problem, therefor this problem doesn't exist, and so you don't have this problem."
> Unfortunately there is an absurdly low limit on purchasing amount in the US.
The maximum safe dose for an adult is 240 mg in a 24 hour period. Current guidelines allow for getting a 10 day supply (the average cold lasts 7-10 days) in a single visit, and basically a limitless supply with a few visits (37 days worth every 30 days).
If you are running into purchasing limits, you are either making meth or blowing out your liver.
Edit: Math is hard. The 30 day limit is 7.5 grams (a 31 day supply), or 3.6 grams per trip (a 15 day supply).
> If you are running into purchasing limits, you are either making meth
This would also be an insanely expensive way to make meth.
I seem to only be able to buy 10 days of Sudafed 24 Hour every 14 days. That doesn't work if you have allergies.
Presumably because places like Walgreen's can't adjust compliance per state and places like Alaska have "No person may purchase or possess more than 6 g of PSE, EPH or PPA per 30 days unless dispensed pursuant to a prescription"
Note that 6g / .240g = 25. So I can only buy 25 days worth of pills every 30 days. Or 12.5 pills every 15 days which is suspiciously close to that 10 every 14 days number.
Aren’t there better things to take longer term for allergies? Pseudoephedrine is amazing for colds etc. but I’ve always seen warnings not to take it for more than a few days at a time…
This is where you need to bring a buddy on every trip...
> Note that 6g / .240g = 25
Fortunately we are both wrong. I have updated my previous post up thread.
How am I wrong? I quoted the Alaska requirements. Are those not correct? Please reference.
I guess you found the one state who isn't in line with federal law. :)
https://www.deadiversion.usdoj.gov/meth/cma2005.html https://worldpopulationreview.com/state-rankings/pseudoephed...
What's 10 days/4 people? like... a family that lives together? Who will almost inevitably get each other sick? If the average cold lasts 7-10 days, one of them's going shopping for more while sick.
Sounds like great public health and safety policy there.
At least some states track it on a household (address) basis.
Or just straight ephedrine, which is also behind the counter at your local pharmacist (brand name Bronkaid).
I've noticed that in the UK all phenylephrine based OTC medications also contain paracetamol (acetaminophen) and often caffine. They are just an expensive way to buy two very cheap compounds with an added bit of placebo effect from the flashy packaging.
I can't take pseudoephedrine due to high blood pressure and I've found that the most effective thing for me, especially at night, is paracetamol, a blast from a nasal spray, and one of those nasal strips that help keep your nostrels open a bit more. It's not quite up there with the real Sudafed, but it's generally enough to get me a good night's sleep.
Cough medicine in the UK is sugar + paracetamol.
My wife's a pharmacists so always laughs at it (and the decongestants) when we visit the UK.
Yep! OTC medicines here are really limited. Although you can always get something stronger from the pharmacist.
I remember being ill in Switzerland and getting something for a nasty cold. I have no idea what it was other than magic in pill form.
> OTC medicines here are really limited
But you can get scopolamine there OTC. In chewables for kids, even! We can only get it as a patch, and only by prescription.
Makes me want to find an importer I feel like I can trust, because I don't get over there often enough to bring it back myself.
>I can't take pseudoephedrine due to high blood pressure
I really miss being able to take pseudoephedrine. I mentioned to my doctor that it seemed to affect my blood pressure and he looked scandalized and told me I should never take it again. Apparently someone should have told me when I was diagnosed with high blood pressure. The only real information I got was a handout for a DASH diet.
I just checked the package for a random pseudoephedrine product
https://www.cvs.com/shop/sudafed-sinus-congestion-maximum-st...
It says consult your doctor before use if you have high blood pressure or heart disease.
How often do you consult your doctor about over the counter medicines that you've taken for years?
Every time I have a new diagnosis or a new medication I absolutely double check any OTC medications.
Yeah, I don't think it was mentioned when I was diagnosed, but the pharmacist asked about it when I next went to buy some more. That was a very sad day.
I miss being able to take Night Nurse and then sleep like a baby.
I'm sure this will be unpopular, but I think the real problem with Phenylephrine is that it isn't dosed appropriately in standard formulations.
The standard 10mg dose is too low. Decongestants work by constricting blood vessels, which inherently increases blood pressure as a side effect.
Pseudoephedrine at standard doses is known to raise blood pressure slightly. Phenylephrine at standard doses (10mg) shows no such effect (Source https://journals.lww.com/ebp/abstract/2018/03000/how_much_do... )
Phenylephrine does increase blood pressure when delivered by IV at doses that work. The oral 10mg dose just isn't enough to get absorbed and do anything.
It's not that phenylephrine is ineffective, it's that it's underdosed in the oral formulation.
There was some article about it on HN a while ago. If I remember right the problem was that its bioavailability is super low. You can take all you want, but only a tiny percent makes it through to get absorbed. In theory you could increase the the dose a lot but I imagine that might have other issues.
I believe the problem is that the oral route causes most of it to be broken down in the digestive system. Nasal spray seems to be more effective because it has a chance to directly enter the blood stream rather than go through the gut.
Finally. I hope this reaches Australia and the rest of the world. Phenylephrine doesn't work, it never worked, it's obvious that it doesn't work, it's a literal scam, and the companies selling it are fraudulent.
Half the products in chemist warehouse are pretty blatant scams. It's insane how effective, important pharmaceuticals are sold side by side with products known to be ineffective and that exist purely to strip uneducated customers of their money.
The brands who have continued to sell this ingredient should be considered untrustworthy. It's basically fraud.
Also the stores that stock it, honestly
Wonder how many people "fell" for it though.
I remember, many years ago, that I got some Antihistamine tables with Pseudoephedrine to take in 'light' emergencies for my allergies, cat hair in my case. I wasn't going to fall over like other people but have trouble breathing and a runny nose, so every time I visited people with cats, I could take one and everything was fine. When they banned it and my supply was used up, I got something with Phenylephrine and it just did... nothing. Then 5min of online research told me just as much.
My anecdata is that, though it's not as effective as pseudoephedrine, phenylephrine actually is effective in an inhaler, and a helluva lot better at clearing up a stuffy nose than "scents and essential oils". Of course, a cylindrical inhaler with a wick inside it doesn't go near my digestive tract... Now I'll have to look around for a replacement inhaler, something quick enough to avert choking-panic. Thanks, CVS.
No you won’t! It’s just the oral formulations that are being taken off the shelves. The inhaled version does indeed work and will still be available.
It's off the shelf at my local CVS (e: and has been for weeks). I looked.
That's their company policy or a supply issue, not the FDA's decision.
Thanks, CVS.
It's only the oral version which has no effect and is thus being pulled. The inhaled version has more evidence that it works and will remain available.
I can't pronounce either one of the Sudafed substances. One time, an old lady asked me which Sudafed work for her as she pointed to a shelf full of Sudafed plus other decongestant drugs. I told her just buy the one that you need to take the flyer and bring it to the pharmacist to get it. Others are just scam. The real one is used to make meth so they put it behind the counter.
She was surprised that the US gov would allow fake decongestant to be sold.
Meanwhile generic decongestants like Ambroxol that actually work are too expensive to go through FDA approval.
https://marginalrevolution.com/marginalrevolution/2024/05/th...
Maybe a shorter duration(<5yrs) patent(for lack of better word) for unapproved generics might do the trick.
Ambroxol is not a decongestant, it's an expectorant. If you take Ambroxol expecting to clear your sinus pressure like pseudoephedrine, you're going to be disappointed.
I've used it. I thought it was going to be better than guaifenesin (equivalent available in the US). In my experience, it was not.
That entire blog post appears to be based on a second-hand report from someone who went on vacation in France and was told something by the person at the pharmacist selling them Ambroxol. I don't understand why rationalist bloggers are so keen to rely on anecdotes and hearsay when it supports a point they're trying to make.
> Maybe a shorter duration(<5yrs) patent(for lack of better word) for unapproved generics might do the trick.
There already is something similar - the NDA exclusivity period. You get 3-5 years where the FDA won't approve any other versions of the product.
https://www.tandfonline.com/doi/pdf/10.4155/ppa.14.30
But ambroxol isn't a decongestant - it supposed to help with phlegm.
Am I taking crazy pills, because I've been taking PE for years and it works just fine? Like yes the behind the counter stuff is stronger but it also comes with more annoying side effects.
I use it to sleep during allergy season and I can tell when I don't take it when I mouth breathe the whole night. I might try some experiments to see if I can tell but I didn't think you could placebo while sleeping.
You're almost certainly experiencing the placebo effect. There's mountains of evidence phenylephrine does exactly nothing.
For most of my adult life, I was "addicted" to sudafed (pseudoephedrine, not phenylephrine). I had absolutely horrific sinus problems. Could never breathe, tons of sinus infections, etc etc. Things like sinus rinses (not a netipot which is gravity driven, but a positive pressure squeeze bottle) helped, but it was still a major inhibitor in life.
I got a new ENT, and I started getting a quarterly "chemical nasal cautery". It has ABSOLUTELY changed my life. I can breathe sooo much easier, and I couldn't recommend it enough to anyone with persistent sinus issues. It is super easy. It doesn't even kind of hurt, the most mild of stings if anything at all. Doc will spray a lot of afrin up your nose, then lidocaine, then carbolic acid which kills a bunch of your immune cells (so they can't overreact to tree pollen and make you miserable). You get it done once a month for three months, then once every 3 months thereafter.
Everyone in the pharma and regulatory world has known this stuff is worthless for years. I feel like the pharma industry should be severely fined for knowingly perpetrating a fraud on the public. Sadly, they would likely be able to defend themselves on the grounds that the FDA allowed it.
A faculty member clued me in when I worked for a college of pharmacy 20 years ago! FDA should be embarrassed. This shouldn't even have been hard. How many drugs have been p-hacked into efficacy and would need expensive trials to disprove? Oral PE is metabolized too quickly make it to the bloodstream and can't be more than a placebo.
Thanks to the Administrative Procedures Act, and per the release from the FDA, the proposal will take some time. Comments are accepted until May 7, 2025. If the government moved with all legal alacrity, the order might get finalized by this time next year, that's if there are no lawsuits, petitions, etc.
I mention this because I can't help but feel the APA takes too long when an agency is doing something proactive for the public good. This should take sixty days, not years, because it's not a removal of a product for safety reasons, that's often done via the FTC.
There is a hole between FDA's authority to create and amend regulations, order the removal of products due to safety, and what should be a more routine streamlining of the FDA cleaning up..
APA - 5 U.S.C. §§ 551–559
Next I hope they do cough medicines, I looked a few years ago when I had a cough and it seems like literally none of the OTC ones are more effective than placebo.
Dextromethorphan (DM or DXM) is the OTC cough suppressant. Marketed as Delsym comes in an orange box, or you can find it in various combo formulations, and it works
Delsym is dextromethorphan-polistirex, a long-acting formulation of DXM that is supposed to last 12 hours. DXM is available in almost all cough syrups.
The 12 hour formula is the only way you can get it OTC by itself. That’s because it’s a recreational drug that is commonly abused (“robo tripping”) and extended release prevents that. Otherwise you have to get it in a combo drug like NyQuil, which I don’t prefer because I can’t manage distinct symptoms and dosages independently with a combo
Can also give you incredible diarrhea as a nice side effect
Dextromethorphan is the only otc cough medicine that works and pretty much the only prescription stuff that works is opiate based. Of course both are regulated.
DXM can be more or less effective. I wish codeine cough syrup was still available without a prescription.
Exactly. Why do I have to cough my head off because some idiot abuses codeine?
Because you and your neighbors think you can interfere with people through your voting decisions. Government has grown so out of line, 'crime' has no meaning anymore beyond "doing that which some group of humans with guns and cages says, who nobody really consented to or contracted with (they've always been there bullying everyone into paying taxes and obeying edicts)." It certainly doesn't mean what it used to mean anymore!
We as a people need to become even more ungovernable, we need to be the opposite of German and be the most annoying red blooded American caricatures we can be.
Don't join the beehives, they're not worth it! My corollary to Franklin: those who would give up essential sovereignty to gain inclusion into a society deserve and shall receive neither.
Not sure if it's still possible, but in eastern europe back in 2010s you could buy bottles of liquid ephedrine nose drops without a prescription. The pharmacists would get raw ephedrine and mix it in the back, filling the generic nose drop bottles. Tho they'd only give you 1 a month or so, looking at you suspiciously if you came multiple times in a row.
Back when I was obsessed with sports and being the peak athlete I can be, I'd go to the different pharmacies around town and buy a bunch of nose drops. These would get mixed in with coffee to get a dumb version of EC stack. Not sure if it was worth it, but it definitely had me wired to the gills.
I had a student once from Sofia (capital and largest city of Bulgaria), she told me her mother mailed her all sort of antibiotics because they were not available here (western Europe) and "what if she'd catch a cold or the flu?" (Both are viruses so antibiotics don't even do anything other than kill the useful bacteria in your body!)
Many of the eastern-european markets around here have a little mini pharmacy where you can buy stuff that's either stronger than what you can find in the US, or can't be found at all. Especially various topicals, they tend to have versions with 2-5% of the active ingredient whereas most of the equivalents I can find in the US are 1%; Obviously nothing that's controlled/scheduled.
So a useless drug has made billions and took 30 years to be taken off the market . And who knows what damage it’s done ? Can we go back to being suspicious of pharmaceutical companies and the fda ?
I don't think it's done any damage, it's just not effective.
Wasting people's money is damage.
Preventing people from getting real medical care due to fraud is absolutely damage.
This is why sovereign immunity needs to be rescinded: bad law should get politicians incarcerated for long periods of time and their assets stripped to help pay back the treasury for the piles of money it should be printing and handing its victims. It should also be legal to lie to police while they're barred from lying to you (again, at threat of incarceration). We are supposed to be sovereign, not them!
>Preventing people from getting real medical care due to fraud is absolutely damage.
Sure, but I don't think you could reliably charge that, at least in the US, where homeopathic medicines with absolutely no effect are allowed to be sold. We're talking about over the counter remedies for temporary sinus congestion often caused by pollen allergies, not prescription medicines that treat actual serious conditions.
Every treatment has ill effects . Look at the number of liver failures from Tylenol
>Every treatment has ill effects
Not necessarily.
can you give an example?
Giving you the benefit of the doubt, I think you mean mean that everything has side effects, not that everything has actual ill effects. But even then, not everything has measurable side effects. There is a common saying of "the dose makes the poison" for a reason. I'll leave it up to you to think up some examples, they are innumerable.
It was on the market more like fifty years.
Wow that’s even more alarming
No you're believing in conspiracies.
It would require the whole scientist communities and the sanctioning organisations to work together in order to validate a drug that is basically infective. Because you see before a drug is out on the market there are a lot of testing on animals, then humans and they have control group to measure how effective (or not) it is.
Things like that CANT happen.
Obviously I'm being sarcastic, that's the usual argument: you can't possibly have all scientist and federal organisation work together on malicious drugs.
The truth is that it happens, see that drug or the oxycontin. It just requires some shity people and the rest of scientist community to not care.
You had me going, I was like Jesus this person is gullible
Some of us were suspicious all along. Especially of Pfizer.
But such suspicions became socially dangerous right around the time that Pfizer stood to make multiple billions selling a novel treatment for a recent pandemic.
(Pfizer testing drugs on Nigerian children) https://pmc.ncbi.nlm.nih.gov/articles/PMC1471980/
(Pfizer pleads guilty to criminal charges over Neurontin) https://pmc.ncbi.nlm.nih.gov/articles/PMC416587/
I found a dirty nurse, he was willing to miss my arm and accidentally vaccinate the sink, for a short stack of benjamins.
Let's be honest about this: the reasons people were skeptical of COVID-19 vaccines had nothing to do with the actual corruption in the pharmaceutical industry, and everything to do with the corruption stories told by people who profit when more people die.
I still don’t get it . Is the corruption there or not ?
It's rather annoying that the only actually effective nasal decongestants are amphetamines or otherwise closely related compounds. Sudafed is great for daytime relief, but there really is no good sleep time decongestant. Sure Nyquil is a thing, but it just relies on the antihistamine to produce drowsiness without any actual decongestant effect. And Dextromethorphan is arguably even more useless than Phenylephrine since at least the latter could conceivably be effective if you shot it up.
Time to hand rifles to everyone (including felons) and ban the State.
I do find it amusing reading hundred year old stories where characters walk into a pharmacy to buy a pint of whiskey, a sandwich, and a vial of cocaine and it’s just an everyday normal thing.
phenylephrine is still pretty effective as a topical nasal spray. so don't write it off if you see it in that form.
Clearly placebo for me, I guess? It's wild how many people are saying phenylephrine is completely ineffective. It saved my ass during a really long COVID stint. It was impossible to find by itself but when we finally found it we bought 2 boxes because we use it and, for us, it works wonders... Hope they release something else better I guess.
The better thing is the original: psuedoephedrine. It was never impossible to buy, it just required going to the pharmacy counter and showing ID. I knew about this when it happened in the 2000's because my dad needed Sudafed often, but the changeover was almost certainly invisible to most people given that the packaging is essentially identical between the two versions of the product.
I have tried many nasal sprays, but what is really effective is a salt in water solution (slightly salty to taste) and a 10 ml syringe. Simply inject it into each nostril so that the water comes out through the mouth, a couple of times a day. Cleans out all the garbage really well.
Among the medications, Flonase spray is effective, but saltwater is enough most of the time.
Make sure you’re using sterile water for this. https://en.wikipedia.org/wiki/Naegleria_fowleri?wprov=sfti1
The saline wash is also known as a Neti pot here.
It's 0.9% by mass. You can buy it easily in large bottles so you don't need to learn to disinfect and filter your water correctly.
Boiling is enough, saltwater sold in pharmacies is $5 a bottle where I am, a rip off. Not that I can't afford $5, but I don't like to be a sucker.
At least filter it. And I'm not sure boiling is enough, that will depend on what is in it.
Cue:
- the entry of trolls everywhere demanding that they can keep the médecine they've been using for ages
- the new administration's agreeing with "popular demand" and disagreeing with the FDA, because that's their thing
- and the companies selling the drug be like "uh, ok, fine".
At least it will be an interesting distraction from trying to fix the opioids epidemic ?
Does anyone else feel like dayquil is an effective decongestant? I do. I can literally feel the gunk running down from my sinuses to the back of my throat when I take it. Confusing to me cause it's phenylephrine, which is what the article states is ineffective. I've had this experience after reading these reports about a year ago.
As mentioned in a sibling, try looking at Mucinex a try. There is a 12h version that has Guaifenesin https://en.wikipedia.org/wiki/Guaifenesin and Dextromethorphan https://en.wikipedia.org/wiki/Dextromethorphan as the only two active ingredients.
Compare with Dayquil - Acetaminophen 650 mg (pain reliever/fever reducer), Dextromethorphan HBr 20 mg (cough suppressant) and Phenylephrine HCI 10 mg (nasal decongestant).
> Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication taken by mouth and marketed as an aid to eliminate sputum from the respiratory tract.
> ...
> Guaifenesin is used to try to help with coughing up thick mucus, and is sometimes combined with the antitussive (cough suppressant) dextromethorphan, such as in Mucinex DM or Robitussin DM.
---
> Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines.
> ...
> The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), or from inhaled particle irritants, as well as chronic cough at a higher dosage.
---
The combination of the two is designed to reduce coughing and when you do cough, it is much more productive with the expectorant and cough suppression. It isn't a decongestant, but it has (personal anecdotal take) a good effect on getting rid of the secondary effects of congestion.
Only issue is the bilayer tablets taste aweful! Why they can’t do dual speed capsules is beyond me.
Guaifenesin, like Phenylephrine, is now widely viewed as having no efficacy.
It's probably the guaifenesin (Mucinex) that you're feeling.
I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?), although I can't find it again, and I may have read it when I was congested and only had PE.
My lived experince with PE is it never works most of the time. But if I realise I need psuedoephedrine and I'm not somewhere or sometime where I can access it, I'll get PE and hope. Sometimes hope works, but it usually doesn't clear my sinuses very effectively. But if I have sinus congestion related to flying, I might also have soreness related to flying and take PE (because you can get it at the airport) and ibuprofen together, and maybe it works.
But also some people are more sensitive to some drugs, so it could work for you, while not being very effective in general.
> I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?)
Oh yeah combine with Tylenol and increase the dose if you want to experience adverse cardiac events. The oral form of PE is really only good for jacking up blood pressure, it doesn't help with congestion more than placebo: https://pmc.ncbi.nlm.nih.gov/articles/PMC4500855/
Might be the other ingredients reducing inflammation, widening your clogged pipes and letting stuff drain.
Do we know the story around the people who pushed this? (EDIT: By "this" I mean phenylephrine.)
Had they never had a stuffy nose?
Phenylephrine doesn't work though. It never did. It was "pushed" as an alternative to pseudoephedrine which can be used to synthesize meth, but afaik every single study done on this shows that phenylephrine does absolutely nothing, it's a placebo drug. The faster it's phased out the better.
How it was approved in the first place should have been reviewed
It was approved back in the 70s after there being some studies that showed it was somewhat effective against congestion. I suspect it was no better than a placebo, but once it gets over the hurdle of being shown to be safe to use it probably didn't take much to get it approved. I don't think it was ever a popular product until the government starting making pseudoephedrine, which is highly effective, hard to buy.
Strictly speaking, phenylphrine works when it’s injected. It is approved and used every day for this indication in the service of general anesthesia.
However, the oral bioavailability is zero.
This is an example of using something off label that’s approved for something else. Sometimes it’s fine. And sometimes, it’s dumb.
That's cool to know - I had no idea! I assumed that it literally did nothing in every scenario.
People bought sudafed / they earned a lot of money from it, and they wanted to continue to earn money off of it. That's basically it. But they will point the blame at legislation I'm sure, both for making the effective stuff more difficult to get, and for being OK with the ineffective stuff being sold.
Phenylephrine worked great for clearing my mucus overproduction. Unfortunately, this has little to do with allergy relief, so I can see why many here hold that it's ineffective. I can imagine how frustrating it must be to have actual allergy issues and be prescribed something that doesn't solve the problem.
It’s not just allergies - taken orally there is no evidence it works for anything, and there’s pretty good evidence it is basically metabolised away.
The frustration largely comes from pharmacists and pharmaceutical companies selling decongestant remedies that do nothing and are known to do nothing.
Looking forward to the FDA recommending ivermectin to take its place in late January 2025.
Didn't see any one talk about it but French health agency recommended all pharmacists and doctors to stop issuing Pseudoephedrine for colds as there is supposedly increased risk of heart attacks and strokes. It was only for people with high BP but seems like it's now for general population too.
Source: https://www.rfi.fr/en/france/20231024-french-health-agency-w...
There's also https://arstechnica.com/health/2024/11/fda-proposes-ditching...
(via https://news.ycombinator.com/item?id=42083559, but we merged the comments hither)
Just as a reminder, you are completely allowed to buy pseudoephedrine without a prescription, you just have to ask your pharmacist. My local pharmacy keeps it behind the counter already pre-compounded, and it's cheap and effective. One of those little things that I never used to purchase because I was somehow not certain if I could actually get it. Yes, you can.
What country are you in? In the US, pseudoephedrine has to be requested at the pharmacy counter, but it's not a compounded medication. Instead it's sold as pills in the usual "blister pack" format.
I live in the US. You're right, it's not compounded by my pharmacy, I was confused because of the branding on the package — it's manufactured somewhere else and just repackaged by my pharmacy:
https://files.catbox.moe/9pbj43.jpg
It's not repackaged by your pharmacy, Good Neighbor Pharmacy is a generic drug brand for pharmacies and supermarkets that don't have their own generic brand.
Ohm Laboratories appears to be a subsidiary of Sun Pharma which is one of the largest generic drug manufacturers in the world. This looks like a pretty standard generic drug with store branding package to me.
There's a limit to how much you can buy per day, per 30 days, and per year.
My local pharmacies keep it behind the counter, but the counter has shorter hours than the rest of the store. And you've got to submit your license to be entered into their system (and who knows what happens with that data).
In Belgium it's no longer available without prescription since this month. Reasoning is that it can trigger cardiac issues, neurological issues, and even psychiatric issues in some people.
You need a drivers license though. And they enter something into the computer.
It was obvious to consumers very quickly that it didn't actually do anything. Astonishing this charade went on so long.
It doesn't relieve nasal congestion and it never did. While it's certainly safe, it's not even slightly effective.
“While the panel upheld the drug's approval, it concluded that more studies were needed for a full assessment.”
That’s comforting. They approved a drug before it’s full assessment.
I find the Sudafed PE is useless but the Alka Seltzer with phenylephrine works and works really fast.
Which is actually supported and documented here: https://pubmed.ncbi.nlm.nih.gov/26097788/
Lots of versions of Alka Seltzer use aspirin instead of acetaminophen, and aspirin in combination with phenylephrine is documented to reduce congestion more than either alone.
Note - avoid the cold & flu versions (the ones with orange bottoms) and the day & night versions (orange and green bottoms), because they're not aspirin, they're acetaminophen. The traditional blue bottom "Alka Seltzer Severe Cold" is the one with aspirin and phenylephrine.
Good to know thanks. Considering it does work it would be weird to pull ALL phenylephrine in that case. I remember the last time PE came up they were just pulling medicines that were only PE like the fake Sudafed.
It's been definitiely shown since at least 2010 that phenylephrine is useless for this purpose. How in the world did the FDA let the decongestant industry push this drug for 15 years before coming down on it?
Great. I always have to explain to people not to buy this crap and get the good stuff instead
Side question; is phenylephrine applied topically under the eyes good for reducing the appearance of dark circles?
I've seen some anecdotes suggesting this due to its vasoconstrictive effects
Well, it doesn't work.
I knew this stuff didn't work the first time I bought it by accident because I thought it was normal Sudafed. Amazing its lasted this long
The outrageous thing about this is that people are getting accused of a crime for trying to buy the effective drug.
Good. I get food poisoning symptoms from it, but it's so popular that my other options are limited.
Just take N-A-C instead. Actually works and your liver will be happy as well.
Make pseudoephedrine great again.
Really hard to trust the FDA when they let this obvious scam go on for so long.
And yet homeopathy stuff is legal and often mixed in on the shelf with actual drugs.
Sigh. Still an improvement.
whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism.
in the 90s and 2000s when meth first began to spike, the rural economy was changing. Jobs weren't paying as well or were going away altogether. Meth found a niche as a kind of performance enhancement drug for people working long hours at physically demanding jobs. journalist Nick Reding found this in the pork industry in Iowa, and anthropologist Jason Pine found in general in Missouri.
neoliberalisms solution was a ham fisted market based restriction that turned a normal cold drug into a rarity. we didnt start working to treat methamphetamine addiction as a disease until it began to spread into more affluent white-collar neighborhoods.
this could have been avoided with competent market reforms and regulation, as well as stronger labor protections and minimum wage law.
You mean caused by the war on drugs.
I blame Progressivism™ and the expansion of the role of government. Laissez Faire is the ideal policy for a force-monopolist to perform by. It is better to have a weak government precisely because it's way easier to fell a badge-less gangster than a badged one.
> whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism.
Did you pull a muscle stretching that argument into place?
People like meth. People in capitalist countries and non-capitalist countries alike.
It was in fact a hamfisted government regulation that drove this.
Neoliberals believe in free market and deregulation, not market restrictions.
Nixon was the one that started the war on drugs and also enacted price controls. I would not call him a neoliberal. He also primarily interested in foreign policy and not the economy.
Also, Sudafed was only banned from being purchased easily in 2006. The bill was introduced by a random congressman from Indiana, a congressman was also easily offended by an offensive joke written on someone’s else cake.
And it's much more profitable to scrape every ounce of working life out of the poor, then use them as slave labor in a prison once their addictions get them into a critical situation or farm them out to a rehabilitation facility that pays councilors 20 bucks an hour and gets a large chunk of it's funding from taxpayer subsidies. If there's any issue, blame the overworked poor for turning to drugs, then sell them energy drinks.
Discussion (136 points, 76 comments) https://news.ycombinator.com/item?id=42083559
Merged hither. Thanks!
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I’ve hearing great things about this new drug called placebo. You can apparently prescribe it for anything and in many cases it’s just as good as existing medications.
Well, I guess I’m here because of one of these miracle drugs. My kidneys would have crapped out year ago without it. I guess call me a fan…
It's also a great band!
Next up, eliminating the work of the Fiendish Fluoridators
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For the record, with regard to treatment, ivermectin was understood to benefit anyone who had a co-occurring worm infection (targeted by ivermectin) while also having Covid. This just rules out most people in the US as they typically don't have the corresponding worm infections. I myself tried two brands of ivermectin while having Covid, with no luck.
Better to have taken it when (and if) you knew you were exposed. It was always considered to be a prophylactic more so than a treatment. And in that capacity it did seem to work for me. (Having never tested positive for COVID, despite numerous tests, numerous exposures and no shots)
I will try it next time in this way. I wonder if it could also be relevant for a viral cold if taken early.
https://en.wikipedia.org/wiki/Demodex_folliculorum is also highly responsive to oral ivermectin. Which makes it very good for treating rosacea. https://www.jaadcasereports.org/article/S2352-5126%2824%2900...
I also suspect that the much maligned "fish tank cleaner" hydroxychloroquine remains effective-as-ever for many issues, which "more targeted" in-patent drugs are on the market for.
It's very interesting to see such skin issues treated with ivermectin, although they are fundamentally a cleanliness issue of skin, clothes, and carpet.
Regarding HCQ, do I have a story to tell. Early in the Covid years, I had its symptoms twice. This was before any vaccine or tests. The first time was from a coworker, and the second time from a stairwell while unmasked. Both times, nothing would fix it, but pure CQ did. This was no fish tank cleaned. It was a proper CQ medicine at 250 mg/day for two days, then repeated again after a week for another two days. The only side effects were very minor visual blurriness which resolved on its own within 3 months, and cardiac arrhythmia which resolved using atenolol. The cardiac arrhythmia could just have been an effect of Covid itself for all I know. Note that I do take quercetin which is one of the few agents that is necessary to get CQ or HCQ to do its magic, failing which it could not work for Covid. Later strains of Covid became weaker and the vaccine also protected, so I didn't need it for future reinfections.
Are you suggesting I can get pseudophedrine via veternary suppliers instead of at a pharmacy counter?
Junk Science invalidates effective medication. I’m calling this right now, in 5-10 years we’ll be discussing how it counteracts the spike protein.
Here's a solid completely factual reason why people don't trust the FDA or the government to give health advice. Pointless drug allowed for decades.
If you want to be trusted you have to be consistently trustworthy.
What else is the FDA wrong about and will continue to be wrong about for decades?
This conversation is confusing without the FDA isn’t everything allowed by default and you get far worse like the current supplement industry?
Regulatory challenge is that the FDA have to combine 3 related but seperate concepts:
1. Manufacturing quality/ingredients accuracy (is the product what is says on the tin) 2. Safety 3. Efficacy
Medicines must pass all three, supplements don't have to meet any.
FDA and DEA should be concerned mainly with the contents matching the box, and not on medical claims of effectiveness.
In your opinion, should any government agency monitor truth of claims, or is this all outsourced to private things like consumer reports? Is it class action lawsuits?
And in the case of drug effectiveness, isn't this a very expensive endeavor, where the primary source of funding would be the companies themselves biasing results?
In this case we had companies happily selling us ineffective drugs, not because the FDA wanted it, but because they did not reject it. In a world without the FDA, what entity rejects?
Easy: Foam of any type and any chemistry in CPAP or ventilators of any type. Also, "soclean" and any other ozone 'cleaners'
Well? What else indeed? Is this the exception or the rule?
I bet you think people should trust you even though I also bet you were wrong about something once.
>I bet you think people should trust you even though I also bet you were wrong about something once.
Is there anything I've been wrong about which has been significant for a couple of decades?
Pseudoephedrine left OTC in about 2006, phenylephrine has been the main decongestant available and there's been solid evidence out there for a long time that it didn't do anything.
Did you think this addressed the point?
I don't hear anything that shows that this mistake is part of the majority or minority.
How long ago it was made is insignificant.
I have no reason to think that you do not have a similar 20 year old ongoing error unless you are physically not yet 20 years old. I'm sure I probably do. I'm sure everyone does. It's not a remarkable thing.
They are also right now self-correcting this error, while I still have mine whatever they are.
Regardless, it still doesn't answer the question of exception vs rule. No matter how bad or long-running this error is, it doesn't matter, what matters is, is it representative of most of their policies and actions? It might be, but you have not shown that it is and I have not shown that it's not.
Companies lie to the public and sell products that contain a useless drug that does nothing, the FDA wants the products with the useless drug removed because the companies selling them are just ripping people off, and your conclusion is that the FDA is the problem?
It makes me wonder if it has anything to do with Trump winning the election.
> What else is the FDA wrong about
Too much. For one, numerous harmful additives are freely allowed. These additives may not cause immediate damage, but over the long term they really inflame the gut. They serve no good purpose in the medicines. Examples include: propylene glycol, sodium lauryl sulfate, titanium dioxide, talc, ammonium hydroxide, monoethanolamine, n-butyl alcohol.
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