[HN Gopher] The Uselessness of Phenylephrine (2022) ___________________________________________________________________ The Uselessness of Phenylephrine (2022) Author : ctoth Score : 142 points Date : 2023-09-13 17:17 UTC (5 hours ago) (HTM) web link (www.science.org) (TXT) w3m dump (www.science.org) | nicole_express wrote: | Phenylephrine did its job of convincing people to accept | restricting access to pseudoephedrine, since there was a | substitute that could still be freely available. Now it'll be | taken off the market, but pseudoephedrine that actually works | will still be restricted. | | At least the homeopathics consumers will buy instead have fewer | side effects | xylophonermore wrote: | I, like many others I suspect, bought phenylephrine when | Sudafed first disappeared from store shelves. It was 100% | ineffective for me from the first dose. | | In the meantime, Sudafed has become one of the most difficult | to acquire substances for my daily life (I need it every day as | directed by my doc). So many times when I go to a pharmacy to | get it, they're out of 96-count or 48-count or any count, | meaning my one allowed purchase/month nets me less than a | month's worth. Or the state's tracking system is down (this | happens frequently) and they won't sell me anything. IOW, | buying Sudafed is difficult and often infuriating. | | Meanwhile, meth problems haven't gone away---in fact meth use | is WAY up since these restrictions were put in place in the | aughts. Sure, hiding and tracking it got some of the meth | production moved south, but it didn't negatively affect meth | availability. Supply is plentiful, prices are down, purity is | up. Even Oregon, who restricted Sudafed to prescription only, | has seen a 3x increase in meth deaths. [1] | | Sadly, the restrictions on Sudafed are unlikely to ever change | as lawmakers rarely care that their laws hurt a ton of law- | abiding people as long as they can claim something about being | tough on crime. | | [1] https://www.nytimes.com/2018/02/13/us/meth-crystal- | drug.html | freedomben wrote: | I've been in this boat too, and it's infuriating. I once had | a doctor that wrote me a script for it though and the | pharmacy let me get a whole 90 day supply with no problems. I | ended up moving and couldn't see this doc anymore, sadly. | This was in the late 00s though, I don't doubt that they | closed this "loophole" and don't allow docs to write for that | anymore. | dang wrote: | Discussed at the time: | | _The Uselessness of Phenylephrine_ - | https://news.ycombinator.com/item?id=30858202 - March 2022 (592 | comments) | rscho wrote: | Phenylephrine is ineffective when taken orally. It is super | effective topically or iv. I can definitely tell, because it's | the most commonly used vasopressor used under anaesthesia (iv). | Also used topically to avoid nosebleeds during nasal intubation. | tech_ken wrote: | Curious about how this aligns with the bioavailability point | discussed in the article. Presumably if the gut lining is where | the bulk of metabolism occurs then IV sidesteps this and | increase the bioavail drug, leading to improved efficacy. | wrs wrote: | The gut metabolism makes it _less_ available, which is why if | you put it in your stomach not much shows up in your nasal | lining. If you spray it or inject it directly where it needs | to go, no problem. | [deleted] | jawns wrote: | I laughed out loud when I read about the lobbyists who are trying | to keep phenylephrine from being taken off store shelves. | | In one article about the FDA panel vote, a lobbyist said that | most consumers hate the alternatives -- nasal sprays because of | the discomfort and pseudoephedrine because it's stored behind the | pharmacy counter -- and so depriving them of a hassle-free option | is anti-consumer. | | The fact that the hassle-free option has been shown to be | ineffective was, as you might guess, never mentioned. | ctoth wrote: | Unfortunately, this is the actual logic which will be used to | justify it staying on shelves. | | > The decongestant is in at least 250 products that were worth | nearly $1.8 billion in sales last year, according to an agency | presentation. | | Look those yachts aren't gonna buy themselves. | pixl97 wrote: | "Ok fine, you can still sell it over the counter... except a | X by Y sign stating 'This product is completely ineffective | if taken in pill form' needs displayed on the shelf where the | product is sold" | kstrauser wrote: | I could actually go along with that so long as other | ineffective things like homeopathic water get labeled the | same way. | dzdt wrote: | The same stores sell completely ineffective homeopathic | "medicines" alongside real medicines already. There are no | signs. Its already up to the consumer to determine what may | or may not actually work at the pharmacy. | badRNG wrote: | A few years back, I came down with the flu and went to | CVS for medicine. I purchased what I thought was a non- | prescription alternative to Tamiflu. It was a bad case, | and I dutifully followed the dosing instructions and took | the medication throughout the whole illness. It turns out | the product and the supposed function is complete | homeopathic nonsense. It was sold in a medicine isle | along with known "functional" cold medicine, and had some | "Active Ingredient" listed on the back (similar to any | other drug label.) | | I spent my money on a product sold by a pharmacy that is | quite literally a scam. I'm naturally a skeptical person, | but I didn't think I needed to independently check | whether what's on a pharmacy store's shelves is medicine | or a scam. That's not my lane, I trusted that the | pharmacy would only sell medicine that works. | fnordpiglet wrote: | If you bought it at a for profit pharmacy, then it did | work precisely as they expected it to. | lazide wrote: | Just wait until you start reading drug trial data! | selimthegrim wrote: | My understanding is the nasal spray version works, but the oral | just gets metabolized ineffectively? | uf00lme wrote: | Thank you for sharing, if this is true it will win me a | really good arguement. I know someone who hates | Phenylephrine, so I will buy some nasal spray just to | surprise them. | lokar wrote: | Correct | nonethewiser wrote: | Oh wow, didn't realize this | tshaddox wrote: | If only there was a simple physical maneuver that could | transform the location of something from behind a pharmacy | counter to the customer-facing shelves! | nonethewiser wrote: | I always assumed that was the whole point. A placater. This | probably isn't even news to them. | saulpw wrote: | I believe the official word is "placebo" :) | blobbers wrote: | https://www.nbcnews.com/health/health-news/fda-panel-says-co... | -- "Phenylephrine -- found in drugs including Sudafed PE, Vicks | Nyquil Sinex Nighttime Sinus Relief and Benadryl Allergy Plus | Congestion -- is the most popular oral decongestant in the United | States, generating almost $1.8 billion in sales last year, | according to data presented Monday by FDA officials." | | * Wasting peoples time and money while consuming their $. | | * key part is consuming their $. | calvinmorrison wrote: | Trust the science guys! | scarface_74 wrote: | Science has been saying that Phenylephrine was ineffective for | years. The news here is that it took so long for the FDA to | officially admit it. | convolvatron wrote: | that wasn't a decision informed by any kind of research | lokar wrote: | But it was, it's just really old research | par wrote: | It's never worked for me and I didn't understand why people | bought these products. | scarface_74 wrote: | This is no different from "cough syrup", that doesn't work | kstrauser wrote: | They were marketed as working and have similar side effects as | pseudoephedrine-based products. I'd think those would be pretty | strong contributors to a placebo effect. | adamredwoods wrote: | Knowledge. Availability. Marketing. FDA. | | But honestly, I would direct my anger at the lack of | transparency and oversight in the supplement market, rather | than this. Glad the FDA has finally corrected course. | greatpostman wrote: | Probably will get downvoted for this, but a bunch of my family | members are pharmacists. Their quiet opinion is that most | pharmaceuticals don't work. Even the ones that are thought | effective. The data is anecdotal, but is over 15 years of | watching people come in for prescriptions. The other aspect, is | they say it's mind boggling to see what kind of drugs people are | on. | jonnycoder wrote: | Anecdotally the most useful drugs are antibiotics and | corticosteroids. Other remedies I found truly impactful are | neti pot usage everyday if needed and zone 2 daily exercise. | h2odragon wrote: | Placebo effect is strong. | | "Medicine" never wandered that far from religion, after all. | scarface_74 wrote: | Of course you are going to get downvoted and you should. | | I know my blood pressure medicine works for instance because | every time I talk to my doctor about reducing it or getting off | it, I monitor my blood pressure and it spikes. | | I know psuedophredrine works. | | And your data is just that, "anecdotal", it's no better than | the people doing "research" by watching YouTube on the toilet. | freedomben wrote: | GP didn't say your blood pressure meds or pseudoephedrine | don't work, they said "most drugs don't work." I would have | preferred some specifics, but we didn't get them so you | shouldn't argue as though they were given. | onco wrote: | Ehh. Your experience is similarly anecdotal. You ignore that | there is a placebo effect, blood pressure is a surrogate | marker for cardiac events, and drugs can have adverse | effects. | | It's best to look at all cause mortality in your example. | Many studies have looked at that endpoint if you are curious. | scarface_74 wrote: | It's "anecdotal" that I can measure with a machine that | gives a number and that I track over a period time? | | It's not like I said "I feel better" when taking it. So my | blood pressure just magically comes down after I'm taking | it? | MockObject wrote: | What did you think "anecdote" means? Why wouldn't your | individual report of your meter measurements count? You | haven't shown us the data, shown that you've controlled | for confounding factors, or anything. | | You posted an anecdote. | scarface_74 wrote: | https://www.ahajournals.org/doi/full/10.1161/01.HYP.00001 | 036... | bee_rider wrote: | I mean it is technically anecdotal evidence; it is just a | story about you and wasn't collected in any systemic way, | we have no way to abstract it. | | But there's also lots of clinically collected evidence | behind blood pressure medicine, right? I don't see why | anyone would have reason to doubt you. | ShamelessC wrote: | This is a really bad take. I hope you or your family members | reconsider. Also maybe they shouldn't hold negative judgemental | views on the customers that make their job possible? | GuB-42 wrote: | This is also a bad take. | | GP specifically mentioned prescriptions, so the | customer/patient is not at fault here, if there is a judgment | here, it is toward the doctors. And just because something | earns you money doesn't mean it is above criticism. | | I still don't share GP's opinion in that _most_ medicine don | 't work. I think _some_ don 't work, and some is misused or | used preemptively, therefore showing no effect. And I am also | dubious about a lot of comfort medicine, but for most people | I know who are under proper prescription, it is obvious that | it works, it includes psychatric medicine. | m463 wrote: | I think american medicine just chooses prescribing medication | first. | | Patients are definitely more likely to take a medication than | change their behavior. Patients also ask for medication. And | then there's the whole pharmaceutical system. | | My personal experience is that many older people I've known | have a startling number of bottles of medication they take | every day. | | I also know some older people that have exercise and eating | right as part of their regimen and rarely take any medication. | 303uru wrote: | >I also know some older people that have exercise and eating | right as part of their regimen and rarely take any | medication. | | Not to be pedantic, well actually let's be. But this is | pretty poor medical thinking. Are patient's not on meds at | advanced age because they exercise? Or are they able to | exercise because they're otherwise healthy and feel good? | This kind of simplifying causes a lot of harm in medicine and | a lot of patient blaming. | m463 wrote: | My observation seems to be two broad groups. Maybe the fit | ones eventually become the bottle ones? Maybe the no-bottle | ones are resisting medicine? | | One thing is for certain - it makes me uncomfortable how | many different medications some people take every day. | matwood wrote: | I don't take many medicines and then only ones that I have | found to work for me. Pseudoephedrine absolutely does work, | phenylephrine does not. | 303uru wrote: | As a pharmacist, I can't help but laugh. I'm guessing they're | quiet because their peers see them as quacks. Most don't work | huh? Cancer death and morbidity rates are falling like a rock. | Antibiotics? Antifungals? Hep C cured? HIV/AIDs guaranteed | death turned to decades of symptom free life? Hell, we wouldn't | have an opioid crisis if the damn things didn't work. The | premise is just laughably silly. | | It seems some people see that placebo's can have effects in a | select few paradigms of care and extrapolate that to "all drugs | must be placebos." Which is just smooth brain conspiracy talk. | kstrauser wrote: | I'd like to think you've heard them grousing about specific | things like this and misinterpreting that as a general | mistrust. Every medicine I've ever taken had an objective, | quantifiable effect on me. | | Except for phenylephrine, of course, which only served to teach | me how to ask the pharmacist for the good stuff. | jrockway wrote: | I think that people are hoping for larger effects. I have | been a lifelong allergy sufferer. Many years ago, my doctor | gave me an intranasal antihistamine. It came with a piece of | paper about the studies done on it. Patients rated their | symptoms on a 1-5 scale, and the study observed the ratings | with and without. The placebo group rated their symptoms, | say, 4.0. The people on the drug rated them 3.5. I would say | that's exactly the effect I got from the medication, an | improvement, but not a complete elimination of symptoms. | Certainly some people are going to go to their pharmacist and | say "this does nothing", and that might lead them to believe | it's all a scam. It's not really a scam, it's just that | expectations were not set correctly. People want "this will | cure you and you'll get a gold metal in the Olympics!" but | all we have is "this will make life slightly less miserable". | | It's probably the same for many conditions and medications. | Antidepressants don't turn you into someone who is always | happy. Painkillers don't make recovering from surgery a joy. | I think that people even had the same feelings about COVID | vaccines; they wanted "one shot and you'll never be sick | again", but all we got was being 90% less likely to get COVID | or whatever. None of this makes these things a scam. Rather, | they are imperfect technologies that we work to improve. | Silver bullets are rare, but they do exist. Just not all the | time. (Have you died from strep throat or polio recently? | People used to all the time!) | kstrauser wrote: | Huh, that's an interesting point and I bet there's | something to it. I'm taking OTC allergy meds right now but | still have _some_ symptoms; it's not an instant and | complete cure. Anyone who expects an instant improvement | from most kinds of medicines is going to be sorely | disappointed, and doctors need to diligently explain that | such-and-such will _help_ a problem, not immediately fix it | altogether. | jrockway wrote: | Yup, exactly. OTC allergy meds are often an improvement; | I certainly notice if I forget to take them. But it's not | like my nose turns into the air-intake equivalent of one | of those helicopters that sucks up water for fighting | forest fires. Such a technology may not exist ;) (That | said, pseudoephedrine is pretty good for me on the worst | days.) | nradov wrote: | We now know that most published medical research findings are | false. That likely includes many of the studies that the FDA | relied upon to approve certain drugs. | | https://doi.org/10.1371/journal.pmed.0020124 | | My impression is that the situation has been improving in | recent years. Between study pre-registration, larger subject | groups, and greater statistical rigor I have a lot more | confidence that drugs getting approved now actually do what | they say on the label. Of course, this is also part of the | reason why it now costs >$1B to bring a new drug to market. | scarface_74 wrote: | It's been known for years that Phenylephrine is useless and | was just kept on the market because of lobbying. | flarg wrote: | Pharmacist here. Most pharmaceuticals do actually work but | finding the right one for a patient can sometimes be harder | than you would think. I suspect your family members are quiet | about their opinions for a very good reason. | adriand wrote: | It's really difficult to untangle the placebo and nocebo | effects. I was recently surprised to learn there are studies | showing placebos can be effective even when people are told | they are taking a placebo. Ie literally telling people, "take | this pill every day, but please understand it's a placebo and | has no active ingredients whatsoever". And yet, their symptoms | improve. The theory is that the subconscious mind acts on some | information (white-coated professional giving me a medicine) | without being fully affected by the conscious mind's knowledge | that the pill ought to do nothing. | | It's even possible that the negative attitudes of your | pharmacist family members toward the medications their patients | are taking are affecting their efficacy! | jtriangle wrote: | You're missing the part where they told participants what the | placebo effect was, and that taking the placebo would make | them feel better in spite of it having no active ingredients, | and it did indeed do so. | cheald wrote: | "Suggestible You" by Erik Vance explores this phenomenon, and | really turned me around on placebos. I'm, generally speaking, | not particularly susceptible to placebo effects, and always | kind of (arrogantly) chalked placebo effects up to people | just being gullible and wanting to see something that wasn't | there. It turns out there are actually genes that might be | responsible for the physical impact of the placebo effect in | the brain. | | There's an enzyme - catechol-O-methyltransferase - which is | coded for by the COMT gene. This enzyme catalyzes the | metabolism of dopamine in the brain. COMT has three common | variations - AA/AG/GG - which substantially alters how | effective the enzyme is at metabolizing dopamine. AA results | in significantly reduced enzyme activity, which can result in | dopamine built-up in the brain, which results in increased | sensitivity to stress, anxiety, and pain, but comes with the | bonus of enhanced cognition, motor skills, and memory. | | AA genotypes also tend to be "placebo responders", while GG | genotypes tend to be non-responders. This tends to imply that | placebo responsiveness isn't purely psychological, but | physical - and indeed, it turns out that in AA "responders" | you can turn off the placebo effect by administrating | naloxone (which works by binding to opioid receptors)! | | This has really interesting implications for pharmacological | research, too - if there are people who are genotypically | predisposed towards or against placebo effects, then a drug | trial that stacks responders in the trial group and non- | responders in the placebo group which would produce a drug | efficacy signal that could be _just_ the placebo effect. | bee_rider wrote: | It seems like a wild breach of professional ethics to sell | medical treatments that they don't believe will help their | patients. Did they mistake themselves for cashiers or | something? | robg wrote: | My kids seem to derive benefit from chewable tablets which I tell | them to suck on. Curious if anyone has found different research | on metabolization in the mouth versus gut? | [deleted] | rscho wrote: | Oral and rectal blood goes directly to the greater circulation | without going through the liver (that metabolizes most toxins) | first. | wrs wrote: | From the referenced paper: | | "Other examples of scientifically proven ineffective OTC | medications include guaifenesin as an expectorant, | dextromethorphan as a cough suppressant, and chlorpheniramine for | cold symptoms." | mattmcknight wrote: | Hoping this adds to the pressure to get pseudoephedrine back on | the shelf. | omginternets wrote: | This strikes me as an example of a larger phenomenon. Take for | example the counter-insurgency wars that have become normalized | since 9/11. In these conflicts, there is enormous pressure to | minimize casualties because these directly undermine the | political will to conduct military operations. As such, the | strategic objectives eventually degenerate to mere "presence", | and commanders are effectively unable to pursue the kinds of | operations that might actually translate into military success. | | Similarly, we've collectively decided that selling an OTC drug | that is effectively inert is somehow preferable to selling a | useful-but-abusable substance, at which point one might argue | that it's _even safer_ to sell nothing at all. | tptacek wrote: | (1) I think there's pretty wide agreement that selling Sudafed | PE is worse than selling nothing at all, and I'd sort of expect | it to be off the shelves sometime soon (it should have been | much earlier than this). | | (2) "Selling nothing at all" is actually not the policy. Real | Sudafed is simply a behind-the-pharmacy-counter drug. You don't | need a script to get it (plenty of non-abusable drugs do | require scripts, a much higher bar). Real Sudafed is to a first | approximation available to everybody. | skipkey wrote: | Not sure if it's still the case, but a few years ago I was | traveling and staying overnight near St Louis, and was | shocked to find that it actually required a prescription | there, but only in the county that St Louis was in. | omginternets wrote: | > Real Sudafed is to a first approximation available to | everybody. | | I didn't actually know this, and it's good to know. That | said, I'm not certain that most people are aware that it is | available without a script. Maybe I'm wrong. | tptacek wrote: | If you walk up to the pharmacy counter at any Walgreens or | CVS, literally the first thing you're going to see is a | shelf of decongestants. | clipsy wrote: | I can't speak for your Walgreens or CVS, but at mine | you'll see a shelf full of phenylephrine-based | decongestants only, because the pseudoephedrine-based | ones are behind the counter and out of sight. | idlewords wrote: | Lots of pharmacies display cards in the regular | decongestant section that you can take up to the counter | to get the ID-required OTC pills. It adds an annoying | step, but they are hardly out of sight. | orangepurple wrote: | The Dutch take this to the extreme, where the actually | effective anti-cough medication dextromethorphan is completely | unavailable, but complete bullshit herbal mixes which claim to | help are a dime a dozen on every store shelf. I can't even | imagine the amount of needless suffering people with chronic | cough go through in the Netherlands. | rscho wrote: | The effectiveness of dextrometorphan is... underwhelming in | most people. But you are correct that no effective cough | suppressant is available OTC in Europe. | wrs wrote: | Dextromethorphan is one of the other "scientifically proven | ineffective" OTC products mentioned by the authors. | | Once when I had a quite severe cough I did some (highly | motivated) research and my conclusion was that there is no | such thing as an effective cough suppressant. At least, | none that isn't also a consciousness suppressant. | rscho wrote: | Low dose codeine is notoriously efficient. | kstrauser wrote: | The risk:reward ratio is infinite -- it has adverse reactions but | essentially no benefit. It's about as much "medicine" as was | drinking radium. | | Good riddance. | tech_ken wrote: | "Phenethylamines I Have Known and Felt Kind of Meh About" | jkingsman wrote: | I laughed out loud. | | For those unaware, "Phenethylamines I Have Known and Loved" | (aka PiHKAL) is Sasha and Ann Shulgin's book that is half semi- | fictional autobiography and half detailed synthesis and in-vivo | effects observed in the enormous family of psychoactive | phenethylamines. The autobiography part is only available in | print, but the chemistry section is freely available[0]. | | There is a sequel, a similar book for tryptamines called | TiHKAL[1]. | | They are stunningly bold in their chemistry, administration and | discovery of novel drugs, and in making good science available | under dubiously legal circumstances. | | [0] https://erowid.org/library/books_online/pihkal/pihkal.shtml | [1] https://erowid.org/library/books_online/tihkal/tihkal.shtml | tech_ken wrote: | Psychoactive phenethylamines??? I've never heard of that, I'm | just really into nasal decongestants. | sitzkrieg wrote: | cant wait for TIKFKMA | hn8305823 wrote: | If you like the author Derek Lowe's writing like I do you might | like his "Things I won't Work with". Here's one of my favorites: | | https://www.science.org/content/blog-post/things-i-won-t-wor... | kstrauser wrote: | > If the paper weren't laid out in complete grammatical | sentences and published in JACS, you'd swear it was the work of | a violent lunatic. I ran out of vulgar expletives after the | second page. | | I love his work. | buildsjets wrote: | The fact that phenylepherine is ineffective is quite old and has | been common knowledge for many years. What is news is that the | FDA is finally acknowledging it. I've maintained my own reserve | of pseudoephedrine for years. | | https://gizmodo.com/report-many-over-the-counter-decongestan... | | https://www.forbes.com/sites/daviddisalvo/2015/10/26/the-pop... | | https://www.newscientist.com/article/2089555-breaking-bad-sn... | cheald wrote: | Indeed. I've known that phenylepherine is worthless for a long | while, and just make it a point to buy a pack of the real stuff | every 6 months or so, so that I always have it on hand when I | need it. In my state, it's controlled - you have to get it from | a pharmacist (though you can do so without a prescription) - | they take your driver's license and don't allow you to purchase | it too often. | anamexis wrote: | That is a US federal law (the Combat Methamphetamine Epidemic | Act of 2005) | jimmaswell wrote: | And now we've got a fentanyl epidemic filling the void and | even more power handed to Mexican cartels since meth got | harder to produce domestically. Drugs continue to win the | war on drugs. | LordDragonfang wrote: | It's worse than that, because it's not actually a void | that's being filled - meth production simply switched to | a different pathway that's even more effective and | potent. There's actually _more meth_ than there was | before the ban. | | https://dynomight.net/p2p-meth/ "The main thing about P2P | meth is that there's so much of it" | akira2501 wrote: | You can't fight a war against inanimate objects. You can | fight a war against drug addicts. You cannot possibly win | a war against drug addicts without addressing the | fundamental problem. | AtlasBarfed wrote: | The problem with decriminalization/legalization is that | those are the most abused drugs. | | However, our drug war is causing Mexico to descend in to | anarchy and people are dying by the thousands, or living | in total fear of cartels that we trained in the School of | the Americas. | | Thus, I conclude we have to decriminalize and treat our | addicts. Enforcement is not working. If we had a sane | drug policy 30-40 years ago, Mexico might be a healthy | vibrant trading partner. | underlipton wrote: | The "fundamental problem" is the breakdown of community | (drug abuse being primarily being a function of the | existence or lack of interpersonal involvement and | responsibilities that would preclude spending time and | money on them). People who are comfortable huddling in | their cars, homes, and exclusive social clubs, and who | would rather spend money on cops rather than social | programs, aren't going to like the fix for _that_. | robocat wrote: | > social programs | | Do you have any links to social programs that have | successfully dealt with meth addiction? | | Can't say I have seen any locally (New Zealand) and we | are a country more likely to see such programs? | ohthehugemanate wrote: | Do you have a source for this? | | > drug abuse being primarily being a function of the | existence or lack of interpersonal involvement and | responsibilities that would preclude spending time and | money on them | | AFAIK there have always been addicts in every culture. | Alcohol, various drugs, and strongly self destructive | behaviors are not recent additions to the human | experience. But I don't know any if the numbers or the | research on this root cause you mention. | jasonfarnon wrote: | "AFAIK there have always been addicts in every culture." | | Surely you would agree that there the proportion of | addicts varies by culture and society, that the US for | example has a much higher proportion than many poorer | nations? I don't know about the first comment's claim | that lack of interpersonal relationship is the root | cause, but a strong social component looks obvious to me. | post_below wrote: | I suspect they're referring to experiments like the | famous "Rat Park". There is clearly a strong social and | environmental component to addiction susceptibility, at | least in rats. | | I don't know if I'd go as far as to say it's _the_ | fundamental problem, but definitely a major factor. | CoastalCoder wrote: | Until the past few years, I held a similar view. I.e., if | we could just dry up the demand for the product, the rest | of the system would crumble. | | Then the whole Sackler / Oxycontin thing came to light. | And I saw (well, second hand) a normal person get hooked | on pain meds after back surgery, thanks to those | assholes. And they're not in prison. | | That's when I concluded that we lack the collective will | to take the necessary steps to fully stop the trade of | addictive drugs. | JoeAltmaier wrote: | Most of us cannot make these drugs ourselves. To restrict | them effectively would certainly curtail their abuse? | fragmede wrote: | Vice or someone reports that you can make the new | formulation, in a backpack, in a Walmart bathroom, with | supplies you haven't even bought yet. Given that, and, | well, the Internet, I'm sure making it isn't hard for an | addict to learn how to make these drugs, even though it's | not common knowledge and you and I can't do it. | p_j_w wrote: | "We just need to wage the war on drugs harder, then it | will surely work." | 01100011 wrote: | Shake-n-bake meth was relatively easy to do for the | average methhead. | | Also, do not underestimate the capabilities of a meth | user when they get fixated on something. | lazide wrote: | Bonus - meth causes among other things incredible focus. | paiute wrote: | I've noticed the comments on hn become more meth curious | over the last couple of years... I know the state of CO | has been pressuring doctors not to prescribe aderall. | Mine got taken away because i only took it when i needed | to force myself to really work (a few times a month). Now | i use pseudoephedrine. | MockObject wrote: | Hard drugs have been illegal in America for generations, | and yet every city has had a junkie community all this | time. How much more failure must we entertain? | akira2501 wrote: | The presumption here is that an addict, unable to get | their "favorite" drug, will now just stop doing drugs | entirely. This is not the case. | | Drugs can also be stolen, from homes, and from | pharmacies, and from ambulances. | | There are way more vectors than people care to ponder. If | you've ever had an addict in your life, you're forced to. | cyberax wrote: | Meth is not harder to produce. It's now mass-produced | from P2P, with chiral purification using various methods | (like pulling one enantiomer with tartaric acid). | tptacek wrote: | Yes. But now it's produced in para-industrial labs, | mostly in other countries, rather than in apartments and | back yards, where those ad hoc labs were actually real | public safety problems. | bee_rider wrote: | I wonder if the users are sad to miss out on the | artisanal small-batch experience. | AnthonyMouse wrote: | Isn't increased financing of major drug cartels a serious | public safety problem? | | Weren't most pseudoephedrine-to-meth operations in rural | areas or otherwise situated away from the general public | to avoid detection? | _a_a_a_ wrote: | I'm curious about the chemistry here (though I have very | little chemistry background), so, bearing in mind that I | have _zero interest_ in producing methamphetamine, | perhaps you can elaborate a little: | | - I can't see how Phenylacetone can have chirality | | - I don't understand how any enantiomer of P2P (if one | exists, see above) can be selected for specifically via a | chemical reaction, especially here with tartaric acid, | which is a chiral molecule itself, so surely you would | need a specific enantiomer of tartaric acid to start | with? | | I'm sure these are basic questions, I'm just a dabbler. | Any links welcome, no problem if this is out of place for | HN.TIA | cyberax wrote: | P2P doesn't have chirality, but methamphetamine does. Any | carbon atom with 4 different groups attached to it will | always be chiral, in meth it's the carbon next to the | nitrogen. It has: methyl group, phenol group, hydrogen, | and the amino group. | | > - I don't understand how any enantiomer of P2P (if one | exists, see above) can be selected for specifically via a | chemical reaction | | You just react P2P and get a racemic mix of L- and D- | enantiomers of meth. Then you react it with tartaric | acid, which will preferentially react with the "right" | meth. | | > tartaric acid, which is a chiral molecule itself | | Ah, I see the confusion. Tartaric acid derived from | biological sources consists of just one enantiomer, | that's why you can use it to do chiral resolution. | supportengineer wrote: | I would like to see "taxes" be the winner of the war on | drugs | nonethewiser wrote: | You can buy 6 boxes of sudafed per month (24 doses each). | Isn't that more than the recommended (and probably safe) | daily limit? I dont doubt your intentions but I don't think | you actually need 6 boxes per month + a stash. | cheald wrote: | The point is more to not be in a position to have to go out | and buy some when I'm feeling cruddy. Since it's | controlled, I can't just have some shipped to my door when | I'm laying in bed sick. I just got in the habit of picking | it up periodically to ensure that it's on hand when I need | it. | lazide wrote: | Yup, nothing says fun times (and mass spreader) like | sitting in line and doing paperwork while sick. | Spooky23 wrote: | When your kid gets sick late and the pharmacist leaves at | 6, why not have a packs of pills wherever you are. | | Or god forbid, you run out at work and forgot the CVS takes | a siesta nationwide at 1:30. | PixyMisa wrote: | They mention one box every six months, which is entirely | reasonable. | criddell wrote: | For an individual, perhaps. But if your house has a lot | of people in it who get sick at the same time because | they live in close quarters, then maybe not. | 13of40 wrote: | Not sure how widespread it is or if there's a federal | limit, but my state (Washington) even makes it illegal to | possess more than 15 grams of it. | dmazzoni wrote: | If my math is correct, 15 grams would mean more than 20 | normal boxes of Sudafed, if each box is 24x 30mg. | | I usually buy boxes of 48x 30mg, but even then I'd have | to stash 10 boxes for it to be illegal. | jacobsimon wrote: | I just came here to say that I actually find phenylephrine | nasal spray quite effective - but I use it for a different use | case: stopping nosebleeds quickly. It's quite effective at that | and came recommended by an ENT, so I do believe it's an | effective vasoconstrictor when applied locally and I'm glad | it's available. | raverbashing wrote: | As per the article, you would likely be correct | rscho wrote: | You are correct. | kstrauser wrote: | That's legitimate. The FDA's issue with oral phenylephrine is | that it's metabolized in the gut before it gets to the sites | where you want it to work. | cyberax wrote: | I wonder if it will work as a suppository. | wmanley wrote: | It's worth a try. I'd recommend buying a separate spray | for your nose though. | kstrauser wrote: | "This medicine smells like crap." | phone8675309 wrote: | Reminds me of the old joke: what's the difference between | an oral thermometer and a rectal thermometer? | | Answer: the taste | tlavoie wrote: | "Oh, Dad..." | | Seriously, my late father _loved_ that joke, as do I. | phone8675309 wrote: | I heard that for the first time from my dad. It's a | certified dad joke. | tlavoie wrote: | As a certified dad, I have to agree. | joe5150 wrote: | Phenylephrine is a popular topical and suppository | treatment for hemorrhoids. | mattkrause wrote: | Yup! | | https://my.clevelandclinic.org/health/drugs/20786-phenyle | phr... | 1MachineElf wrote: | It helps me a lot with post-nasal drip. | purpleblue wrote: | The fact that drug companies' "tests" indicated that it worked | shows how corrupt the system is. There is in fact no way it | could have worked, yet the data they provided decades ago | showed that it did. This is why we should never, ever trust | drug companies, it's just kind of funny that somehow in the | last few years some people decided that Pfizer was a hero | instead of a psychopathic (in the purest clinical definition) | money machine. | paint wrote: | I mean, I get the reason behind it and I honestly don't know if | it's a good or a bad thing, but the idea of pseudoephedrene | sales being monitored like that is so foreign to me. I bought | cold medication in pharmacies in 3 different countries always | asking specifically for pseudoephedrine and it never occured to | me that was a meth cook thing. | JJMcJ wrote: | You can still get pseudoephedrine, for example Claritin D, the | D for decongestant. It's not by prescription but you have to | sign for it at the pharmacy desk, present ID, and I believe | it's reported to FDA/DEA and there are limits to how much you | can buy per month. | tyingq wrote: | That's mostly right, but it's not reported to anyone. It came | from the _" The Combat Methamphetamine Epidemic Act of | 2005"_. | | If you want to sell pseudoephedrine, your org has to "self | certify", keep a logbook purchasers have to sign, require ID, | enforce the purchase limits, train employees, etc. But, the | logbook doesn't go anywhere unless some investigation or | audit prompts that. So, if you're a really determined cooker, | you can still go to a bunch of different stores...though | you're leaving a paper trail. And some big brands might | cross-check and have an org-wide electronic log book. | | https://www.deadiversion.usdoj.gov/meth/index.html | tshaddox wrote: | > So, if you're a really determined cooker, you can still | go to a bunch of different stores...though you're leaving a | paper trail. | | Isn't meth a lot easier to come by these days? I have to | imagine it's more convenient to cook street meth back into | Sudafed to fix your stuffy nose than it is to cook Sudafed | into meth to get your fix. | NickNameNick wrote: | see "A Simple and Convenient Synthesis of Pseudoephedrine | From N-Methylamphetamine" | | https://improbable.com/airchives/paperair/volume19/v19i3/ | Pse... | pengaru wrote: | A "cook house" burned down from me a couple months ago, | so there's clearly still domestic cooking going on here | (Cali hi-desert around JTNP). | dragonwriter wrote: | > I have to imagine it's more convenient to cook street | meth back into Sudafed to fix your stuffy nose than it is | to cook Sudafed into meth to get your fix. | | Maybe, but more people are willing to do felonies to | get/sell meth than to do the same thing for | pseudoephedrine, and its just as illegal to by meth to | cook pseudoephedrine as to cook meth from | pseudoephedrine. | tyingq wrote: | >but it's not reported to anyone | | I'm apparently wrong about that. Seems NPLEX/MethCheck was | made a requirement US state by US state over a number of | years. So there's no national monitoring, but many (most?) | US states require it and give law enforcement access. And | like most things set up that way, enforcement and | monitoring varies by state/county/etc. | dragonwriter wrote: | > That's mostly right, but it's not reported to anyone. | | IIRC, its reported to a centralized state database in | (near) realtime in some states, but in any case it is | definitely the case that chain pharmacies generally have | their own electronic tracking and flagging to avoid getting | nailed the way CVS did [0], which may be shared systems | like MethCheck [1], which can also be used by independent | pharmacies. | | So, you've got to choose your targets carefully for your | "shop at lots of different pharmacies" plan. | | [0] https://www.justice.gov/archive/usao/cac/Pressroom/pr20 | 10/14... | | [1] https://totalverify.equifax.com/solutions/methcheck | terribleperson wrote: | I was under the impression that there are state-level | databases in some states that actually track sales. I am | likely incorrect, since a quick google doesn't find | anything. | alex_young wrote: | Doesn't it take a ton of the stuff though? I thought people | stealing pallets of it was the only viable way to source | enough of it. Seems like just having some inventory control | is a sufficient deterrent. | tyingq wrote: | Googling around a bit, a typical 20-count box of | pseudoephedrine (2.4 grams of "active ingredient") yields | roughly 2 grams of "high quality" meth with the shake- | and-bake/one-pot method. Not the only ingredient, of | course, but close to 1:1 of in/out. | dylan604 wrote: | Depends on how much you're wanting to make. Sending | smurfs to buy/steal from several locations was a thing | for a while. But these cooks were never going to be | cartel level secret lab under the commercial laundry | location. These were the cook a batch in the trailer out | back type of cooks. Jesse before teaming up with Mr White | Damogran6 wrote: | I haven't tried lately (moved on to aother anti-histimines) but | with a Driver's license, I could pretty readily get ahold of | it. | | Then had to disengage based on what it was doing to my blood | pressure. | jamiek88 wrote: | Were you using a 'D' version? Like Claritin-D? I got that by | accident once and my heart pounded like I was on speed. I'm | highly sensitive to that stuff, same at the dentist the local | anesthesia makes my heart race. | | Third generation antihistamines are amazing. | | Zyrtec changed my life. | | I used to majorly struggle with 'hayfever' as we called it, | to the point it ruined my summer. | | I was miserable as a child, only winter gave relief as I was | allergic to both tree and grass pollen. | | Then zirtec came out. Originally as a prescription and that | coupled with Flonase completely got rid of my symptoms | without fatigue! | | The old antihistamines I'd have to take so many to get help | that I could barely keep my eyes open. | | Then I moved to Texas from UK and the flora was completely | different thus I didn't react at all! | | It was heavenly. | | Then I moved to Oregon and many, many, trees and plants are | the same as in the UK and my allergies came back. | | Much weaker this time as a lot of people age out of these | types of allergies, as my mother did. | | OTC zirtec sorts it out. | | Anecdotal really but I thought I'd share. | hn_throwaway_99 wrote: | > my heart pounded like I was on speed. | | Pseudoephedrine literally is an amphetamine, and famously | the precursor to meth(amphetamine). I don't have a similar | reaction but I'm not surprised some people are more | sensitive. | Damogran6 wrote: | Yeah, I cycle between kirkland nasal spray and eyedrops. | | And now going back on-site, the headcolds you pick up with | proximity to people, Sudafed was AWESOME, it's just a pita | to get and I shouldn't use it a lot. | p1mrx wrote: | Note that Zyrtec's patent expired in 2007, so it's now | available as generic Cetirizine. | kerblang wrote: | Surprised this is the only comment mentioning the amazing | Zyrtec (with Cetirizine) (probably misspelled, even with | the bottle in front of me), in poem form. | | But yeah it does work, smashingly. Also I found changing my | AC air filter helped. | jeffbee wrote: | > I've maintained my own reserve of pseudoephedrine for years. | | Synthesizing it from widely-available and affordable street | drugs, I assume. | | https://improbable.com/airchives/paperair/volume19/v19i3/Pse... | hn_throwaway_99 wrote: | Lol, that article is really brilliantly hilarious. SNL should | do a "Bizarro-World Breaking Bad" where Walter and Jesse go | around buying up crystal meth so they can cook Sudafed. | nimish wrote: | Easily the best example of why the stupid federal law | limiting access to a useful decongestant backfired. | hn_throwaway_99 wrote: | You realize your "best example" is a joke, right? | nimish wrote: | Yes, the punchline of the joke is that synthesizing | pseudoephedrine from meth is more convenient than buying | Sudafed after the law on restricting sales ostensibly to | reduce meth production. | | i.e., the law didn't do much to halt meth production but | did put a bunch of barriers around a useful drug _and_ | promoted the use of phenylephrine instead, a useless drug | in pill form. A huge net negative. | tptacek wrote: | In what way did it backfire? It's a useful decongestant. | But it also basically _is_ methamphetamine, with just a | couple easily-reversible Rubik 's turns to make it a | decongestant instead of an ultra-powerful stimulant. | amanaplanacanal wrote: | Didn't prevent people from getting meth, but did allow | drug companies to make millions selling a useless | compound. I doubt that was the intent of the legislation. | tptacek wrote: | The same company sells both compounds. I don't think this | was a huge moneymaker. I think the PE thing was just | there to retain the sales that moving Sudafed behind the | counter sacrificed. That doesn't make it OK, but it does | sort of argue against the idea that the regulation was | just a moneymaking scheme. | amanaplanacanal wrote: | Agree with that. Just more failed war on drugs stuff. | tptacek wrote: | Only if you judge the outcome strictly by how many people | are consuming meth, but there are other important | endpoints to this policy, like "reducing the number of | backyard meth labs", which are problems in their own | right. | fragmede wrote: | Water, consisting of _hydrogen_ "basically is" and | explosive, as is table salt, consisting of Sodium, which | explodes when coming into contact with water. How can we | let these two dangerous substances go unregulated! Think | of the children! who will get to have interesting high | school chemistry labs, that is. | | That Sudafed "basically is" meth misunderstands | chemistry, and the resourcefulness of the real life | Walter Whites of the world. Hells Angels and the Cartels | operate under the nose of the DEA so there's no way meth | or drugs are going away. It's time for the government to | admit they lost the current battle of the war on drugs to | drugs. Current tactics aren't working and it's time to | take the war to the demand side of the equation. Cut down | the demand for drugs by getting addicts off opiates and | stimulants with an army of therapists and councilors and | rehab programs. With a large helping of harm reduction | and government assistance. Wishful thinking, I know, but | making all forms of basic chemistry illegal is like | trying to make water not wet. | tptacek wrote: | No, this analogy isn't plausible. | buildsjets wrote: | At least if I followed that path, I would not be required to | have my purchase recorded in an insecure government database. | mikeweiss wrote: | Something tells me there is more than just a government | owned database involved. Likely at least one third party | vendor system... Not to mention every pharmacy chain | probably stores or at least transmits it through one their | own systems. | tptacek wrote: | Why are you worried about the government recording your | usage of Sudafed? What is anybody going to do with that | information? Serious question! I understand the principle | involved; I just want to know if there's some practical | concern. | kstrauser wrote: | For me, it's a matter of _it's none of their business_. | No one's accused me of making meth, but here's all my PII | in a database "just in case". | | It's literally harder for me to buy cold medicine than a | gun. I hate everything about that situation. | tptacek wrote: | I mean, the reason they keep the database is especially | clear here, right? They're just trying to enforce a rate | limit. It's the most obvious public policy response you | can have to "a drug that in small quantities is a useful | decongestant, but in moderate quantities or above is an | ultra powerful stimulant whose abuse is ravaging parts of | the country". | kstrauser wrote: | I get it. I just find it frustrating, and I'd like to | know that my PII was removed after the rate limit period. | tptacek wrote: | I agree with this! | phone8675309 wrote: | The primary question to me is whether the risk of data | breech outweighs the harm from not keeping the data, and | while 20 years ago this tradeoff may have made sense, I'm | not so sure it makes sense now. | akerl_ wrote: | If the data is breached, an attacker learns... that | sometimes you have a cough? | phone8675309 wrote: | In addition to at least your full legal name, birthday, | gender, home address, driver's license number, telephone | number, location(s) you've been to buy medication, and | possibly email address. | tptacek wrote: | You do not in fact provide an email address to buy | Sudafed. The rest of that information is for most people | already a public record. | | I'm not saying that makes it OK to assemble into a | database, and I think the point about amassing PII is | well taken, but I think people are probably | overestimating the value/hazardousness of this particular | data set. | kstrauser wrote: | ...and your SSN, and your driver's license info, and all | the other personally identifying information they collect | and store in the DB. | phone8675309 wrote: | Generally not your SSN - I've never had to give it for | Sudafed - but at least full legal name, birthday, gender, | home address, driver's license number, telephone number, | location(s) you've been to buy medication, and possibly | email address. | | Much of which would be covered as PII and PPI, and, in | combination with info from other other data breaches can | tell someone a lot about you. | civilitty wrote: | It's legal defense in depth, similar to not talking to | police without an attorney present. All it takes is an | overzealous prosecutor or social worker to ruin someone's | life by misrepresenting some random circumstantial facts. | This happens all the time in drug cases, for example, | where the possession of innocuous items like small | baggies allows prosecutors to take charges from regular | possession to intent to distribute or trafficking. | | Even if someone isn't doing anything illegal, since >90% | of cases end in plea deals it's good legal hygiene. | [deleted] | fluidcruft wrote: | Every database that contains your PII increases your | exposure to a breach and likelihood of having to deal | with it. It's not the sudafed use that makes it a target: | it's the driver's license. | tptacek wrote: | Right, but this particular database presumably doesn't | have anything especially sensitive in it, apart from your | Sudafed consumption. | | I don't mean to dismiss that point, it's a valid point, | I'm just considering it closely. | fluidcruft wrote: | Anything a government uses to uniquely identify and track | individuals (i.e. driver's license) is the target. | tptacek wrote: | Until very recently, drivers license numbers were | effectively public in a lot of states (they're | deterministically generated from public information). | fluidcruft wrote: | Hey, that's pretty cool. I suppose I now know Ron | DeSantis's drivers license number up to the last digit. | And the soundex algorithm is cool (using fuzzy lookup in | a list that way to get close/vague matches is novel to me | and might be useful). I had heard of soundex but didn't | know how it worked until now. Thanks for the TILs! | | https://stevemorse.org/dl/dl.html | | http://www.highprogrammer.com/alan/numbers/index.html | lazide wrote: | Sudafed usage, probably a copy of the drivers license, | your address, any phone number you give them, and how | often you buy a drug the DEA considers a precursor to | something really terrible. | | Usually no one even looks at it (so why have it even?!?), | but when they do it's a potential intro to a full on | Brazil situation. | | Luckily the whole thing is generally considered a waste | of time, so usually nothing comes of it. But why make | yourself a target if you can avoid it? | tptacek wrote: | Well, it seems pretty obvious why they have it: so they | can match purchases of Sudafed at different retail | outlets at different points in time. And it's obvious why | they want to do that: because there really was a huge | epidemic of people making straw purchases of Sudafed to | feed large numbers of low-volume amateur meth labs. | | In the years after this policy was put into place, there | were news stories about how effective it had been in | eliminating backyard meth production. You don't see those | stories anymore. I suggest, with weak confidence, that | the reason you don't isn't that backyard meth has roared | back, but rather that it's so decisively not a part of | the equation anymore that stats about it don't really | matter. Meth comes from overseas now, not from backyards. | | That doesn't solve the meth consumption problem, but it | does eliminate one significant meth externality. | lazide wrote: | I love how we're still stuck not being able to buy | Sudafed normally though. :( | tptacek wrote: | You mean, by walking into the drug store and asking for | it? | lazide wrote: | By literally going to the aisle with the decongestants, | taking a pack, and paying for it like every other thing I | would be buying. Like every other OTC drug. | | Without having to give ID, find a pharmacist, etc. I | remember those days. They're long gone, obviously. | tptacek wrote: | "Find a pharmacist"? I can tell you where the pharmacist | is! They have their own checkout aisle! | lazide wrote: | And bankers hours, and their own waiting line! Perfect! | CamperBob2 wrote: | It's none of their business. Simple as that. | akira2501 wrote: | What they're going to do with it is prevent me from | making a purchase if I've crossed some arbitrary limit as | if exceeding that limit automatically makes me a drug | trafficker. | | From there, it's not too far of a stretch to imagine the | government assigning someone to review the list and to | expend additional investigative resources into merely | "suspicious" cases. Plenty of good tragedies start this | way. | | If the government has an interest in preventing drug | manufacture then this is the absolute worst way to go | about prosecuting that agenda. It harms the wrong people | and it offers no impediment to actual producers. | | The information cannot possibly be useful, it may become | a liability, and I didn't ask to be protected from | myself. | tptacek wrote: | They're just going to say "no", right? They're not going | to "automatically make you a drug trafficker". They're | just trying to enforce a rate limit. | akira2501 wrote: | So, if the concern isn't that I'm trafficking, then why | am I being told no? Isn't this the logic the government | used to assert this right for itself in the first place? | | Otherwise, what right is it of the government to enact | this rate limit? What interest are they protecting? How | is the rate limit decided? What can I do if I disagree | with the rate limit? Why is a private business being | burdened with the governments agenda here? | | I get where you're coming from, it _is_ a /small/ thing, | but the implications immediately become onerous if you | think about their meaning inside of a "free" country. | tptacek wrote: | You're not being told "no". You can just go buy some | Sudafed right now if you want to. It's not like there's | an application process. There is a rate limit; that's it. | akira2501 wrote: | In order for a rate limit to be effective, at some point | it has to apply, and at that point, I'm told "no." More | concretely, in order to implement a rate limit, you have | to sign an electronic log book, and the government can | view that log book whenever it likes, without any sort of | review or auditing, of course. | | This isn't the primary concern anyways, the point was, in | order to implement this seemingly simple action, many | liberties have to be sacrificed and the boundary between | innocent and criminal and government and private business | become significantly marred. | | Perhaps those sacrifices are immaterial to most lives and | could be ignored without consequence, but the originalist | in me says this is folly, and as I've shown it's easy to | think of the dangers that some innocent people might | endure as a result. Worse, comparing these dangers to the | outcomes of the system itself, the whole endeavor seems | to have negative value. | | Finally, as we've seen in history many times, now that | this electronic logbook exists, it's use will naturally | continue to expand until the government has secured for | itself the right to view nearly every single | "questionable" purchase you make at a pharmacy. | | It's an entirely unaccountable act from the government. | I'm not sure why anyone would expend effort minimizing | it. | tptacek wrote: | The only liberty being sacrificed here is showing an ID | at a pharmacy counter to get Sudafed. I'll stipulate | that's a liberty being sacrificed, but it isn't "many". | | This particular "logbook" has existed for almost 2 | decades now, and its scope hasn't creeped from there, so | your second argument is pretty easy to shoot down. | | I think the evidence pretty strongly suggests that this | policy, which was put in place to create a rate limit on | the purchase of a chemical that isn't so much a precursor | to methamphetamine as it is a slightly tweaked version | _of_ methamphetamine, is in fact simply used to create a | rate limit. | AnthonyMouse wrote: | > The only liberty being sacrificed here is showing an ID | at a pharmacy counter to get Sudafed. | | It would be interesting to know if the people concerned | about the need to show an ID to vote share that concern | about the need to show an ID for access to medicine. | | > This particular "logbook" has existed for almost 2 | decades now, and its scope hasn't creeped from there, so | your second argument is pretty easy to shoot down. | | The policy has proved ineffective at curtailing the | availability of methamphetamine while inconveniencing | honest people. That's not something the public is | clamoring for more of. | | But it never really was. It came about to begin with as | part of the Patriot Act. The lack of expansion is | unsurprising given the lack of any 9/11-style crisis to | use as an excuse in the intervening two decades. The test | is when the next one comes. | | One of the failings of the existing style of government | is that the "passage by both houses of Congress and | signed by the President" system used to pass legislation | is the same system required to repeal it, which | rightfully makes it harder to pass bad laws, but | wrongfully makes it harder to repeal them. And then they | get passed during a crisis and inconveniently stick. | lazide wrote: | Oh, sweet summer child. | | Every time the DEA gets bored/needs to pump up their | stats, they look through the database to figure out who | to start investigating. | tptacek wrote: | Respectfully, I don't believe you. This is another one of | those cases where the Bayesian Base Rate Fallacy suggests | that the "scary" version of this supposed DEA policy, | where they pursue marginal cases of people with extra- | stuffy noses, can't possibly work. | lazide wrote: | https://www.justice.gov/archive/ndic/pubs36/36407/36407p. | pdf | | Legit extra-stuffy-noses? Sure. But that isn't a Brazil | type situation. A Brazil type situation is where you get | mistakenly caught in the gears of a no-win bureaucracy | just trying to survive. | | Not a super high risk IMO, but definitely not ZERO risk. | The DEA hasn't always been known to give the benefit of | the doubt, or ask questions before shooting. | tptacek wrote: | None of this supports the argument you made? It's just a | DOJ report talking about the smurfing-to-lab pipeline, | which was obviously very real, until we made it annoying | enough to get Sudafed that smurfing became irrelevant and | production shifted offshore. | | No, this is an instance where I won't hedge, because I | think my cards in this hand are strong enough: the risk | of what you said earlier, of DEA getting bored and | looking for marginal cases of Sudafed acquisitions in the | logs to trigger enforcement work, is zero. Absent some | important other high-signal source to correlate with, | that tactic is mathematically guaranteed not to work. | lazide wrote: | Dude, that report was written AFTER the laws which | required it to be moved behind the counter, people to | take IDs, etc. 2 years after. | | Smurfing was the response to that. | | They used those databases to identify it and target | folks. That's the whole point. | tptacek wrote: | I re-read it again. It says that exactly nowhere. In | fact, the one specific case it did talk about, the | causality was reversed: the investigation started with a | couple that was recruiting _other people_ to buy. | lazide wrote: | The law causing all these effects was passed in 2005. | | https://www.deadiversion.usdoj.gov/meth/index.html | | https://obamawhitehouse.archives.gov/sites/default/files/ | pag... | | Page 5. | | I've read press releases where the DEA flat out says they | looked at the logs to identify suspicious purchasers, but | i can't find them in the noise. | [deleted] | ksaj wrote: | I wish they would give similar treatment to homeopathic | "remedies." It's appalling to find them sold at drug stores when | they've never even been proven effective in any way. You can | literally give the opposite "medicine" to someone and they | wouldn't be able to tell the difference. | no-dr-onboard wrote: | phenylepherine is the otc version of pseudoephedrine, what | Sudafed was originally created with. | | If you need Sudafed that works, go to the phamacist and ask for | "real sudafed". You might have to scan your ID if you live in | certain states and you actually need a Rx if you're in Oregon | (lol), but for most free states you're good to just purchase it | at the counter. | wging wrote: | > phenylepherine is the otc version of pseudoephedrine | | That's mostly incorrect, both are "otc" (over-the-counter) | wherever you can buy them without a prescription. That's what | that means. | Kirby64 wrote: | Psuedophedrine requires an ID to purchase and must be kept | behind the counter in any state in the US. It's a federal | requirement. Stores are also required to keep a record of | purchases for 2 years. | | If you were able to purchase Sudafed without having someone get | it from the back or out of some locked cabinet, and also hand | over your ID, it wasn't psuedophedrine. | scarface_74 wrote: | He said "at the counter". | dragonwriter wrote: | He said "you might have to scan your ID in certain states"; | the ID and logbook requirements for a purchase of anything | but a "single sales package" (basically, 2 Sudafed) of | pseudoephedrine is a federal requirement applying to every | US state and territory. | Kirby64 wrote: | It's ambiguous. GP said "some states" require an ID. I'm | clarifying it's all 50 states require an ID to purchase | psuedophedrine and the other associated federal | restrictions. | dopa42365 wrote: | It's a different substance. Not version. | dragonwriter wrote: | > You might have to scan your ID if you live in certain states | | The "certain states" involved being "the United States" since | 2006, unless you are buying a "single sales package" with less | than 60mg of pseudoephedrine [0] (which is the dose in _two_ | Sudafed caplets [1].) | | [0] https://www.fda.gov/drugs/information-drug-class/legal- | requi... | | [1] https://www.sudafed.com/products/sudafed-sinus-congestion | RockRobotRock wrote: | They changed that last year: | https://www.statesmanjournal.com/story/news/politics/2022/01... | zinclozenge wrote: | Oregon no longer requires a prescription since 2022. | AlbertCory wrote: | Public service announcement: sinus rinse (e.g. NeilMed) works. | Available in every drug store with no prescription or pharmacist | involvement necessary. | | It's gross, though. Do it in private. | the_sleaze9 wrote: | I have swollen nasal polyps (or something) which causes every | single cold I get to eventually transform into a 2 week sinus | infection + cough ordeal. | | Netty pot with salty water and a pinch of baking soda, and an | even saltier water gargle clears things up nicely. And is very | budget friendly. | quercusa wrote: | Ask your ENT to look into adding Budesonide [0] to your | saline rinse. It is intended to keep polyps from growing (and | has worked wonders for me). | | [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374675/ | AlbertCory wrote: | It was when I had the mother of all sinus infections that | someone told me about this. Never had the problem again. | YMMV. | | People imagine it must burn, because getting water up your | nose when swimming burns. But the salt & baking soda | neutralizes that. | doug_durham wrote: | It doesn't reduce the sinus inflammation. At least for me all I | end up with is a still congested, but now watery nose. | AlbertCory wrote: | Noted. At least you've tried it. | | The water dripping out of your nose: that's a feature, not a | bug /s | quercusa wrote: | It's useful to rinse out the sinuses so that nasties don't | grow there. | lazide wrote: | If you already are pretty bad off, yeah it usually doesn't | help. It _really_ helps prevent it from getting that bad | though, by washing out pollen, gunk, etc. and hydrating | things. | m463 wrote: | yesterday: | | Phenylephrine for colds and allergies don't work, FDA panel says | | https://news.ycombinator.com/item?id=37485940 | wffurr wrote: | Context: On Sept 12th 2023, an FDA panel (the NDAC) definitively | voted to find phenylephrine ineffective: | https://www.medscape.com/viewarticle/996369 Next will be re- | assessing its GRASE status and potentially removing it from | stores. | mullingitover wrote: | I always thought it was pretty brazen of them to openly label | their cold medicine as 'placebo effect' (pretty sure that's what | the 'PE' stands for). | samtheprogram wrote: | I always thought it was for Phenyl-Ephrine, but this is so | funny/perfect I will use this when explaining to people to not | buy Sudafed unless it's behind the counter. | meatmanek wrote: | I always assumed it was there to subtly confuse people into | thinking they were getting Pseudo-Ephedrine. ___________________________________________________________________ (page generated 2023-09-13 23:01 UTC)