The Sudafed Security Trade-Off

This writer wrestles with the costs and benefits of tighter controls on pseudoephedrine, a key chemical used to make methamphetamine:

Now, personally, I sincerely doubt that the pharmaceutical industry has reliable estimates of how many of their purchasers actually have colds--or that they would share data indicating that half of their revenues came from meth cooks. But let's say this is accurate: half of all pseudoephedrine is sold to meth labs. That still wouldn't mean that manufacturers of cold medicines are making "hundreds of millions of dollars a year" off of the stuff--not in the sense that they end up hundreds of millions of dollars richer. The margins on off-patent medicines are not high, and in retail, 50% or more of the cost of the product is retailer and distributor markup*. Then there's the costs of manufacturing.

But this is sort of a side issue. What really bothers me is the way that Humphreys--and others who show up in the comments--regard the rather extraordinary cost of making PSE prescription-only as too trivial to mention.

Let's return to those 15 million cold sufferers. Assume that on average, they want one box a year. That's going to require a visit to the doctor. At an average copay of $20, their costs alone would be $300 million a year, but of course, the health care system is also paying a substantial amount for the doctor's visit. The average reimbursement from private insurance is $130; for Medicare, it's about $60. Medicaid pays less, but that's why people on Medicaid have such a hard time finding a doctor. So average those two together, and add the copays, and you've got at least $1.5 billion in direct costs to obtain a simple decongestant. But that doesn't include the hassle and possibly lost wages for the doctor's visits. Nor the possible secondary effects of putting more demands on an already none-too-plentiful supply of primary care physicians.

I like seeing the debate framed as a security trade-off.

Posted on February 15, 2012 at 7:09 AM • 62 Comments

Comments

WinterFebruary 15, 2012 7:28 AM

The number of synthetic and natural substances that affect psychological state is for all purposes infinite. Trying to ban the the trade in chemical supplies is an arms race that kills all parts of the economy, except the illicit drug trade.

On the other hand, the effort now spend on controlling these substances could be spend on controlling their (limited) bad effects on their users. In countries where they do that they have less users, much less problems, and even much less spending.

As a security trade off, abating the risks of methamphetamine after use by information and health care is way cheaper and more effective than any policy that includes a ban.

NeilFebruary 15, 2012 7:29 AM

It is one of those things that is only going to make things harder for the people that really need the drug. Prohibition doesn't really work. They will truck it in from Mexico, probably already are.

Am I to assume you are for increasing the difficulty of obtaining pseudoephedrine?

Nick CoghlanFebruary 15, 2012 7:46 AM

@Neil: I think Bruce was just noting that a trade-off is the right way to frame the discussion without stating his own opinion either way. The key line in the article is this one: 'But no policy question is ever as simple as "How can we stop X", unless "X" is an imminent Nazi invasion. We also have to ask "at what cost?" and "by what right?"'

I found the article overly cavalier in dismissing phenylephrine as barely better than placebo, thus exaggerating the costs of limiting the general availability of pseudophedrine, but the overall approach to the problem is excellent.

noble_serfFebruary 15, 2012 7:51 AM

like other "security" decisions, US culture has us following some odd, time-honored tradition of childhood.

"I'll take this away from you if you don't behave."

it never worked on kids or adults, but we still do it.

good education, decent health care and meaningful employment could probably go a long way cure to the drug problem at a lower cost to society -- we'll never know

PeteFebruary 15, 2012 7:56 AM

@Neil - they are trucking it in - there was a drug bust 2/13 in the Atlanta area where a panel truck with 500 lbs of cocaine and meth was found. Atlanta is quite a way from the Mexican border!

BrianFebruary 15, 2012 7:57 AM

Regarding the side issue of margins and this quote: "The margins on off-patent medicines are not high, and in retail, 50% or more of the cost of the product is retailer and distributor markup*"

About 15 years ago, I worked in a drug store. Unless something has changed dramatically in the cost of manufacturing PSE, I can assure you that the margins on PSE are huge. The markup was several hundred percent on generic PSE.

WinterFebruary 15, 2012 8:00 AM

@noble_serf
"we'll never know"

Some countries, eg, Switzerland and the Netherlands, follow a "liberal" enforcement policy. Where the enforcement is most liberal, costs and (health) damage are minuscule compared to that of comparable countries with USA style enforcement.

Every study done on supplying heroin to drug addicts showed they could actually live a normal life. Including living to an old age (they build "old-age" homes for them).

DerfFebruary 15, 2012 8:03 AM

As a long time chronic allergy sufferer, I loathe politicians and lawyers telling me what medicines I can and can't take to ease my suffering. Back in the 80s, people started taking massive doses of a decongestant ingrediant to lose weight. At those doses, it caused heart valve problems so the drugs were pulled from the market. Unfortunately, the lawyers and politicians got involved to have the decongestants pulled as well, even though they weren't the problem.

Same thing with pseudo ephedrine and meth. The politicians and lawyers have risen to save us from ourselves, and in the process made it borderline criminal to have a cold.

If a politician and a lawyer were drowning and you could save only one of them, would you go get a sandwich or buy a beer?

Jeff HeardFebruary 15, 2012 8:04 AM

Actually, I would guess that they do have fairly reliable numbers for how many of their customers have a cold. "Fairly" meaning that they could probably give estimates with 15% or so a margin of error. I would be surprised if they didn't have computational epidemiology algorithms estimating the breadth and depth of a cold season or a flu season, as these would be essential to how much of their higher value drugs they make and when they start (flu vaccines, value-added cold medicines). It's a demographics problem and one we have decent models for.

cdFebruary 15, 2012 8:35 AM

You don't need to go to a doctor to get it. You ask for it at the pharmacy.

So sick of people justifying fascism in this country in the name of "safety."

Steven HooberFebruary 15, 2012 9:02 AM

CD: Read the article, titled "Do We Need Even Tighter Controls on Sudafed?"

Even tighter is the key part. Positing doctor visits, etc. Been mooted for a few years.

skippernFebruary 15, 2012 9:10 AM

This is a little like criminal record declaration. In my line of work I from time to time need a criminal record declaration (as a proof that I have no criminal record) . This is necessary in various occupations, such as security guards. If we start requiring it for more occupations such as gatbage collectors, because they might come in contact with sensitive information not properly disposed of, the strain on the system will be such that us that really need it will suffer.

lazloFebruary 15, 2012 9:11 AM

The disparity in security seems bizarre to me. At my pharmacy, I can get the actual amphetamines my son has a prescription for with no ID at the drive-through window with nothing but a name and a birthdate.[1] If I want Nyquil-D on the other hand, I have to park, go into the store, not just show but actually swipe my drivers license, and sign the signature pad (wtf? That's pointless enough for CC transactions, would they actually turn me down if I just drew a smiley face and hit "OK"?)

[1] - I'm curious about that birthdate... They ask it when I drop off the script and when I pick up the med, are they using that to prove to Insurance that it's actually me picking these up and not the pharmacy multi-billing, or to differentiate between people with the same name, or is it supposed to be an actual security measure to match the drop-off birthdate with the pick-up birthdate (in which case you could increase the security of the system by lying about your birthday from a one-time-pad of random dates)

JohnPFebruary 15, 2012 9:12 AM

About every 2 years, I make the trek to Walmart to buy some of those wonderful little red pills that drain my congestion for 12 hours with no other side-effect besides keeping me awake for the first few hours. I buy the 24-pak. The US military used to give this away at the hospital. I've tried the alternatives - more expensive and good for 4 hours at a time. Some also made me jittery.

A few years ago, I started having to show my ID to the pharmacist. Whatever. Last year I mentioned that I thought it was a waste of effort and the pharmacist got upset and said this specific drug was ruining lives all over the country. My cold response that "people ruin their lives all the time" didn't go over well. I thought she was going to take back the pills.

Alcohol ruins more lives, but nobody is writing down buyer names of beer, whiskey, or rum ... yet.

Automobiles are killing more people annually, but nobody is saying we need to stop driving. Think of all the kiddy porn that gets transferred in ... cars. We must stop it NOW!

This is another nanny-state law with good intension that has gone bad.

AndyFebruary 15, 2012 9:13 AM

I just bought the generic version of sudafed last week. Walgreens scanned my driver's license! My thought was that this would make the wholesale purchases of methamphetamine more valuable.

TLFebruary 15, 2012 9:19 AM

My, perhaps flip, assessment of the restrictions on purchasing pseudoephedrine are that they are a boondoggle for the retailers. Limiting my ability to purchase Claritin-D to a 14 day supply every 14 days was a serious annoyance. I used to take it daily for allergy control. This restriction meant I had to go to Target/Walmart/CVS EVERY TWO WEEKS instead of once every 90 days to get my drugs.
I seriously think that Walmart, et al., pushed this to force consumers into their stores more frequently. But at least I can buy more tinfoil for hats while I am there...

lazloFebruary 15, 2012 9:22 AM

One other thing... Meth must be one heck of a drug. When I have a cold, I think I would consider violence an acceptable solution if someone got between me and some pseudophedrine, and considering that people are willing to break the law to convert that into meth, then it stands to reason that meth must be *even better*. The mind boggles.

Also missing from this trade-off discussion is the health cost of forcing people with communicable diseases to have physical contact with more people. As it is, I can stock up on PSE when I'm well, and spend my infectious time closed up in my house with no contact to the outside world. If I have to go to a doctor and a pharmacist *while I'm sick* to get and fill a prescription, I *will* infect more people.

Erin LazzaroFebruary 15, 2012 9:26 AM

@lazlo: The insurance company uses the birthdate to distinguish between people with the same ID number (you and your kids). As a fixed-length number, it can be treated as part of the ID -- it's a better primary key than a name is.

As a mother of twins, I have found some flaws in this system.

Clive RobinsonFebruary 15, 2012 9:36 AM

As Winter above notes there are many other ways of dealing with peoples undesirable excesses and addictions.

As a society it is to our benifit to use the least costly method to society as a whole to deal with the issues arising.

However we rarely get to se the real cost to society of Political "Social Policy" because politicos have developed effective methods of hiding the information (including ruining scientists careers).

So on the (probably incorrect) assumption that most of the meth production is carried out in the US using over the counter medicines, what do these self serving politicos and talking head pundits expect to happen with their policy?

Lets ignore for the minute the costs discussed above for turning an over the counter medication into prescription, and look at it from the addicts costs to society.

Well the first thing we know is that the demand for the illicit substances will not go down (it usually goes up) and from basic economics we know that when demand if high and supply is short the prices rise (have a look at the price differential for medical and street cocaine and likewise opiates such as Heroin).

We also know that with addicts price is not a deterant they simply turn to other revenue streams also known as crime. We also know that this crime hits the bottom end of society in the form of street crime such as muggings, store hold ups and house breaking.

Now let us assume tthat the average addict needs $100 / day for their habbit. We know that the price they are likly to realise on stolen goods is about 1/10th of the second hand price that is usually around 1/3 of the retail value.

So that $100 is now around $3000/day in replacment value the insurance companies will pick up. It is highly unlikley that the criminal will obtain that value from a single crime so they are likley to be commiting upto five breakins a day.

But... usually there are other costs with house breaking damaged doors locks and other damage resulting in redecorating through to compleatly rebuilding the property (a very few criminals will burn the house down to cover their tracks). I don't know the US price but a couple of years ago insurance companies were looking at the equivalent of $4000 per room pay out and around another $1000 in admin expenses.

So five break ins a day with one rooms worth of damages gives another $25,000 / day.

But the police have to be involved so you are probably looking at another $1000 in their costs per break in so another $5000 / day.

So that $100/ day habbit is costing society well upwards of $30,000/day... that's a masive cost for a drug that in reality could be manufactured industrialy and supplied to retail for less than $1/day.

So where does the money come from and where does it go, well it comes from the premiums you pay the insurance companies and goes back into the economy via the security market. But it's not a normal market, it's a faux market that has been created by political policy and therefor can be regarded as a form of hidden taxation. And it's created a whole artificial churn cycle on it's own, that unfortunatly only realy works in good economic times.

As we know one of the first things that goes out the window when times get tough is household insurance. We also know that LEO's can only do so much investigation between visiting crime scenes and interviewing witnesses etc. So the effectivness of the response drops dramaticaly with only a small increase in crime.

I know from chatting to the local police after I caught a pair of addicts trying to force their way into my home that there had been a 600% rise in house breaking crime in the preceading week that just happened to coincide with the arival of the pair, and that officers were run off their feet. Although the pair were not prosecuted (UK CPS decided not to proceed to prosecution for what is almost certainly an underlying lack of resources). They were "run out of the area" by the police and the mini crime wave immediatly stoped and house breaking in the area dipped below it's normal levels.

bad sinus down in MississippiFebruary 15, 2012 9:43 AM

I live in Mississippi, one of the states that put "sudafed" back on the prescription list.
Most people just drive across the state line and pick up some, which I would assume is what meth addicts do. The head of the Mississippi Bureau of Narcotics, Marshall Fisher, stated several times that this was not about stopping meth, this was about shutting down mom-and-pop/shake-and-bake labs. The majority of Meth in this country comes from Mexico, which is why I find it utterly laughable that a failed state like Mexico has banned pseudo ephedrine. From my understanding, the labs that are being targeted are the most dangerous as they are not operated by experienced cookers and they are usually operated in a home. Fires are common and innocent people are put at risk. I am only paraphrasing the official line. Just to clarify, MS is not practicing prohibition and the idea is reduce dangerous labs. In the short-term, meth labs are moved across state lines and all the issues become another state's problem - until they pass a "sudafed bill". I wish it was a simple issue of fascism. I was initially against the bill, but I work in health care and have seen fewer meth addicts. That's completely anecdotal. The state shows a reduction in labs. We are trading a restricted liberty for a proven benefit to the community. It would be much easier to argue against a regulation that failed. It would be simpler if American drug addicts were as polite and genteel as their European counterparts.

I used to take pseudo ephedrine, but it's bad for my heart and blood pressure so I have resorted to nasal irrigation and herbal remedies. I get by, but I'm curious, is some of the angst generated by the bills regulating pseudo ephedrine coming from a "cold" sufferers OTC addiction? Are you guys really tweaking a little?

Scott G. LewisFebruary 15, 2012 9:48 AM

@lazlo - "The disparity in security seems bizarre to me. At my pharmacy, I can get the actual amphetamines my son has a prescription for with no ID at the drive-through window with nothing but a name and a birthdate.[1] If I want Nyquil-D on the other hand, I have to park, go into the store, not just show but actually swipe my drivers license, and sign the signature pad"

-----------------

That's because actual amphetamines are already a controlled substance, schedule II, and the prescription writing is already tracked.

By you swiping your ID, this allows the same tracking, without requiring it to become something you need to drop a co-pay on and go to a doctor's office.

NathanFebruary 15, 2012 9:54 AM

I was under the impression that nobody who makes methamphetamines actually buys pseudoephedrine at the pharmacy. Have they stopped stealing the stuff since it was moved from the shelf to behind the pharmacist?

MuffinFebruary 15, 2012 10:15 AM

What's more, restricting access to pseudoephedrine may not even have the desired effect.

While it may be true that pharma companies make hundreds of millions off meth labs, the goal is not to hurt the pharmaceutical industry, the goal is to hurt the meth labs. Thus the cost for pharma companies is the wrong metric in considering the trade-off.

If meth labs can just switch to another chemical that can be obtained at a slightly higher cost, they'll do that. Suppose that they'll be faced with a 20% increase in prices, so instead of spending, say, a hundred million dollars per year, they'll spend a hundred and twenty million.

So the cost to them would be 20 million, vs. 1.5+ billion for society; quite different still from the (already difficult to justify) "a hundred million vs. 1.5+ billion" trade-off.

Of course, the numbers are all ass-pulls, but you get the idea.

mcbFebruary 15, 2012 10:42 AM

If we're going to discuss the trade-offs don't we need to know if there is any evidence the restrictions - locked cabinets, behind the counter, or putting it back on the prescription list - have any effect on the quality, availability, or cost of meth?

While we're at it, how many people use meth? How many users become addicted? How many addicts end up on those nasty "before and after" posters the Sheriff's Office distributes?

Kiri MorganFebruary 15, 2012 11:06 AM

The local Walgreen's refuses to allow you to purchase sudafed unless you actually hand them your ID and allow them to handle it. As my Canadian friend refuses (rightly) to hand over her passport for anything but a legal request to do so, I have often found myself in the position of buying her cold medicine.

I have not noticed any decline in the amount of meth being used in SF.

trapspam.honeypotFebruary 15, 2012 11:09 AM

My primary care doctor (also a Pharm. D.) will not write Rx scripts for antihistamine/decongestant nor will my government health care insurance cover say Allegra D because of the ban of scripted use by patients.

Over the counter 18 tabs of the same med is now regulated by SC state DHEC control at the pharmacy and my monthly dose that had cost me about $6 per month under prescription coverage is now over $74 across the counter.

nonegivenFebruary 15, 2012 11:23 AM

Sure cold sufferers use one or two boxes per year but how many allergy sufferers take the pills every day of their lives just to breathe?
The prescription drug containing PSE that my husband was taking was recently replaced by a generic that didn't last as long and then went OTC so he could no longer buy it from the mail order pharmacy. They wanted ~$50/month just to buy the generic at the pharmacy and didn't carry the brand name. I went on the mail order pharmacy website and had them request his doctor to prescribe a similar drug that was still under patent. The copay is less than $25/month and works better than the only thing I can find OTC and I don't have to go to the store every 10 days to get it for him, making it so that I can't buy it for myself if I get a cold.

AnthonyFebruary 15, 2012 11:28 AM

I would have thought a more effective strategy would be to mandate the addition of additional substances which interfere with the meth synthesis but not with the consumer use. Sure, larger operations will be able to get around this if they have to, but they're not who this is really targeted at.

NorrisFebruary 15, 2012 12:11 PM

Remember when phenylpropanolamine was taken off the market?

It's only been about ten years. PPA has similar effects to pseudoephedrine, was also used as (part of) a diet drug. It was implicated as causing a vanishingly small number of strokes in very large doses. I don't remember whether the FDA actually banned it or just convinced the manufacturers to stop selling it. I remember that one of the justifications was that it was "unnecessary" because psuedoephedrine was easily available and worked just as well.

ErichFebruary 15, 2012 12:17 PM

Another use for Sudafed is for people who scuba dive and suffer from difficulty clearing (popping) their ears to deal with the pressure changes. Sudafed is accepted as *the* drug that helps with this issue, and has been proven to be safe to have in your system under pressure, at depth. The replacements that eliminate pseudoephedrine do not seem to work nearly as well.

It's already a pain to get at this time. We don't need more controls on it. Prescriptions don't keep Vicoden and other drugs out of junkies hands, it won't stop it here either.

DanFebruary 15, 2012 12:41 PM

@Anthony

"Sure, larger operations will be able to get around this if they have to, but they're not who this is really targeted at."

Don't you know the gub-mint is *always* targeting larger operations and corporations as long as there's a Democrat in office. The feds hate business and hate America.

ReptileFebruary 15, 2012 12:43 PM

I didn't see a single comment (correct me if I'm wrong) regarding the immense economic impact from the destruction meth production has on all society. It's insane. In many places as many as 40% of emergency room visits are from burns resulting from mfr'g. A lot of politicians were dead set against dragging these chemicals back under prescriptions until they saw the impact this stuff was having. It's fine if you want to frame this as a security thing, so long as you don't want to look any closer than that. Maybe then someone will compare the issue to the parking meter divisions in many cities that can't even support their own budgets from fines. But if you want to wake up to what it really going on, then quit all the ridiculous "can't stop it so don't try" nonsense, and all the frivolous arguments about Medicare, etc. I really think we've come to a point where, if there a big red button that would obliterate Western Civilization if anyone pushed it, millions would line up to push it, arguing about their rights to push big red buttons "how dare anyone tell me I can't push a red button".

karrdeFebruary 15, 2012 1:03 PM

@Reptile: Citation needed.

How many regions have 40% of their ER visits caused by burns due to home-meth productions? Where are they?

And will reduction of access to one supply component cause them to stop operating?

Are there other chemical pathways to meth, and are they also available to the home chemist?

kingsnakeFebruary 15, 2012 1:07 PM

If one could buy one's drugs legally, then there would be no need to make it for oneself, thus negating the possibility of turning oneself into a crispy critter.

The point is, no law, rule or procedure is pure win. There are negatives, often measurable, sometimes in monetary terms, and those must be weighed against the benefits.

Nick PFebruary 15, 2012 1:37 PM

In Tennessee, we get carded for any medicine that contains dextromethorphan. They don't scan the ID or anything at most places. They just look at the birthday & type it in. So, if you're 18 or over, you can buy the stuff (sick or not). If you're not, you can't. Cashiers have told me that they've had to send sick teens packing b/c they weren't old enough.

And meth production in TN, especially in the rural areas, was at an all time high after the ban if we consider the number of news stories about busts. Doesn't stop that problem at all: just hurts sick people. Sick f***ing lawmakers....

JessFebruary 15, 2012 3:01 PM

Another point to make about meth specifically: if all drugs were legalized, far fewer people would start taking meth, because it is an awful drug. Pot, 'shrooms, coke, the pharma stimulants, K, even heroin and its friends are far more enjoyable (I haven't sampled all these, but others have and one can observe the effects). Unfortunately, most of these are more difficult to create without being detected than meth is. Which is the reason that hillbillies who failed 8th grade are cooking in their bathtubs. If the fuzz would just leave them alone, they'd be fertilizing their crops rather than pestering pharmacies.

Eventually. Unfortunately, our draconian regime of prohibition has quite effectively created several generations of meth addicts. These unfortunates no longer possess brains; they've scooped those out and replaced them with a meth-seeking OODA loop. Until the most recent generation dies out (shouldn't take more than 15 years really), even after our laws are fixed, we'll still have meth addicts.

Who am I kidding? If this country's laws were written for the benefit of its people rather than its prison-builders drug prohibition would never have started in the first place.

GeorgeFebruary 15, 2012 4:22 PM

My understanding is that the Patriot Act contained a special provision that exempted anything connected with the Wars on Terror and Drugs from any cost-benefit analysis. Any measures officials decree as necessary for the War Effort are deemed effective and appropriate, and the agencies that decree them are empowered to reject any rational or fact-based assertion to the contrary as "unpatriotic."

TFebruary 15, 2012 4:49 PM

In my country, PSE's been regulated to some degree. You have to get it from a pharmacy, and you have to show government-issued photo ID (such as a passport or driver's license) to get it. The purchase is recorded in a central database, which (I believe) is consulted at the time of purchase.

I *presume* that they reject your purchase if you've gotten too much - and I have no idea what the limit is - but in a household of three allergy-sufferers, we've never hit that limit. The system seems to work. I imagine that some people still manage to fake the system to some degree, but it must not be terribly trivial to do.

Erin LazzaroFebruary 15, 2012 5:05 PM

I'm in New York. They scan your driver's license. I was once in line behind someone who was denied because he had hit his limit for the month. He argued: "That's ridiculous! I was able to buy six boxes at [competing drugstore] just a couple of weeks ago!" I don't think he quite understood what the license scan meant.

XFebruary 15, 2012 5:57 PM

So, the new plan is that at EVERY doctors visit EVERYONE gets a bunch of scripts for sudafed?

Yeah, those won't get lost, misplaced, or sold.

They we can all have tons of extra boxes of sudafed lying around, just in case... 'Cause it's cheaper than visiting the doctor again. That couldn't possibly go wrong...

Wouldn't it be easier for the addicts just to rob the drugstore? Steal a car, drive through the wall? How good is the physical security?

LauraFebruary 15, 2012 6:23 PM

Maybe this is the solution to the problem of doctors feeling pressured into prescribing antibiotics inappropriately for colds. If the patient leaves the office with a prescription for Sudafed, they'll feel like the doctor has done something for them.

(I think that making it any more difficult to get Sudafed is a terrible idea -- but a decrease in unnecessary antibiotic prescriptions might actually turn out to be a side effect).

A blog readerFebruary 15, 2012 10:59 PM

Perhaps it would be possible to apply the principles of security trade-offs to other drug control measures, such as regulations on obtaining laboratory glassware...

@karrde:
Among other possibilities, there is the "phenyl-2-propanone" technique which involves using phenyl-2-propanone and other chemicals, but not ephedrine or pseudoephedrine; it is said that this technique leads to lower quality meth.

@George:
Not sure about "a special provision that exempted anything connected with the Wars on Terror and Drugs from any cost-benefit analysis," but around 2006, the reauthorization of USA Patriot Act provisions included nationwide restrictions on the sale of pseudophedrine products (including keeping such products behind counters, ID checks, and per-day/per-month purchase limits.)

Ravan AsterisFebruary 16, 2012 1:35 AM

This whole sudafed thing is infuriating. It used to be that I got my guaifenesin/pseudoephedrin as a 90 day prescription, cheap, mail order. I took two a day, so I could breathe - I have several allergies.

Then mucinex bought off the FDA so that only they could sell "extended release" guaifenesin. No more generic. The cost went up by at least 10x.

Then the idiots in Congress came up with restricting a common drug for treating allergies and colds to try to control meth production. Never mind that other components of the process are even harder to come by, they had to restrict the one that lets lots and lots of people breathe.

You see, unlike the lies you've been told, pseudoephedrine (sold sometimes under the brand "sudafed") is not just used "for colds". It is a ****DAILY**** requirement for numerous allergy sufferers.

No, the substitute stuff doesn't work. It's a joke. Every time I try it, it's like taking a nasty sugar pill - no congestion relief, but a bad taste in my mouth.

But because of the idiots in Congress trying to look "tough on drugs", I have had to cut my daily dosage in half, because I can't get to a pharmacy *three* *damn* *times* *a* *month*. Plus I have to show *more* identification than I do for a schedule II drug like Vicodin, and I can't even get a month's supply! Talk about dumb.

I could try to get a prescription, but it wouldn't be covered by insurance, and the doctor's visit costs money, and all of this time and expense is because some bright boy in Congress thought that inconveniencing ordinary people would make meth production go down.

Drug problems are solved by reducing demand, not trying to control supply. Prohibition, vs the anti-smoking crusade, should be examples of that.

IMO, pseudoephedrine should just go back on the shelf, no extra fascism required. The meth cooks probably just steal it from the warehouses directly anyway.

ytFebruary 16, 2012 6:16 AM

The blog ate my comment yesterday, so I apologize if it appears later and makes it look like I'm repeating myself.

Pseudoephedrine is already prescription-only in my country. Pseudoephedrine is not often used to produce methamphetamine, not because it's difficult to obtain, but because it's more economical for drug dealers to just import ready-made amphetamines from who-knows-where. An interesting side effect of the lack of a meth industry is a lack of innovation in decongestants: pseudoephedrine is pretty much all you can get. I wish the pharmaceutical industry had an incentive to introduce alternatives here, because I don't tolerate pseudoephedrine well. When I tried some of the non-pseudoephedrine Sudafed, it worked about as well as pseudoephedrine, but without the side effects.

Anonymous CowardFebruary 16, 2012 7:15 AM

@lazlo - Yes. You could draw a pair of breasts or a penis on the signature screen and it'd be accepted.

Anonymous because I have tested this.

jeffkFebruary 16, 2012 8:43 AM

In Oregon, and probably elsewhere, there is an OTC alternative readily available called phenylephrine HCl (aka Sudafed PE) that anyone can buy without a prescription, and without a signature. It has replaced pseudoephedrine (PSE) in most OTC cold meds, and works well enough for me, and well enough for most people.

In my experience, phenylephrine HCl (sudafed PE) works almost as well as the old sudafed, and has milder side effects, so it's what I prefer. I could easily get a prescription for the old sudafed, but I don't need to.

I have also seen a reduction in the side-effects of from cheap, readily available meth, so I think Oregon's approach has been effective and worthwhile. The goal of making PSE prescription-only isn't to eliminate meth, it's to make it harder cheaply manufacture, i.e. to cut down on small meth labs. That also makes meth more expensive, so it becomes a less-attractive alternative to other drugs.

IMHO, if you have a medical condition that *requires* pseudoephedrine, you're probably visiting a doctor regularly, and can easily get a prescription for it. Unlike some people, I don't see that as a huge inconvenience or a huge social cost. If you prefer the old sudafed, it's easy enough to call your doctor's office and get a prescription for it sent directly to the pharmacy of your choice.

No OneFebruary 16, 2012 9:49 AM

@jeffk: In my experience phenylephrine has a minimal effect when I have a head cold whereas proper pseudoephedrine clears me up within ten minutes and keeps me clear for six to ten hours.

Also, it makes me fly like Superman.

But that's all just anecdotal evidence of course.

B. D. JohnsonFebruary 16, 2012 10:33 AM

I've always wondered about creating a new lowest-tier for controlled drugs. One that would mandate reporting, but not require a prescription akin to how Title 31 operates for financial transactions. If a person is attempting to buy more than a reasonable amount, it triggers the retailer to file something to generate a paper trail. This would mean that when they want to try and locate an operation in a particular area, there'd be a starting point.

Tack on a law making it a felony if you supply any illegal lab where an incident occurs which results in serious bodily injury or death and you'll start to tip the risk vs. reward scale a bit.

I think that's the key in these kinds of situations. Spending all the time, money, and effort trying to enforce restrictions that a pain in the ass across the board isn't as effective as making the reward not worth the risk, and squeezing out the "runners" who are going around to a bunch of pharmacies buying Sudafed. "Trickle-up" law enforcement, if you will.

LinkTheValiantFebruary 16, 2012 2:24 PM

Tack on a law making it a felony if you supply any illegal lab where an incident occurs which results in serious bodily injury or death and you'll start to tip the risk vs. reward scale a bit.

And how is a pharmacy clerk to know whether or not the young woman sniffling in front of him is genuinely unwell, or a runner buying her little packet from each supplier in town? It's not like there's a convenient "I'm sick" ID as we have for age verification on alcohol or tobacco. (Not that age verification is perfect either, but at least there's something to work with there.)

Rather than resulting in happiness and joy for all, you'll simply end up with pharmacies that won't stock Sudafed. Or you will create a monstrous new network that will track purchases between pharmacies and attempt to discern lab buying patterns, in turn driving up the cost of Sudafed and other drugs.

donb2000February 16, 2012 2:50 PM

Oregon made pseudoephedrine prescription-only several years ago, and apparently it has been remarkably successful in reducing the meth problem in the state. Maybe there are reasons not to do this, but the hypothesis that it doesn't work to reduce meth use is contradicted by the experience in Oregon.

SkukkukFebruary 16, 2012 3:16 PM

In my experience phenylephrine has a minimal effect when I have a head cold whereas proper pseudoephedrine clears me up within ten minutes and keeps me clear for six to ten hours.... But that's all just anecdotal evidence of course.

It's supported by real evidence, though:
http://www.annallergy.org/article/...

Note that even when two drugs are "equally effective" in studies, that's a long way from saying they have the same effects on the same people; removing an alternative from the market generally means screwing people who don't respond to the remaining one or can't tolerate its side effects. But these drugs aren't equally effective in the first place. The evidence that phenylephrine is even any better than placebo is equivocal (though some people think the currently approved dose is just too low).

SkukkukFebruary 16, 2012 4:24 PM

Oregon made pseudoephedrine prescription-only several years ago, and apparently it has been remarkably successful in reducing the meth problem in the state. Maybe there are reasons not to do this, but the hypothesis that it doesn't work to reduce meth use is contradicted by the experience in Oregon.

Can you point me to the evidence you're using to determine that? What I keep seeing people use is a statistic on the number of "meth clandestine laboratory incidents," which includes lab busts, dumpsites, and seizures of chemicals and glassware. That number is, first of all, affected by law enforcement priorities and budgets -- some states have actually scaled back meth lab investigations becuase they don't have the money to clean up labs they do discover. And since it only tracks the *number* of incidents, not the size of the labs, it's also extremely sensitive to consolidation and fragmentation in the meth production industry, which can occur for many reasons. If you move people from buying small amounts with photo ID to doing warehouse breakins, you could create fewer, larger meth labs without changing the amount of production, let alone use.

In fact, if you look at the data from 2004-2010, Oregon has gone down from 467 to 12, which is certainly dramatic, but all the neighboring states are way down over the same period. In fact, the Oregon numbers went from 467 to 190 in 2004-2005, before either the federal or state pseudoephedrine laws were passed.

WilliamFebruary 16, 2012 5:06 PM

Methamphetamine should not be illegal, rather D-methamphetamine should be what we are talking about. The term by itself is used improperly since the same chemical compound with the "mirror" structure isn't addictive and in fact is used in over the counter drugs. (even "Breaking Bad" makes this point - http://goo.gl/2Ynwc). The lack of a distinction combined with vague laws put into practice is a security risk in itself. (Ahem Alan Baxter and the bronze medal controversy - http://goo.gl/Iqi1b).

Last years National Appellate Advocacy Competition for law students used an interesting and related issue - What would happen if a state government restricted advertising of pseudo ephedrine or ephedrine related products so that you could not know the price of the item or so that the items were placed behind the counter.

Generally this is seen as an unanswered 1st amendment issue.

Unfortunately, it also highlights what lawyers anticipate will be a potential or possible problem - that government is willing to attempt to abridge your rights in the fact of perceived danger, and it is altogether unclear for most people (and even lawyers) what your rights are at times.

benEzraFebruary 16, 2012 5:13 PM

@Skukkuk,

"The evidence that phenylephrine is even any better than placebo is equivocal (though some people think the currently approved dose is just too low)."

Have you ever noticed that the common dose of pseudoephedrine is 2 of the little red tablets, but the "official" OTC dose of phenylephrine is *1* tablet? In my observation, most people accustomed to taking the usual 2-tablet dose of Sudafed keep taking 2 tablets when they buy "Sudafed PE", even though the fine print says the PE dose is 1 tablet. I have wondered at the reasoning behind that dose switch, and the cynical side of me wonders whether it's an attempt by phenylephrine advocates to make PE seem less ineffective than it is, despite the obvious risks:

http://www.consumermedsafety.org/article.asp?...

In my own experience, even 2 phenylephrine are still way less effective than 2 pseudoephedrine. I have sinus congestion that leads to migraines, and NSAID + pseudoephedrine is my treatment of choice, when I can get it.

guestFebruary 16, 2012 5:38 PM

What would the professionnal hockey player do if they cannot take sudafed to keep them awake during the game :-p

cleekFebruary 17, 2012 1:30 PM

my wife and i have been having a hell of a time with sinus congestion this winter. so, we've been using a lot of PSE. but, because i do all the grocery shopping, i hit my monthly limit on PSE on the 15th of the month. now she has to go to the store to buy it for us. but she's going to hit her limit soon, too. and then what?

we get sinus infections is what.

what a stupid law.

Bob ShettelFebruary 17, 2012 1:49 PM

Coming from western CO, close to Utah, I wonder why bother with placing sudafed behind the counter. It's a short hop to plenty of locales in Utah were one can find the plant, Morman tea, which is ephedra. Mormans long used it as a natural decongestant. it works well. It ought to. The active ingredient is ephedrine HC, which is easily converted straight to meth. I'm surprised there is not a big rush to harvest the stuff...

gibgerFebruary 17, 2012 7:26 PM

I take Sudafed a few times a month: it is quite effective at helping hold back my allergies. Here in Canada they keep it behind the counter, and the pharmacists won't sell it to you if they suspect you are cooking meth with it. My local pharmacist tells me there is no problem with the system that she has noted, so....where's the beef? Seems to work just fine here, and it is no big deal that I have to ask for it at the counter. No muss, no fuss.

Some people feel the need to make a big deal out of everything

bobFebruary 21, 2012 1:44 PM

The most effective antihistimine ever invented was Hismanal. However, if you took TEN TIMES the legitimate dose you would probably have a heart attack. So they banned it and now there is no really effective antihistamine.

Then there was Nasacort (a nasal inhalation steroid). This is the ONLY drug I have ever ever ever ever sprayed into my nose that did something other than run back out. But if ONE THOUSAND TIMES the entire population of the world used the stuff 24/7 (or about 1e+32 times the ACTUAL use) then it would cause a 0.0001% increase in the ozone hole; so it was outlawed and replaced with ..nothing; I guess because if you die from lack of breathing thats good for the enviroment as well cause you'll stop driving your SUV.

Now sudafed. One of the few drugs still on sale in the US that actually accomplishes what it claims on the outside of the box.

So here's my solution: make sudafed prescription only AND make cocaine completely legal. This way: Either I feel so happy I dont mind suffocating OR I can trade my cocaine to the junkies to get their sudafed they got cheaply and unlawfully.

In the entire history of the US they have never banned anything and had the supposed desired result - and nevermind defeating the purpose of a "free country". Is no one at any level of government capable of learning (well, anything really, but at a minimum) the fairly obvious lessons of prohibition: If you outlaw something it becomes MORE valuable and therefore more people will attempt to supply it.

conservative spartanFebruary 22, 2012 9:09 PM

It seems we’re always fighting the government just to maintain basic freedoms. Here we go again. Now we have an effort to restrict cold tablet sales to law abiding citizens in an effort to thwart meth labs.
Various legislative bills will mandate going to the doctor to get cold tablets. The Big 3, the police, some in the Assembly and Senate believe this will save the state money and solve our meth problems.
Excellent! A bi-partisan effort to save Oklahoma from its meth problem and save the state some money. We applaud those efforts.
From Kentucky’s fiscal note on a similar bill currently under consideration, “Although the exact amount of savings cannot be determined, the information reviewed above indicates that a conservative estimate of savings would be in the $12 to $20 million range.” Millions saved, perfect!
But let’s examine the facts behind “solving the meth problem” and its impact on us, the law abiding citizens of Oklahoma.
First, according to the U.S. Justice Department’s National Drug Intelligence Center’s 2011 threat assessment, Mexico is once again the “primary source of methamphetamine” in the U.S. That’s after Mexico banned the sale of all pseudoephedrine (PSE) in 2008. So a complete ban of PSE in Mexico produced the #1 threat of meth in the U.S. within two years. In fact, seizures of methamphetamine at the Laredo, TX customs district — the nation’s largest inland port — are on pace this fiscal year to surpass last year’s total by about 60 percent, reaching an expected total of about 1,650 pounds. Hmmm. Seems like the drug manufacturers are resilient.
Well that’s Mexico, what about Oklahoma? In order to get around the restrictions on PSE sales, a new method to manufacture meth has been developed or more accurately an old method has been rediscovered. The P2P method was popular in the 1970’s. There is no new chemistry here; in fact, most of it is almost 100 years old. Sounds a bill can’t defeat a resourceful and knowledgeable illegal drug manufacturer.
Certainly with the state saving millions, the Big 3’s good intentions are worth something. But let’s look at the new costs to Oklahoma. Instead of going to the corner pharmacy and buying $10 worth of cold tablets, you’ll have to go to the doctor.
The new system will be to call your Doctor and make a priority appointment. Go to the appointment, lose 2 hours of work ($15/hr. = $30), pay a visit co-pay of $20 (insurance pays the balance of $150), drop off the prescription at pharmacy, and go back to work. After work pick up prescription, pay $5 co-pay (insurance picks up the now $15 balance) go home and take the medication. Total projected cost is $220. That’s a $210 premium!
$210 multiplied by Oklahoma’s estimate of 1.5 million packages sold per year and you get $315,000,000. That’s over a quarter of a billion dollar cost shift.
So let’s add this up. Mexico is the #1 meth manufacturer. New manufacturing methods are getting around cold tablet bans. Oklahoman’s will absorb over a quarter of a billion dollars to save Oklahoma a maximum of $20 million. Only the Big 3 would call a complete ban good. “Government logic?”
It’s not the medicine, it how it’s being misused. Duh.
We’re glad Gov Fallin is trying to find a realistic and reasonable approach to this issue. In fact, Gov Fallin is wisely trying to find the middle ground here.
At least Gov Fallin realizes the citizens of Oklahoma don’t need to pay the Fab 3’s quarter billion dollar vanity premium to solve the misuse of a legal drug.

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