[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.
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