One of my favorite papers is "A simple and convenient synthesis of pseudoephedrine from N-methylamphetamine" [1].
This is a satirical paper. Because pseudoephedrine (i.e. the good decongestant) is very difficult to obtain due to restrictions, but "N-methylamphetamine can be procured at almost any time on short notice", the paper describes how to synthesize pseudoephedrine from meth with a procedure that looks valid.
I found out recently that you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from, because apparently each state administers its own database. If you run out and have a persistent cough (weakened immune system from not licking doorknobs the last few years of covid, or so do the doctor says) from a common cold while on vacation, you're shit out of luck unless you go back home or you and an accomplice are willing to procure your cough medicine with their license.
> you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from
The FDA rule on this [1] doesn't appear to be quite that strict: it says the ID can be "a photo identification card issued by the State or the Federal Government or a document that is considered acceptable by the seller". It doesn't explicitly say it has to be from the same state as the one in which you are buying the medication, and it leaves the seller some latitude in what to accept.
Possibly some states have more restrictive rules. Or particular sellers might be more leery about what they are willing to accept.
The FDA rule doesn't restrict the IDs but the phrase "that is considered acceptable by the seller" lets the pharmacy put any restrictions in place they want. They can tell you it has to be hot pink and glow-in-the-dark and you've got no choice but to deal with it.
While true as long as they're in compliance with the law, wouldn't they want to sell all the Sudafed they can? They can deny service to anyone for pretty much any reason. No shirt, no shoes, no Sudafed or anything else. So yeah, but in reality it isn't aligned with their interests and if they don't want to serve you they can always find a different justification.
Maybe they want that, maybe they don't. Retail drug stores in the US are an oligopoly, that industry may not be a monopoly (yet) but they don't function under perfect competition. Maybe if you're the management or the shareholders of a retail drug chain you're just kind of shrugging your shoulders and working on the next merger at this point since the fewer competitors you have, the less hard you have to work for the customer's dollar.
Here in Vietnam it's completely impossible to get pseudoephedrine at all and I think it's the same in all Asian countries. I even resorted to trying to buy some ephedra tea (Chinese medicinal herb from which ephedrine was first discovered). I ordered a box of tea bags from Shoppee and rather amusingly received an envelope with some the amount I had paid including shipping in cash and an apology letter saying they could no longer sell this herb and please don't leave a bad review.
However, a few months earlier due to a Google translate mixup where I thought I was ordering peppermint oil, I got 100ml of sassafras oil [0]. It's a precursor to MDMA and at least as restricted as pseudoephedrine.
Refused sale of Sudafed because my license was expired. Apparently I accidentally tossed my new license and kept the old one. Doh! However they happily refilled my schedule III meds with the expired license.
It's ironic that the pharmacies are so paranoid that you'll cook meth from Sudafed but are happy to enable amphetamine habits in kids that have trouble focusing in school.
Adderall is a 3:1 dextroamphetamine/levoamphetamine mix.
Methamphetamine is a whole other level of stimulant.
> amphetamine habits in kids that have trouble focusing in school.
1) Do you have evidence that Adderall at therapeutic dosages is anywhere near as addictive as methamphetamine at recreational dosages?
2) Yeah, ADHD makes it real hard to focus at school. I never graduated from high school, and I dropped out of university as an adult student without even completing one year, thanks to untreated ADHD. Not to mention the impulsive behaviour, the inability to stick at boring things etc. etc. It's not great in our society.
You're implicitly minimising the very real impact of ADHD, that's not super great.
In fact, one of the biggest issues for people finally being treated for ADHD as adults is the grieving process around "What my life could've been if my parents hadn't believed that ADHD wasn't real and my issues in school and my 'disruptiveness' was solely due to 'food intolerances', because my Mom read a magazine article about it once, then paid a quack to stick a probe in my ear, one on my finger, and then rub food on my skin while looking at a galvanometer making 'hmmm' noises sagely."
3) You know there's been Adderall shortages in the USA recently due to DEA manufacturing limitations right? So it's not like they're just throwing out to kids like it's a lolly scramble.
Anyway, it's about as ironic as 10,000 spoons when all you need a knife. That is, not at all.
> Methamphetamine is a whole other level of stimulant.
The extra methyl group that differentiates it from regular amphetamine salts mainly serves the purpose of crossing the blood-brain barrier quicker. However, during this process it loses that extra methyl group. So whether you're taking meth or adderal, the chemical that actually reaches your brain is ultimately the same
In fact, methamphetamine is available as a prescription ADHD medicine under the brand name "Desoxyn"
I thought that (1) meth (e.g. methylphenidate a.k.a. ritalin) blocks reuptake of dopamine, and (2) amphetamine (e.g. dextroamphetamine) stimulates production of dopamine, and (3) methamphetamine (a.k.a. desoxyn) does both. Is that understanding accurate?
> I think the parent post is more likely alluding to the abuse of the medication, particularly in higher learning institutions.
It's kind of weird that people are calling this "abuse" when it's apparently using the drug in the same context and dosage as it's prescribed therapeutically, plausibly by people who actually have ADHD but don't have the time or insurance to get a prescription.
It's an interesting case study in what would happen if it was more widely available in a pharmaceutical form with a known dose and purity. What percentage of these college students are actually getting addicted to amphetamine vs. just taking a therapeutic dose here and there?
~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
_Edit: I am told I'm wrong on this front, and I stand corrected_
The fact that doctors are prescribing them too freely is definitely worth looking into.
But severely restricting medication that is used to effectively treat disease because it has abuse potential only harms legitimate users. But definitely worth auditing prescriptions to ensure that they're being issued for valid diagnoses.
But as for illegitimate users? You ban it, they'll find something else.
And as someone who needs ADHD meds to do things like "remember I have a todo list, remember where I left it, and remember to use it", I very much resent the people who abuse the meds I need to function in our society to pass their law degrees easier.
I resent the meth addicts who try to get an ADHD diagnosis for their kids so they can abuse (or sell...) their children's ADHD meds when they can't afford meth, because it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
(My country uses methylphenidate / Ritalin / Concerta (the slow release form) as the first treatment for ADHD, Adderall is not prescribed here that much, if ever, but it is possible to be prescribed dexamphetamine if you're bad enough).
But I really do object to glibly implying that every child who is prescribed a treatment for ADHD is actually a case of pharmacists gleefully overmedicating, it's naïve, unsympathetic, and, tbh, rather unfair to pharmacists.
As for what schedule a drug is... ...is the harm of Adderall abuse the same as the harm of fentanyl abuse?
Drug schedules aren't a good way to determine harm, IMO. They're a good way to discern moral panics though.
E.g., in my country, Class A, the drugs that attract the highest penalties, include magic mushrooms, mescaline, DMT, and that one you get from licking toads, bufotentine or something, alongside classics like heroin and cocaine.
Fentanyl is Class B, alongside opium, morphine, amphetamine, methylphenidate, MDMA, and one that always amuses me, hashish.
* There's probably some dumb-ass rules around declining to dispense abortifacients because of religious beliefs, I'm sure.
> I very much resent the people who abuse the meds I need to function ... I resent the meth addicts ... it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
It's important to remember that no addict did this to you. An addict doesn't force Kaiser to charge me $20 when they demand I piss in a cup in order to receive my legally prescribed medication. It's fucking Kaiser, and the DEA, and the mad cap conservative politicians and their shitty fucking values. Drug addicts are suffering from a health problem, just like you and I are with our ADHD. None of us have the power to influence the massive engine of carceral drug policy and the promotion of mass moral panic about people taking medication that helps them.
It's important to point the anger at the right people.
Using telemedicine in New Hampshire, I don't have to take any drug tests for mine, just self-report my blood pressure and pulse on zoom every 3 months.
> ~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
As others said, it's not true. Pharmacists are also trained to spot any possible adverse drug interactions with other medications that you might be taking.
It more often happens in the clinical setting, rather than at retail pharmacies, but it still is a possibility.
> Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.
This is not true. Pharmacists have the right to not fill a prescription for a number of reasons, and in fact can be held liable for not doing so.
If they feel the use of the drug is medically inappropriate they can decide not to fill it. If they feel the patient is taking it for a non-medical reason (abuse) they can choose not to fill it.
Pharmacists are medical professionals who are expected to use their judgement to make sure medicines are not used inappropriately.
Damn, if Schedule II drugs are that bad, Schedule I drugs must be terrible. Let me go see:
> Some examples of Schedule I drugs are: lysergic acid diethylamide (LSD), marijuana (cannabis)
Oh damn, marijuana is worse than this drug? I hope they arrest anyone selling marijuana. What’s that you say? Legal? In California? Oh, in lots of states?
I don’t know why you are being downvoted, adhd medication is insanely overprescribed. Turns out, kids get antsy and hard to control after cramming them into overcrowded rooms for 8-9 hours a day doing slop work. Some schools are now forgoing any form of recess at all. Modern public education is inhuman and dystopian.
It is absolutely not the job of a pharmacist to make decisions about which drugs are being overprescribed, and IMHO it's a dangerous thing to suggest. The pharmacist should assess for drug interactions, but we can't burden pharmacists with knowing the details that went into a prescription, and we shouldn't have them second guessing the diagnosis of a doctor. Down that road lies madness.
I get where you're coming from but pharmacists have the right to refuse to fill a prescription and in fact can be held liable for not doing so. Pharmacists are trained medical professionals and are expected to use their judgement
Another thing is, do you get an actual trained and knowledgeable pharmacist, or a technician?
In Poland, pharmacies are required by law to have a MSc in pharmacy present during operating hours - that is, no less than one pharmacist with a Masters degree. One is enough. Which means that's all you get. You may not even see them unless you're buying ADHD meds, which need MSc to sign off on them. Otherwise, you're almost always dealing with a pharmacy technician. Some are pretty knowledgeable[0], others could be replaced by GPT-3.5[1] with net benefit to the customer. The latter type, if they're going to notice anything about you, it's whether you're likely to buy some useless supplement or homeopathic product.
--
[0] - Probably on their way to MSc in Pharmacy, which is a mistake if they're looking for a pharmacy job - pharmacies don't want people with MSc, there's enough of them around already; they want the cheap technician labor.
The more interesting take for me is that these meds work roughly the same way and almost as well in people without ADHD (a symptom cluster, not a single disease per se, like everything else in the DSM). As we give them to people with ADHD why not let anyone get a scrip?
People without ADHD already get more than enough benefit from just coffee. Stimulants might be able to benefit them further, but if you let anyone take them, eventually it'd become expected of everyone due to their increased productivity, and the potential consequences of abuse are much higher than coffee.
Chronic use of caffeine blunts the effects, it doesn't do much to regular drinkers. You develop tolerance very quickly. I can drink several cups and get basically no effect. Apparently your body just increases the quantity of adenosine receptors in the brain to offset the caffeine.
"simple and convenient" does a lot of heavy lifting in this paper - n-BuLi, chromium hexacarbonyl and MoOPH (had to look that one up!) is not something you find outside of a well equipped lab and shouldn't be touched by anyone who isn't highly experienced.
> Other side effects may include violent urges or, similarly, the urge to be successful in business or finance.
...
> We expect that the simultaneous trends of restricting pseudoephedrine sales while N-methylamphetamine becomes less expensive and of higher purity will make the methods presented here increasingly attractive.
Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
Pseudoephedrine should be easy and plentiful to obtain. I don't care if people use it to make meth. What they do in their private time doesn't concern me. Not being able to get Sudafed when I'm sick kills me. It's not like those people won't be able to get meth some other way.
We let people buy cars and cause 43,000 automobile deaths a year. People should be able to live life without stuffy noses. Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
And don't get me started on ADHD medication and their shortages.
Edit: and there are 178,000 alcohol related deaths per year in the US. If you're going to allow that without prohibition, then please let us unstuff our noses.
I'm tired of living in a nanny state when we let people buy and own guns and swords and flamethrowers. Simply hiking on a mountain can kill you. Must we install guardrails on all the high places?
It's not that bad of a negative externality. Honestly. Not relative to all the other ones we've deemed acceptable. This is weird picking and choosing that doesn't make sense.
> Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
What's even worse, modern pseudoephedrine is produced in a form that makes meth synthesis from it extremely tedious and generally impossible in home conditions: https://pmc.ncbi.nlm.nih.gov/articles/PMC3793278/
Addictive is the argument in favor of making it over the counter. Addicts will do whatever it takes to get their fix, so if there isn't a legal path, they buy on the street, creating a funding source for organized crime and spurring gang violence.
Then, because the black market is already in violation of the law, there are no purity standards. The customer who thinks they're getting Adderall or codeine is actually getting fentanyl because fentanyl's much higher potency makes it easier to smuggle, but for the same reason makes it much more prone to addiction and overdose, especially when careless street dealers get their proportions wrong. All of which is avoided if you just let them buy it from the pharmacy.
Notice that there is no thriving black market for antibiotics propping up international drug cartels, because they're not addictive.
Strongly agreed, with one correction: black markets are driven by shortage. The role of addiction is in creating demand, and at the same time making authorities restrict access.
There is no thriving black market for antibiotics, because they are accessible when you need them (and most people need them very infrequently for a short duration). In contrast, I believe there is a black market for insulin in the US, and that's because of how ridiculously expensive it is. Exuberant pricing is a form of restricting access, too.
> Addictive is the argument in favor of making it over the counter
You want to control the general population’s access to physically-addictive substances to control addiction. Managing addicts is not a pharmaceutical matter.
> Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
I sympathize with your broader point, but... how is that better? "Sorry, you were buying too much nasal decongestant a decade ago, so no cancer medication for you"?
I understood your parent comment in a specific drug way: you can buy pseudo until your license to buy that specific compound, or maybe a group or related chemicals, is revoked. But you can still get any other compound.
Not that different from current situation: we have all our "license" to buy scheduled compounds revoked, but we still can get a lot of other compounds.
The car stat is a good example of trying new policies to lower car deaths! They are the greatest risk to my children's lives and I find it terrifying that we let them roll around everywhere so close to people, like we do in parking lots.
>Maybe license people to buy meds and take it away if they abuse it?
I'm a bit confused, because you can buy it already with an ID, correct? You don't even need a purchasing license, just a drivers license or other government ID.
You can only buy from a pharmacist (behind the counter) and you need to provide your national ID number. Your purchase is put in a database that any pharmacist can see.
I read a study here in Australia a little while ago that showed that removal of easily accessible pseudoephedrine had done nothing to either stop the proliferation of clandestine labs, nor curtail the availability of crystal meth. They just switched to different syntheses, and there are still large-scale imports that sometimes get caught, sometimes don't.
People were still trying to claim the program was a success because they had stopped gangs getting pseudo as a precursor.
But so what? it's done literally nothing to stop criminals profiting, nor to stop people getting addicted to meth, with all the associated public health and petty-criminal consequences of that. And now it's harder for ordinary people to get effective decongestant.
It just seems that nobody is willing to admit the whole thing was pointless.
Same in New Zealand, we removed pseudoephedrine as an option unless you had a special dispensation from the Ministry of Health - mainly due to pharmacies being ram-raided for the pseudo.
The end result? The gangs just started importing pseudo, before later just switching to importing methamphetamine directly (something that Australia's deportation policies really helped with as the "501s" as we call them that were deported back to NZ often had existing connections that could facilitate the direct importation of meth).
It's a really interesting supply chain that involves organised crime groups in multiple countries, often starts in India for the precursors, then clandestine labs in Laos/Vietnam/Thailand overseen by Chinese groups in conjunction with local groups, then smuggled via the Pacific Islands, notably Fiji and Samoa where the Chinese groups have established transshipment facilities, before being smuggled into Australia and NZ by local groups who then distribute and supply it.
A new development has been the Central American cartels branching out from cocaine to meth so there's been a bunch of meth coming directly from the Americas.
I remember complaining to my friends about how frustrating it was to hear that a medicine I frequently used turned out to be placebo, exactly one year ago today. Opened this article up, I'm currently taking the _exact same_ one in the article photo - it's what I had lying around and I had forgotten the name of the "bad" sudafed (it's sudafed PE). They need to take it off the shelves quicker. Every day is tens of thousands of more people who are scammed.
Putting my money where my mouth is and leaving a comment on the FDA proposal...
I remember when the law first went into place. I bought some meds and the next day was back at the store because the new stuff didn’t work. For me it was even more obvious because pseudoephedrine works so well for me.
If you're referring to Zicam, there's actually evidence that zinc gluconate helps reduce the length and severity of colds... and it's actually present in more than trace amounts in Zicam. They market it as "homeopathic" in order to get around FDA regulations, and they've gotten in trouble because zinc in your nose can knock out your sense of smell, perhaps permanently. (The lozenges don't appear to have this issue.)
How can you believe you've been taking a placebo for years? Phenylephrine is used for the illicit synthesis of methamphetamine, so there's an inherent bias towards anything that gets it off the shelves. Cherry picking studies that say it's ineffective is more velvet glove than using only the iron fist to ban the stuff. But make no mistake that the iron fist is taking your meds away either way.
Pseudoephedrine is the one that is both proven to be effective and is the precursor to meth. Phenylephrine is the useless placebo that they put in the tablets on the shelf only because it can’t be used to make meth. It should be torn off the shelves because it’s useless.
The only reason the ‘PE’ (marketing term for the ineffective phenylephrine) tablets might be helpful is because they usually also have paracetamol (acetaminophen) in them which is probably the only bit that works. They don’t work as a decongestant for most people like pseudoephedrine does though.
I believe that it doesn’t work wholeheartedly, because every time I try it, it is ineffective - but my sinus problems are rarely bad enough to warrant medication (it’s been one year) and by then I’ve forgotten what works and what doesn’t.
Also, I suspect you’re mixing up your drugs. Phenylephrine (the drug in this article) lacks the methyl structure to be used for the synthesis of methamphetamines. In fact, that’s why it was popularized - pseudoephedrine, the truly effective sibling, was becoming too good for meth production, so they created a less potent alternative, phenylephrine, that lacks the ingredients necessary. They then locked pseudoephedrine behind the counter. Turns out the oral form of phenylephrine is less than “weaker” - it’s largely useless - so they pumped out enough of this crap to the tune of $1.7B that the American public spent every year for 18 years after they knew.
I think you're confusing Pseudoephedrine (which works and is used to produce meth) with Phenylephrine (which doesn't work and cannot be used to produce meth).
This article is about removing phenylephrine (sudafed PE) from shelves. Studies have pretty thoroughly showed it is completely ineffective for what it is marketed for
Way overdue. I wonder if the purveyors of this fraud have ever been sued.
One refrain I got tired of hearing was that it "wasn't a safety issue." WRONG. Anyone who has ever had a ruptured eardrum can tell you that it is 100% a safety issue.
If you're about to take a flight with any congestion, you're relying on decongestant to save your ears. I've had ruptured eardrums; it's probably the worst pain I've experienced. I had to take a flight a couple years ago with only this crap, and must have come extremely close to rupturing them again. It was EXCRUCIATING.
It works wonders on me and family members. Except we just always go for the Neil Med bottles from Costco or Target. They are also easy to disinfect in the microwave.
Always distilled water, though. It’s not worth waiting to boil the water, let it cool down, and then manage the dish used after. It’s also easy to get just the right temperature using distilled water in the microwave.
I tried this once when I was a teenager. As far as I remember, I took the precautions of sterilized water, getting the right salt, etc.
Guess I didn’t know how to properly use it, since I gave myself an awful sinus infection and was bedridden for next two weeks. To this day it’s the worst I’ve ever felt. Never touching a neti pot since then :/
Most worthless law. Now i have to wait in line for 10 minutes to get it and yet meth is still widely available and usage actually increased. Did nothing except shift manufacturing to outside of the US.
Pseudoephedrine should be unrestricted, there’s no way to compete on price with meth cooked in an industrial lab in Mexico by using pseudoephedrine as a precursor. Keep it behind the counter (to prevent theft) but let adults buy as much as they want.
And I can't stockpile it for allergy season (which is about 9 months out of the year for me). I have to make regularly scheduled trips to the pharmacy every two weeks which is a huge pain in the ass
Corticosteroids are powerful substances, and have lots of potential adverse effects - and long-term usage can wreak havoc. The physiological side-effects of corticosteroid withdrawal can be quite awful. They are amazing, necessary, drugs for society. But, when something as safe and effective as pseudoephedrine can do the trick (it really is quite safe, and even has less potential interactions with things than plenty of OTC drugs do), there is literally no reason for anything else.
When I get a cold, (pseudo)ephedrine is the only medication that actually really helps. I don't need it often, I just try to remember to buy some once in a blue moon when I'm already at the pharmacy so that when I need some, it will be there. But for people with allergies or those who get sick a lot, the current process is yet another completely pointless annoyance.
I once actually got denied and had to buy a smaller box (for the same price). What the hell happens to families with multiple teens who all get sick at the same time?
My life on an ADHD med, a mental health med, and 3 other meds for transgender stuff.
I am very lucky to have a backlog of estradiol, my main HRT drug, because I was purposely "playing under speed" for most of a year, otherwise all 5 drugs would be randomly running out at 5 different times throughout the month. Almost nothing gets assigned to 90-day fills for some stupid fucking reason.
So from personal experience you can often just ask docs for a longer prescription if something isn't particularly restricted (like stimulant-type ADHD medications).
From friends, I know that some therapists and endocrinologists are willing to give 6 mo or even 1 yr scripts of hormones, though some will only do so under certain conditions. You might want to find a different doc. I know one person who gets a 3 mo supply of estradiol from a telehealth provider.
They make twelve hour extended release versions now. There are twelve per box and you can get three boxes at a time. That's 18 days but only if you take them twice a day, which you probably shouldn't if you like sleeping. If you take one a day, that's a whole month's worth.
I was denied this the last time I tried to buy it and the pharmacist couldn't even tell me why aside from "the system won't let me". I went to a different chain a half mile away and walked out with a month's supply of the stuff. Hilariously incompetently-designed regulation.
Meanwhile meth making is more efficient, cheaper, and delivers purer-grade glass than ever.
I've only had to buy it in three states, but generally my experience has been that you can buy a "30 day supply" per month. How often are you sick that you need more than 30 days of the stuff every month? If we run out I'll buy a 30 day supply and that generally lasts the whole family a year or more.
You definitely don't have anyone in your family who gets severe congestion from allergies then. The "funnest" form it takes for me is when I start going partially blind in one eye due the the sinus pressure
> Unfortunately there is an absurdly low limit on purchasing amount in the US.
The maximum safe dose for an adult is 240 mg in a 24 hour period. Current guidelines allow for getting a 10 day supply (the average cold lasts 7-10 days) in a single visit, and basically a limitless supply with a few visits (37 days worth every 30 days).
If you are running into purchasing limits, you are either making meth or blowing out your liver.
Edit: Math is hard. The 30 day limit is 7.5 grams (a 31 day supply), or 3.6 grams per trip (a 15 day supply).
What's 10 days/4 people? like... a family that lives together? Who will almost inevitably get each other sick? If the average cold lasts 7-10 days, one of them's going shopping for more while sick.
Sounds like great public health and safety policy there.
I seem to only be able to buy 10 days of Sudafed 24 Hour every 14 days. That doesn't work if you have allergies.
Presumably because places like Walgreen's can't adjust compliance per state and places like Alaska have "No person may purchase or possess more than 6 g of PSE, EPH or PPA per 30 days unless dispensed pursuant to a prescription"
Note that 6g / .240g = 25. So I can only buy 25 days worth of pills every 30 days. Or 12.5 pills every 15 days which is suspiciously close to that 10 every 14 days number.
Aren’t there better things to take longer term for allergies? Pseudoephedrine is amazing for colds etc. but I’ve always seen warnings not to take it for more than a few days at a time…
I can't pronounce either one of the Sudafed substances. One time, an old lady asked me which Sudafed work for her as she pointed to a shelf full of Sudafed plus other decongestant drugs. I told her just buy the one that you need to take the flyer and bring it to the pharmacist to get it. Others are just scam. The real one is used to make meth so they put it behind the counter.
She was surprised that the US gov would allow fake decongestant to be sold.
My anecdata is that, though it's not as effective as pseudoephedrine, phenylephrine actually is effective in an inhaler, and a helluva lot better at clearing up a stuffy nose than "scents and essential oils". Of course, a cylindrical inhaler with a wick inside it doesn't go near my digestive tract... Now I'll have to look around for a replacement inhaler, something quick enough to avert choking-panic. Thanks, CVS.
It's only the oral version which has no effect and is thus being pulled. The inhaled version has more evidence that it works and will remain available.
Phenylephrine worked great for clearing my mucus overproduction. Unfortunately, this has little to do with allergy relief, so I can see why many here hold that it's ineffective. I can imagine how frustrating it must be to have actual allergy issues and be prescribed something that doesn't solve the problem.
Does anyone else feel like dayquil is an effective decongestant? I do. I can literally feel the gunk running down from my sinuses to the back of my throat when I take it. Confusing to me cause it's phenylephrine, which is what the article states is ineffective. I've had this experience after reading these reports about a year ago.
> Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication taken by mouth and marketed as an aid to eliminate sputum from the respiratory tract.
> ...
> Guaifenesin is used to try to help with coughing up thick mucus, and is sometimes combined with the antitussive (cough suppressant) dextromethorphan, such as in Mucinex DM or Robitussin DM.
---
> Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines.
> ...
> The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), or from inhaled particle irritants, as well as chronic cough at a higher dosage.
---
The combination of the two is designed to reduce coughing and when you do cough, it is much more productive with the expectorant and cough suppression. It isn't a decongestant, but it has (personal anecdotal take) a good effect on getting rid of the secondary effects of congestion.
I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?), although I can't find it again, and I may have read it when I was congested and only had PE.
My lived experince with PE is it never works most of the time. But if I realise I need psuedoephedrine and I'm not somewhere or sometime where I can access it, I'll get PE and hope. Sometimes hope works, but it usually doesn't clear my sinuses very effectively. But if I have sinus congestion related to flying, I might also have soreness related to flying and take PE (because you can get it at the airport) and ibuprofen together, and maybe it works.
But also some people are more sensitive to some drugs, so it could work for you, while not being very effective in general.
> I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?)
Oh yeah combine with Tylenol and increase the dose if you want to experience adverse cardiac events. The oral form of PE is really only good for jacking up blood pressure, it doesn't help with congestion more than placebo: https://pmc.ncbi.nlm.nih.gov/articles/PMC4500855/
Just as a reminder, you are completely allowed to buy pseudoephedrine without a prescription, you just have to ask your pharmacist. My local pharmacy keeps it behind the counter already pre-compounded, and it's cheap and effective. One of those little things that I never used to purchase because I was somehow not certain if I could actually get it. Yes, you can.
What country are you in? In the US, pseudoephedrine has to be requested at the pharmacy counter, but it's not a compounded medication. Instead it's sold as pills in the usual "blister pack" format.
I live in the US. You're right, it's not compounded by my pharmacy, I was confused because of the branding on the package — it's manufactured somewhere else and just repackaged by my pharmacy:
It's not repackaged by your pharmacy, Good Neighbor Pharmacy is a generic drug brand for pharmacies and supermarkets that don't have their own generic brand.
Ohm Laboratories appears to be a subsidiary of Sun Pharma which is one of the largest generic drug manufacturers in the world. This looks like a pretty standard generic drug with store branding package to me.
My local pharmacies keep it behind the counter, but the counter has shorter hours than the rest of the store. And you've got to submit your license to be entered into their system (and who knows what happens with that data).
Finally. I hope this reaches Australia and the rest of the world. Phenylephrine doesn't work, it never worked, it's obvious that it doesn't work, it's a literal scam, and the companies selling it are fraudulent.
Half the products in chemist warehouse are pretty blatant scams. It's insane how effective, important pharmaceuticals are sold side by side with products known to be ineffective and that exist purely to strip uneducated customers of their money.
Next I hope they do cough medicines, I looked a few years ago when I had a cough and it seems like literally none of the OTC ones are more effective than placebo.
Dextromethorphan (DM or DXM) is the OTC cough suppressant. Marketed as Delsym comes in an orange box, or you can find it in various combo formulations, and it works
Delsym is dextromethorphan-polistirex, a long-acting formulation of DXM that is supposed to last 12 hours. DXM is available in almost all cough syrups.
Dextromethorphan is the only otc cough medicine that works and pretty much the only prescription stuff that works is opiate based. Of course both are regulated.
Am I taking crazy pills, because I've been taking PE for years and it works just fine? Like yes the behind the counter stuff is stronger but it also comes with more annoying side effects.
I use it to sleep during allergy season and I can tell when I don't take it when I mouth breathe the whole night. I might try some experiments to see if I can tell but I didn't think you could placebo while sleeping.
whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism.
in the 90s and 2000s when meth first began to spike, the rural economy was changing. Jobs weren't paying as well or were going away altogether. Meth found a niche as a kind of performance enhancement drug for people working long hours at physically demanding jobs. journalist Nick Reding found this in the pork industry in Iowa, and anthropologist Jason Pine found in general in Missouri.
neoliberalisms solution was a ham fisted market based restriction that turned a normal cold drug into a rarity. we didnt start working to treat methamphetamine addiction as a disease until it began to spread into more affluent white-collar neighborhoods.
this could have been avoided with competent market reforms and regulation, as well as stronger labor protections and minimum wage law.
Neoliberals believe in free market and deregulation, not market restrictions.
Nixon was the one that started the war on drugs and also enacted price controls. I would not call him a neoliberal. He also primarily interested in foreign policy and not the economy.
Also, Sudafed was only banned from being purchased easily in 2006. The bill was introduced by a random congressman from Indiana, a congressman was also easily offended by an offensive joke written on someone’s else cake.
And it's much more profitable to scrape every ounce of working life out of the poor, then use them as slave labor in a prison once their addictions get them into a critical situation or farm them out to a rehabilitation facility that pays councilors 20 bucks an hour and gets a large chunk of it's funding from taxpayer subsidies. If there's any issue, blame the overworked poor for turning to drugs, then sell them energy drinks.
>I bet you think people should trust you even though I also bet you were wrong about something once.
Is there anything I've been wrong about which has been significant for a couple of decades?
Pseudoephedrine left OTC in about 2006, phenylephrine has been the main decongestant available and there's been solid evidence out there for a long time that it didn't do anything.
It makes me wonder if it has anything to do with Trump winning the election.
> What else is the FDA wrong about
Too much. For one, numerous harmful additives are freely allowed. These additives may not cause immediate damage, but over the long term they really inflame the gut. They serve no good purpose in the medicines. Examples include: propylene glycol, sodium lauryl sulfate, titanium dioxide, talc, ammonium hydroxide, monoethanolamine, n-butyl alcohol.
For the record, with regard to treatment, ivermectin was understood to benefit anyone who had a co-occurring worm infection (targeted by ivermectin) while also having Covid. This just rules out most people in the US as they typically don't have the corresponding worm infections. I myself tried two brands of ivermectin while having Covid, with no luck.
Better to have taken it when (and if) you knew you were exposed. It was always considered to be a prophylactic more so than a treatment. And in that capacity it did seem to work for me. (Having never tested positive for COVID, despite numerous tests, numerous exposures and no shots)
I also suspect that the much maligned "fish tank cleaner" hydroxychloroquine remains effective-as-ever for many issues, which "more targeted" in-patent drugs are on the market for.
One of my favorite papers is "A simple and convenient synthesis of pseudoephedrine from N-methylamphetamine" [1].
This is a satirical paper. Because pseudoephedrine (i.e. the good decongestant) is very difficult to obtain due to restrictions, but "N-methylamphetamine can be procured at almost any time on short notice", the paper describes how to synthesize pseudoephedrine from meth with a procedure that looks valid.
[1] https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
I found out recently that you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from, because apparently each state administers its own database. If you run out and have a persistent cough (weakened immune system from not licking doorknobs the last few years of covid, or so do the doctor says) from a common cold while on vacation, you're shit out of luck unless you go back home or you and an accomplice are willing to procure your cough medicine with their license.
> you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from
The FDA rule on this [1] doesn't appear to be quite that strict: it says the ID can be "a photo identification card issued by the State or the Federal Government or a document that is considered acceptable by the seller". It doesn't explicitly say it has to be from the same state as the one in which you are buying the medication, and it leaves the seller some latitude in what to accept.
Possibly some states have more restrictive rules. Or particular sellers might be more leery about what they are willing to accept.
[1] https://www.fda.gov/drugs/information-drug-class/legal-requi...
The FDA rule doesn't restrict the IDs but the phrase "that is considered acceptable by the seller" lets the pharmacy put any restrictions in place they want. They can tell you it has to be hot pink and glow-in-the-dark and you've got no choice but to deal with it.
While true as long as they're in compliance with the law, wouldn't they want to sell all the Sudafed they can? They can deny service to anyone for pretty much any reason. No shirt, no shoes, no Sudafed or anything else. So yeah, but in reality it isn't aligned with their interests and if they don't want to serve you they can always find a different justification.
Maybe they want that, maybe they don't. Retail drug stores in the US are an oligopoly, that industry may not be a monopoly (yet) but they don't function under perfect competition. Maybe if you're the management or the shareholders of a retail drug chain you're just kind of shrugging your shoulders and working on the next merger at this point since the fewer competitors you have, the less hard you have to work for the customer's dollar.
Here in Vietnam it's completely impossible to get pseudoephedrine at all and I think it's the same in all Asian countries. I even resorted to trying to buy some ephedra tea (Chinese medicinal herb from which ephedrine was first discovered). I ordered a box of tea bags from Shoppee and rather amusingly received an envelope with some the amount I had paid including shipping in cash and an apology letter saying they could no longer sell this herb and please don't leave a bad review.
However, a few months earlier due to a Google translate mixup where I thought I was ordering peppermint oil, I got 100ml of sassafras oil [0]. It's a precursor to MDMA and at least as restricted as pseudoephedrine.
https://en.m.wikipedia.org/wiki/Safrole
Seems like it varies by state - I’ve purchased Sudafed in at least two states other than my own.
Same here.
Me too.
I've purchased Sudafed in Nevada with a foreign drivers' license with no issues.
My WAT.
Refused sale of Sudafed because my license was expired. Apparently I accidentally tossed my new license and kept the old one. Doh! However they happily refilled my schedule III meds with the expired license.
As I said WAT.
That's not universally applicable, as I've purchased it in Washington plenty of times with an Oregon ID.
It's ironic that the pharmacies are so paranoid that you'll cook meth from Sudafed but are happy to enable amphetamine habits in kids that have trouble focusing in school.
Adderall is a 3:1 dextroamphetamine/levoamphetamine mix.
Methamphetamine is a whole other level of stimulant.
> amphetamine habits in kids that have trouble focusing in school.
1) Do you have evidence that Adderall at therapeutic dosages is anywhere near as addictive as methamphetamine at recreational dosages?
2) Yeah, ADHD makes it real hard to focus at school. I never graduated from high school, and I dropped out of university as an adult student without even completing one year, thanks to untreated ADHD. Not to mention the impulsive behaviour, the inability to stick at boring things etc. etc. It's not great in our society.
You're implicitly minimising the very real impact of ADHD, that's not super great.
In fact, one of the biggest issues for people finally being treated for ADHD as adults is the grieving process around "What my life could've been if my parents hadn't believed that ADHD wasn't real and my issues in school and my 'disruptiveness' was solely due to 'food intolerances', because my Mom read a magazine article about it once, then paid a quack to stick a probe in my ear, one on my finger, and then rub food on my skin while looking at a galvanometer making 'hmmm' noises sagely."
3) You know there's been Adderall shortages in the USA recently due to DEA manufacturing limitations right? So it's not like they're just throwing out to kids like it's a lolly scramble.
Anyway, it's about as ironic as 10,000 spoons when all you need a knife. That is, not at all.
> Methamphetamine is a whole other level of stimulant.
The extra methyl group that differentiates it from regular amphetamine salts mainly serves the purpose of crossing the blood-brain barrier quicker. However, during this process it loses that extra methyl group. So whether you're taking meth or adderal, the chemical that actually reaches your brain is ultimately the same
In fact, methamphetamine is available as a prescription ADHD medicine under the brand name "Desoxyn"
And you get a erdös number for taking them : https://en.wikipedia.org/wiki/Paul_Erd%C5%91s#Personality
I thought that (1) meth (e.g. methylphenidate a.k.a. ritalin) blocks reuptake of dopamine, and (2) amphetamine (e.g. dextroamphetamine) stimulates production of dopamine, and (3) methamphetamine (a.k.a. desoxyn) does both. Is that understanding accurate?
I have never seen "meth" taken to mean anything other than methamphetamine, and certainly not methylphenidate.
Yeah, precisely, that methyl group is why methamphetamine is super popular, it makes a whole lot of difference in the felt effect.
I think the parent post is more likely alluding to the abuse of the medication, particularly in higher learning institutions.
https://psych.wisc.edu/news/easy-access-pressure-on-students....
Aderrall is a Schedule II drug. This is the same category as oxycodone and fentanyl.
https://www.therecoveryvillage.com/adderall-addiction/adhd-a...
> I think the parent post is more likely alluding to the abuse of the medication, particularly in higher learning institutions.
It's kind of weird that people are calling this "abuse" when it's apparently using the drug in the same context and dosage as it's prescribed therapeutically, plausibly by people who actually have ADHD but don't have the time or insurance to get a prescription.
It's an interesting case study in what would happen if it was more widely available in a pharmaceutical form with a known dose and purity. What percentage of these college students are actually getting addicted to amphetamine vs. just taking a therapeutic dose here and there?
~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
_Edit: I am told I'm wrong on this front, and I stand corrected_
The fact that doctors are prescribing them too freely is definitely worth looking into.
But severely restricting medication that is used to effectively treat disease because it has abuse potential only harms legitimate users. But definitely worth auditing prescriptions to ensure that they're being issued for valid diagnoses.
But as for illegitimate users? You ban it, they'll find something else.
And as someone who needs ADHD meds to do things like "remember I have a todo list, remember where I left it, and remember to use it", I very much resent the people who abuse the meds I need to function in our society to pass their law degrees easier.
I resent the meth addicts who try to get an ADHD diagnosis for their kids so they can abuse (or sell...) their children's ADHD meds when they can't afford meth, because it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
(My country uses methylphenidate / Ritalin / Concerta (the slow release form) as the first treatment for ADHD, Adderall is not prescribed here that much, if ever, but it is possible to be prescribed dexamphetamine if you're bad enough).
But I really do object to glibly implying that every child who is prescribed a treatment for ADHD is actually a case of pharmacists gleefully overmedicating, it's naïve, unsympathetic, and, tbh, rather unfair to pharmacists.
As for what schedule a drug is... ...is the harm of Adderall abuse the same as the harm of fentanyl abuse?
Drug schedules aren't a good way to determine harm, IMO. They're a good way to discern moral panics though.
E.g., in my country, Class A, the drugs that attract the highest penalties, include magic mushrooms, mescaline, DMT, and that one you get from licking toads, bufotentine or something, alongside classics like heroin and cocaine.
Fentanyl is Class B, alongside opium, morphine, amphetamine, methylphenidate, MDMA, and one that always amuses me, hashish.
* There's probably some dumb-ass rules around declining to dispense abortifacients because of religious beliefs, I'm sure.
> I very much resent the people who abuse the meds I need to function ... I resent the meth addicts ... it means I have to pee into a jar every three months to prove I'm not a meth addict who is abusing methylphenidate.
It's important to remember that no addict did this to you. An addict doesn't force Kaiser to charge me $20 when they demand I piss in a cup in order to receive my legally prescribed medication. It's fucking Kaiser, and the DEA, and the mad cap conservative politicians and their shitty fucking values. Drug addicts are suffering from a health problem, just like you and I are with our ADHD. None of us have the power to influence the massive engine of carceral drug policy and the promotion of mass moral panic about people taking medication that helps them.
It's important to point the anger at the right people.
Using telemedicine in New Hampshire, I don't have to take any drug tests for mine, just self-report my blood pressure and pulse on zoom every 3 months.
> ~~Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.~~
As others said, it's not true. Pharmacists are also trained to spot any possible adverse drug interactions with other medications that you might be taking.
It more often happens in the clinical setting, rather than at retail pharmacies, but it still is a possibility.
I do believe you quoted my edit after being corrected :)
I was definitely wrong.
> Pharmacists have no ability* to not dispense medicines if a doctor prescribes them.
This is not true. Pharmacists have the right to not fill a prescription for a number of reasons, and in fact can be held liable for not doing so.
If they feel the use of the drug is medically inappropriate they can decide not to fill it. If they feel the patient is taking it for a non-medical reason (abuse) they can choose not to fill it.
Pharmacists are medical professionals who are expected to use their judgement to make sure medicines are not used inappropriately.
Interesting, do you have any material I can read up on about this?
P.S., have edited that statement after your correction, much obliged :)
Damn, if Schedule II drugs are that bad, Schedule I drugs must be terrible. Let me go see:
> Some examples of Schedule I drugs are: lysergic acid diethylamide (LSD), marijuana (cannabis)
Oh damn, marijuana is worse than this drug? I hope they arrest anyone selling marijuana. What’s that you say? Legal? In California? Oh, in lots of states?
I don’t know why you are being downvoted, adhd medication is insanely overprescribed. Turns out, kids get antsy and hard to control after cramming them into overcrowded rooms for 8-9 hours a day doing slop work. Some schools are now forgoing any form of recess at all. Modern public education is inhuman and dystopian.
It is absolutely not the job of a pharmacist to make decisions about which drugs are being overprescribed, and IMHO it's a dangerous thing to suggest. The pharmacist should assess for drug interactions, but we can't burden pharmacists with knowing the details that went into a prescription, and we shouldn't have them second guessing the diagnosis of a doctor. Down that road lies madness.
I get where you're coming from but pharmacists have the right to refuse to fill a prescription and in fact can be held liable for not doing so. Pharmacists are trained medical professionals and are expected to use their judgement
Judgment based on what? The five-second interaction we have while they're doing twenty other things thirty feet away?
Another thing is, do you get an actual trained and knowledgeable pharmacist, or a technician?
In Poland, pharmacies are required by law to have a MSc in pharmacy present during operating hours - that is, no less than one pharmacist with a Masters degree. One is enough. Which means that's all you get. You may not even see them unless you're buying ADHD meds, which need MSc to sign off on them. Otherwise, you're almost always dealing with a pharmacy technician. Some are pretty knowledgeable[0], others could be replaced by GPT-3.5[1] with net benefit to the customer. The latter type, if they're going to notice anything about you, it's whether you're likely to buy some useless supplement or homeopathic product.
--
[0] - Probably on their way to MSc in Pharmacy, which is a mistake if they're looking for a pharmacy job - pharmacies don't want people with MSc, there's enough of them around already; they want the cheap technician labor.
[1] - Yes, not even 4.
Oh good, another round of "ADHD isn't real."
The more interesting take for me is that these meds work roughly the same way and almost as well in people without ADHD (a symptom cluster, not a single disease per se, like everything else in the DSM). As we give them to people with ADHD why not let anyone get a scrip?
People without ADHD already get more than enough benefit from just coffee. Stimulants might be able to benefit them further, but if you let anyone take them, eventually it'd become expected of everyone due to their increased productivity, and the potential consequences of abuse are much higher than coffee.
Chronic use of caffeine blunts the effects, it doesn't do much to regular drinkers. You develop tolerance very quickly. I can drink several cups and get basically no effect. Apparently your body just increases the quantity of adenosine receptors in the brain to offset the caffeine.
"simple and convenient" does a lot of heavy lifting in this paper - n-BuLi, chromium hexacarbonyl and MoOPH (had to look that one up!) is not something you find outside of a well equipped lab and shouldn't be touched by anyone who isn't highly experienced.
How did I miss this article before?!? Love it!
> Other side effects may include violent urges or, similarly, the urge to be successful in business or finance. ... > We expect that the simultaneous trends of restricting pseudoephedrine sales while N-methylamphetamine becomes less expensive and of higher purity will make the methods presented here increasingly attractive.
Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
Pseudoephedrine should be easy and plentiful to obtain. I don't care if people use it to make meth. What they do in their private time doesn't concern me. Not being able to get Sudafed when I'm sick kills me. It's not like those people won't be able to get meth some other way.
We let people buy cars and cause 43,000 automobile deaths a year. People should be able to live life without stuffy noses. Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
And don't get me started on ADHD medication and their shortages.
Edit: and there are 178,000 alcohol related deaths per year in the US. If you're going to allow that without prohibition, then please let us unstuff our noses.
I'm tired of living in a nanny state when we let people buy and own guns and swords and flamethrowers. Simply hiking on a mountain can kill you. Must we install guardrails on all the high places?
It's not that bad of a negative externality. Honestly. Not relative to all the other ones we've deemed acceptable. This is weird picking and choosing that doesn't make sense.
> Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.
What's even worse, modern pseudoephedrine is produced in a form that makes meth synthesis from it extremely tedious and generally impossible in home conditions: https://pmc.ncbi.nlm.nih.gov/articles/PMC3793278/
> Pseudoephedrine should be easy and plentiful to obtain
Anything that isn't directly physically addictive (e.g. opiates) or subject to a tragedy of the commons (e.g. antibiotics) should be over the counter.
Addictive is the argument in favor of making it over the counter. Addicts will do whatever it takes to get their fix, so if there isn't a legal path, they buy on the street, creating a funding source for organized crime and spurring gang violence.
Then, because the black market is already in violation of the law, there are no purity standards. The customer who thinks they're getting Adderall or codeine is actually getting fentanyl because fentanyl's much higher potency makes it easier to smuggle, but for the same reason makes it much more prone to addiction and overdose, especially when careless street dealers get their proportions wrong. All of which is avoided if you just let them buy it from the pharmacy.
Notice that there is no thriving black market for antibiotics propping up international drug cartels, because they're not addictive.
Strongly agreed, with one correction: black markets are driven by shortage. The role of addiction is in creating demand, and at the same time making authorities restrict access.
There is no thriving black market for antibiotics, because they are accessible when you need them (and most people need them very infrequently for a short duration). In contrast, I believe there is a black market for insulin in the US, and that's because of how ridiculously expensive it is. Exuberant pricing is a form of restricting access, too.
> Addictive is the argument in favor of making it over the counter
You want to control the general population’s access to physically-addictive substances to control addiction. Managing addicts is not a pharmaceutical matter.
> Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.
I sympathize with your broader point, but... how is that better? "Sorry, you were buying too much nasal decongestant a decade ago, so no cancer medication for you"?
I understood your parent comment in a specific drug way: you can buy pseudo until your license to buy that specific compound, or maybe a group or related chemicals, is revoked. But you can still get any other compound.
Not that different from current situation: we have all our "license" to buy scheduled compounds revoked, but we still can get a lot of other compounds.
How is that any better than the current system which is just “no cancer medication for you”?
I think they were deliberately pointing out the absurdity by comparing it to other far more dangerous things we just waive off if you have a license.
The car stat is a good example of trying new policies to lower car deaths! They are the greatest risk to my children's lives and I find it terrifying that we let them roll around everywhere so close to people, like we do in parking lots.
>Maybe license people to buy meds and take it away if they abuse it?
I'm a bit confused, because you can buy it already with an ID, correct? You don't even need a purchasing license, just a drivers license or other government ID.
It is even easier to get in Singapore.
Really? As in, in spite of how bonkers the overall import rules in Singapore are?
I just travelled there few weeks ago, and the government websites made it sound like it’s best to just not bring any pills at all (or chewing gum).
- Tool you can to use to check active ingredients and whether its allowed: https://www.hsa.gov.sg/personal-medication/check-requirement...
- Anything that might be controlled/require prescription, have to apply for permit it to bring it: https://www.hsa.gov.sg/personal-medication/submit-applicatio...
- They provide a tool to show illegal health products. Better not bring one of them: https://oscar.hsa.gov.sg/Publication/ahpdm/faces/AHPPublicat...
It's the same in Singapore.
You can only buy from a pharmacist (behind the counter) and you need to provide your national ID number. Your purchase is put in a database that any pharmacist can see.
I read a study here in Australia a little while ago that showed that removal of easily accessible pseudoephedrine had done nothing to either stop the proliferation of clandestine labs, nor curtail the availability of crystal meth. They just switched to different syntheses, and there are still large-scale imports that sometimes get caught, sometimes don't.
People were still trying to claim the program was a success because they had stopped gangs getting pseudo as a precursor.
But so what? it's done literally nothing to stop criminals profiting, nor to stop people getting addicted to meth, with all the associated public health and petty-criminal consequences of that. And now it's harder for ordinary people to get effective decongestant.
It just seems that nobody is willing to admit the whole thing was pointless.
Same in New Zealand, we removed pseudoephedrine as an option unless you had a special dispensation from the Ministry of Health - mainly due to pharmacies being ram-raided for the pseudo.
The end result? The gangs just started importing pseudo, before later just switching to importing methamphetamine directly (something that Australia's deportation policies really helped with as the "501s" as we call them that were deported back to NZ often had existing connections that could facilitate the direct importation of meth).
It's a really interesting supply chain that involves organised crime groups in multiple countries, often starts in India for the precursors, then clandestine labs in Laos/Vietnam/Thailand overseen by Chinese groups in conjunction with local groups, then smuggled via the Pacific Islands, notably Fiji and Samoa where the Chinese groups have established transshipment facilities, before being smuggled into Australia and NZ by local groups who then distribute and supply it.
A new development has been the Central American cartels branching out from cocaine to meth so there's been a bunch of meth coming directly from the Americas.
I remember complaining to my friends about how frustrating it was to hear that a medicine I frequently used turned out to be placebo, exactly one year ago today. Opened this article up, I'm currently taking the _exact same_ one in the article photo - it's what I had lying around and I had forgotten the name of the "bad" sudafed (it's sudafed PE). They need to take it off the shelves quicker. Every day is tens of thousands of more people who are scammed.
Putting my money where my mouth is and leaving a comment on the FDA proposal...
I remember when the law first went into place. I bought some meds and the next day was back at the store because the new stuff didn’t work. For me it was even more obvious because pseudoephedrine works so well for me.
My grocery store pharmacy has homeopathic stuff next to the Sudafed too. Is literally a placebo.
At least the Sudafed has acetaminophen in it ...
If you're referring to Zicam, there's actually evidence that zinc gluconate helps reduce the length and severity of colds... and it's actually present in more than trace amounts in Zicam. They market it as "homeopathic" in order to get around FDA regulations, and they've gotten in trouble because zinc in your nose can knock out your sense of smell, perhaps permanently. (The lozenges don't appear to have this issue.)
How can you believe you've been taking a placebo for years? Phenylephrine is used for the illicit synthesis of methamphetamine, so there's an inherent bias towards anything that gets it off the shelves. Cherry picking studies that say it's ineffective is more velvet glove than using only the iron fist to ban the stuff. But make no mistake that the iron fist is taking your meds away either way.
Pseudoephedrine is the one that is both proven to be effective and is the precursor to meth. Phenylephrine is the useless placebo that they put in the tablets on the shelf only because it can’t be used to make meth. It should be torn off the shelves because it’s useless.
The only reason the ‘PE’ (marketing term for the ineffective phenylephrine) tablets might be helpful is because they usually also have paracetamol (acetaminophen) in them which is probably the only bit that works. They don’t work as a decongestant for most people like pseudoephedrine does though.
I believe that it doesn’t work wholeheartedly, because every time I try it, it is ineffective - but my sinus problems are rarely bad enough to warrant medication (it’s been one year) and by then I’ve forgotten what works and what doesn’t.
Also, I suspect you’re mixing up your drugs. Phenylephrine (the drug in this article) lacks the methyl structure to be used for the synthesis of methamphetamines. In fact, that’s why it was popularized - pseudoephedrine, the truly effective sibling, was becoming too good for meth production, so they created a less potent alternative, phenylephrine, that lacks the ingredients necessary. They then locked pseudoephedrine behind the counter. Turns out the oral form of phenylephrine is less than “weaker” - it’s largely useless - so they pumped out enough of this crap to the tune of $1.7B that the American public spent every year for 18 years after they knew.
Ah gotcha. So the cynical thing I thought would happen already happened.
Glad to hear we're on a road where peak cynicism is looking behind us.
I think you're confusing Pseudoephedrine (which works and is used to produce meth) with Phenylephrine (which doesn't work and cannot be used to produce meth).
This article is about removing phenylephrine (sudafed PE) from shelves. Studies have pretty thoroughly showed it is completely ineffective for what it is marketed for
Way overdue. I wonder if the purveyors of this fraud have ever been sued.
One refrain I got tired of hearing was that it "wasn't a safety issue." WRONG. Anyone who has ever had a ruptured eardrum can tell you that it is 100% a safety issue.
If you're about to take a flight with any congestion, you're relying on decongestant to save your ears. I've had ruptured eardrums; it's probably the worst pain I've experienced. I had to take a flight a couple years ago with only this crap, and must have come extremely close to rupturing them again. It was EXCRUCIATING.
As long as we're giving decongestant advice, in my experience a neti pot (sinus rinse) really helps.
I also take pseudoephedrine when things get bad. I'm not trying to push a natural stuff only approach.
The neti pot really seems to reduce the odds that sinus congestion will spiral into a terrible sinus headache.
Do be aware of the need to use sterilized water to avoid a possible dangerous infection, though. Distilled water is the easiest way.
It works wonders on me and family members. Except we just always go for the Neil Med bottles from Costco or Target. They are also easy to disinfect in the microwave.
Always distilled water, though. It’s not worth waiting to boil the water, let it cool down, and then manage the dish used after. It’s also easy to get just the right temperature using distilled water in the microwave.
I tried this once when I was a teenager. As far as I remember, I took the precautions of sterilized water, getting the right salt, etc.
Guess I didn’t know how to properly use it, since I gave myself an awful sinus infection and was bedridden for next two weeks. To this day it’s the worst I’ve ever felt. Never touching a neti pot since then :/
Meanwhile generic decongestants like Ambroxol that actually work are too expensive to go through FDA approval.
https://marginalrevolution.com/marginalrevolution/2024/05/th...
Maybe a shorter duration(<5yrs) patent(for lack of better word) for unapproved generics might do the trick.
> Maybe a shorter duration(<5yrs) patent(for lack of better word) for unapproved generics might do the trick.
There already is something similar - the NDA exclusivity period. You get 3-5 years where the FDA won't approve any other versions of the product.
https://www.tandfonline.com/doi/pdf/10.4155/ppa.14.30
But ambroxol isn't a decongestant - it supposed to help with phlegm.
So stupid. It was plainly obvious how ineffective it was, compared to pseudoephedrine, anytime you got sick.
Back to Pseudoephedrine! It's behind the counter at your local pharmacist.
Most worthless law. Now i have to wait in line for 10 minutes to get it and yet meth is still widely available and usage actually increased. Did nothing except shift manufacturing to outside of the US.
Bring back domestic manufacturing jobs!
Small batch, organic, artisanal, fair trade meth for the win!
Pseudoephedrine should be unrestricted, there’s no way to compete on price with meth cooked in an industrial lab in Mexico by using pseudoephedrine as a precursor. Keep it behind the counter (to prevent theft) but let adults buy as much as they want.
There was actually a push to make it rx only. Oregon and Mississippi passed laws to make it RX, luckily those laws have been rolled back.
And I can't stockpile it for allergy season (which is about 9 months out of the year for me). I have to make regularly scheduled trips to the pharmacy every two weeks which is a huge pain in the ass
Any reason you choose to take PE rather than a corticosteroid nasal spray?
Corticosteroids are powerful substances, and have lots of potential adverse effects - and long-term usage can wreak havoc. The physiological side-effects of corticosteroid withdrawal can be quite awful. They are amazing, necessary, drugs for society. But, when something as safe and effective as pseudoephedrine can do the trick (it really is quite safe, and even has less potential interactions with things than plenty of OTC drugs do), there is literally no reason for anything else.
When I get a cold, (pseudo)ephedrine is the only medication that actually really helps. I don't need it often, I just try to remember to buy some once in a blue moon when I'm already at the pharmacy so that when I need some, it will be there. But for people with allergies or those who get sick a lot, the current process is yet another completely pointless annoyance.
I once actually got denied and had to buy a smaller box (for the same price). What the hell happens to families with multiple teens who all get sick at the same time?
My life on an ADHD med, a mental health med, and 3 other meds for transgender stuff.
I am very lucky to have a backlog of estradiol, my main HRT drug, because I was purposely "playing under speed" for most of a year, otherwise all 5 drugs would be randomly running out at 5 different times throughout the month. Almost nothing gets assigned to 90-day fills for some stupid fucking reason.
So from personal experience you can often just ask docs for a longer prescription if something isn't particularly restricted (like stimulant-type ADHD medications).
From friends, I know that some therapists and endocrinologists are willing to give 6 mo or even 1 yr scripts of hormones, though some will only do so under certain conditions. You might want to find a different doc. I know one person who gets a 3 mo supply of estradiol from a telehealth provider.
You take 48 pills in two weeks?!
That’s pretty easy when the dose is two pills every six hours.
They make twelve hour extended release versions now. There are twelve per box and you can get three boxes at a time. That's 18 days but only if you take them twice a day, which you probably shouldn't if you like sleeping. If you take one a day, that's a whole month's worth.
I can get 15 of the 24 hour generic Claritins every 2 weeks. Works out to about 1 a day
I was denied this the last time I tried to buy it and the pharmacist couldn't even tell me why aside from "the system won't let me". I went to a different chain a half mile away and walked out with a month's supply of the stuff. Hilariously incompetently-designed regulation.
Meanwhile meth making is more efficient, cheaper, and delivers purer-grade glass than ever.
Or just straight ephedrine, which is also behind the counter at your local pharmacist (brand name Bronkaid).
Unfortunately there is an absurdly low limit on purchasing amount in the US.
In addition, I can't seem to find the 24 hour versions anywhere right now. I could probably buy meth more conveniently. :(
Cue: "A Simple and Convenient Synthesis of Pseudoephedrine From N-Methylamphetamine" https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
I've only had to buy it in three states, but generally my experience has been that you can buy a "30 day supply" per month. How often are you sick that you need more than 30 days of the stuff every month? If we run out I'll buy a 30 day supply and that generally lasts the whole family a year or more.
You definitely don't have anyone in your family who gets severe congestion from allergies then. The "funnest" form it takes for me is when I start going partially blind in one eye due the the sinus pressure
When it’s that bad why wouldn’t you just get a prescription for an appropriate amount for your situation?
> When it’s that bad why wouldn’t you just get a prescription for an appropriate amount for your situation?
Prescriptions take time and money.
"I don't have this problem, therefor this problem doesn't exist, and so you don't have this problem."
> Unfortunately there is an absurdly low limit on purchasing amount in the US.
The maximum safe dose for an adult is 240 mg in a 24 hour period. Current guidelines allow for getting a 10 day supply (the average cold lasts 7-10 days) in a single visit, and basically a limitless supply with a few visits (37 days worth every 30 days).
If you are running into purchasing limits, you are either making meth or blowing out your liver.
Edit: Math is hard. The 30 day limit is 7.5 grams (a 31 day supply), or 3.6 grams per trip (a 15 day supply).
> If you are running into purchasing limits, you are either making meth
This would also be an insanely expensive way to make meth.
At least some states track it on a household (address) basis.
What's 10 days/4 people? like... a family that lives together? Who will almost inevitably get each other sick? If the average cold lasts 7-10 days, one of them's going shopping for more while sick.
Sounds like great public health and safety policy there.
I seem to only be able to buy 10 days of Sudafed 24 Hour every 14 days. That doesn't work if you have allergies.
Presumably because places like Walgreen's can't adjust compliance per state and places like Alaska have "No person may purchase or possess more than 6 g of PSE, EPH or PPA per 30 days unless dispensed pursuant to a prescription"
Note that 6g / .240g = 25. So I can only buy 25 days worth of pills every 30 days. Or 12.5 pills every 15 days which is suspiciously close to that 10 every 14 days number.
Aren’t there better things to take longer term for allergies? Pseudoephedrine is amazing for colds etc. but I’ve always seen warnings not to take it for more than a few days at a time…
This is where you need to bring a buddy on every trip...
> Note that 6g / .240g = 25
Fortunately we are both wrong. I have updated my previous post up thread.
How am I wrong? I quoted the Alaska requirements. Are those not correct? Please reference.
I guess you found the one state who isn't in line with federal law. :)
https://www.deadiversion.usdoj.gov/meth/cma2005.html https://worldpopulationreview.com/state-rankings/pseudoephed...
I can't pronounce either one of the Sudafed substances. One time, an old lady asked me which Sudafed work for her as she pointed to a shelf full of Sudafed plus other decongestant drugs. I told her just buy the one that you need to take the flyer and bring it to the pharmacist to get it. Others are just scam. The real one is used to make meth so they put it behind the counter.
She was surprised that the US gov would allow fake decongestant to be sold.
My anecdata is that, though it's not as effective as pseudoephedrine, phenylephrine actually is effective in an inhaler, and a helluva lot better at clearing up a stuffy nose than "scents and essential oils". Of course, a cylindrical inhaler with a wick inside it doesn't go near my digestive tract... Now I'll have to look around for a replacement inhaler, something quick enough to avert choking-panic. Thanks, CVS.
No you won’t! It’s just the oral formulations that are being taken off the shelves. The inhaled version does indeed work and will still be available.
It's off the shelf at my local CVS (e: and has been for weeks). I looked.
That's their company policy or a supply issue, not the FDA's decision.
Thanks, CVS.
It's only the oral version which has no effect and is thus being pulled. The inhaled version has more evidence that it works and will remain available.
Cue:
- the entry of trolls everywhere demanding that they can keep the médecine they've been using for ages
- the new administration's agreeing with "popular demand" and disagreeing with the FDA, because that's their thing
- and the companies selling the drug be like "uh, ok, fine".
At least it will be an interesting distraction from trying to fix the opioids epidemic ?
Phenylephrine worked great for clearing my mucus overproduction. Unfortunately, this has little to do with allergy relief, so I can see why many here hold that it's ineffective. I can imagine how frustrating it must be to have actual allergy issues and be prescribed something that doesn't solve the problem.
It’s not just allergies - taken orally there is no evidence it works for anything, and there’s pretty good evidence it is basically metabolised away.
The frustration largely comes from pharmacists and pharmaceutical companies selling decongestant remedies that do nothing and are known to do nothing.
phenylephrine is still pretty effective as a topical nasal spray. so don't write it off if you see it in that form.
Does anyone else feel like dayquil is an effective decongestant? I do. I can literally feel the gunk running down from my sinuses to the back of my throat when I take it. Confusing to me cause it's phenylephrine, which is what the article states is ineffective. I've had this experience after reading these reports about a year ago.
As mentioned in a sibling, try looking at Mucinex a try. There is a 12h version that has Guaifenesin https://en.wikipedia.org/wiki/Guaifenesin and Dextromethorphan https://en.wikipedia.org/wiki/Dextromethorphan as the only two active ingredients.
Compare with Dayquil - Acetaminophen 650 mg (pain reliever/fever reducer), Dextromethorphan HBr 20 mg (cough suppressant) and Phenylephrine HCI 10 mg (nasal decongestant).
> Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication taken by mouth and marketed as an aid to eliminate sputum from the respiratory tract.
> ...
> Guaifenesin is used to try to help with coughing up thick mucus, and is sometimes combined with the antitussive (cough suppressant) dextromethorphan, such as in Mucinex DM or Robitussin DM.
---
> Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines.
> ...
> The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), or from inhaled particle irritants, as well as chronic cough at a higher dosage.
---
The combination of the two is designed to reduce coughing and when you do cough, it is much more productive with the expectorant and cough suppression. It isn't a decongestant, but it has (personal anecdotal take) a good effect on getting rid of the secondary effects of congestion.
It's probably the guaifenesin (Mucinex) that you're feeling.
I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?), although I can't find it again, and I may have read it when I was congested and only had PE.
My lived experince with PE is it never works most of the time. But if I realise I need psuedoephedrine and I'm not somewhere or sometime where I can access it, I'll get PE and hope. Sometimes hope works, but it usually doesn't clear my sinuses very effectively. But if I have sinus congestion related to flying, I might also have soreness related to flying and take PE (because you can get it at the airport) and ibuprofen together, and maybe it works.
But also some people are more sensitive to some drugs, so it could work for you, while not being very effective in general.
> I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?)
Oh yeah combine with Tylenol and increase the dose if you want to experience adverse cardiac events. The oral form of PE is really only good for jacking up blood pressure, it doesn't help with congestion more than placebo: https://pmc.ncbi.nlm.nih.gov/articles/PMC4500855/
Might be the other ingredients reducing inflammation, widening your clogged pipes and letting stuff drain.
Previously (with direct link to the FDA ruling): https://news.ycombinator.com/item?id=42082998
Just as a reminder, you are completely allowed to buy pseudoephedrine without a prescription, you just have to ask your pharmacist. My local pharmacy keeps it behind the counter already pre-compounded, and it's cheap and effective. One of those little things that I never used to purchase because I was somehow not certain if I could actually get it. Yes, you can.
What country are you in? In the US, pseudoephedrine has to be requested at the pharmacy counter, but it's not a compounded medication. Instead it's sold as pills in the usual "blister pack" format.
I live in the US. You're right, it's not compounded by my pharmacy, I was confused because of the branding on the package — it's manufactured somewhere else and just repackaged by my pharmacy:
https://files.catbox.moe/9pbj43.jpg
It's not repackaged by your pharmacy, Good Neighbor Pharmacy is a generic drug brand for pharmacies and supermarkets that don't have their own generic brand.
Ohm Laboratories appears to be a subsidiary of Sun Pharma which is one of the largest generic drug manufacturers in the world. This looks like a pretty standard generic drug with store branding package to me.
My local pharmacies keep it behind the counter, but the counter has shorter hours than the rest of the store. And you've got to submit your license to be entered into their system (and who knows what happens with that data).
You need a drivers license though. And they enter something into the computer.
[dupe]
Official release:
https://news.ycombinator.com/item?id=42082998
Finally. I hope this reaches Australia and the rest of the world. Phenylephrine doesn't work, it never worked, it's obvious that it doesn't work, it's a literal scam, and the companies selling it are fraudulent.
Half the products in chemist warehouse are pretty blatant scams. It's insane how effective, important pharmaceuticals are sold side by side with products known to be ineffective and that exist purely to strip uneducated customers of their money.
Junk Science invalidates effective medication. I’m calling this right now, in 5-10 years we’ll be discussing how it counteracts the spike protein.
Great. I always have to explain to people not to buy this crap and get the good stuff instead
Next I hope they do cough medicines, I looked a few years ago when I had a cough and it seems like literally none of the OTC ones are more effective than placebo.
Dextromethorphan (DM or DXM) is the OTC cough suppressant. Marketed as Delsym comes in an orange box, or you can find it in various combo formulations, and it works
Can also give you incredible diarrhea as a nice side effect
Delsym is dextromethorphan-polistirex, a long-acting formulation of DXM that is supposed to last 12 hours. DXM is available in almost all cough syrups.
Dextromethorphan is the only otc cough medicine that works and pretty much the only prescription stuff that works is opiate based. Of course both are regulated.
DXM can be more or less effective. I wish codeine cough syrup was still available without a prescription.
Exactly. Why do I have to cough my head off because some idiot abuses codeine?
Am I taking crazy pills, because I've been taking PE for years and it works just fine? Like yes the behind the counter stuff is stronger but it also comes with more annoying side effects.
I use it to sleep during allergy season and I can tell when I don't take it when I mouth breathe the whole night. I might try some experiments to see if I can tell but I didn't think you could placebo while sleeping.
You're almost certainly experiencing the placebo effect. There's mountains of evidence phenylephrine does exactly nothing.
Just take N-A-C instead. Actually works and your liver will be happy as well.
And yet homeopathy stuff is legal and often mixed in on the shelf with actual drugs.
Sigh. Still an improvement.
whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism.
in the 90s and 2000s when meth first began to spike, the rural economy was changing. Jobs weren't paying as well or were going away altogether. Meth found a niche as a kind of performance enhancement drug for people working long hours at physically demanding jobs. journalist Nick Reding found this in the pork industry in Iowa, and anthropologist Jason Pine found in general in Missouri.
neoliberalisms solution was a ham fisted market based restriction that turned a normal cold drug into a rarity. we didnt start working to treat methamphetamine addiction as a disease until it began to spread into more affluent white-collar neighborhoods.
this could have been avoided with competent market reforms and regulation, as well as stronger labor protections and minimum wage law.
You mean caused by the war on drugs.
Neoliberals believe in free market and deregulation, not market restrictions.
Nixon was the one that started the war on drugs and also enacted price controls. I would not call him a neoliberal. He also primarily interested in foreign policy and not the economy.
Also, Sudafed was only banned from being purchased easily in 2006. The bill was introduced by a random congressman from Indiana, a congressman was also easily offended by an offensive joke written on someone’s else cake.
> whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism.
Did you pull a muscle stretching that argument into place?
People like meth. People in capitalist countries and non-capitalist countries alike.
It was in fact a hamfisted government regulation that drove this.
And it's much more profitable to scrape every ounce of working life out of the poor, then use them as slave labor in a prison once their addictions get them into a critical situation or farm them out to a rehabilitation facility that pays councilors 20 bucks an hour and gets a large chunk of it's funding from taxpayer subsidies. If there's any issue, blame the overworked poor for turning to drugs, then sell them energy drinks.
Here's a solid completely factual reason why people don't trust the FDA or the government to give health advice. Pointless drug allowed for decades.
If you want to be trusted you have to be consistently trustworthy.
What else is the FDA wrong about and will continue to be wrong about for decades?
This conversation is confusing without the FDA isn’t everything allowed by default and you get far worse like the current supplement industry?
If you were informed on how we got to this point, you'd likely have a different opinion.
But that would take some research, and hey, it's easier to just have a kneejerk reaction right?
Easy: Foam of any type and any chemistry in CPAP or ventilators of any type. Also, "soclean" and any other ozone 'cleaners'
Well? What else indeed? Is this the exception or the rule?
I bet you think people should trust you even though I also bet you were wrong about something once.
>I bet you think people should trust you even though I also bet you were wrong about something once.
Is there anything I've been wrong about which has been significant for a couple of decades?
Pseudoephedrine left OTC in about 2006, phenylephrine has been the main decongestant available and there's been solid evidence out there for a long time that it didn't do anything.
It makes me wonder if it has anything to do with Trump winning the election.
> What else is the FDA wrong about
Too much. For one, numerous harmful additives are freely allowed. These additives may not cause immediate damage, but over the long term they really inflame the gut. They serve no good purpose in the medicines. Examples include: propylene glycol, sodium lauryl sulfate, titanium dioxide, talc, ammonium hydroxide, monoethanolamine, n-butyl alcohol.
I'm sure there will also be a super effective Ivermectin-based option on shelves in a few months.
For the record, with regard to treatment, ivermectin was understood to benefit anyone who had a co-occurring worm infection (targeted by ivermectin) while also having Covid. This just rules out most people in the US as they typically don't have the corresponding worm infections. I myself tried two brands of ivermectin while having Covid, with no luck.
Better to have taken it when (and if) you knew you were exposed. It was always considered to be a prophylactic more so than a treatment. And in that capacity it did seem to work for me. (Having never tested positive for COVID, despite numerous tests, numerous exposures and no shots)
I will try it next time in this way. I wonder if it could also be relevant for a viral cold if taken early.
https://en.wikipedia.org/wiki/Demodex_folliculorum is also highly responsive to oral ivermectin. Which makes it very good for treating rosacea. https://www.jaadcasereports.org/article/S2352-5126%2824%2900...
I also suspect that the much maligned "fish tank cleaner" hydroxychloroquine remains effective-as-ever for many issues, which "more targeted" in-patent drugs are on the market for.
Are you suggesting I can get pseudophedrine via veternary suppliers instead of at a pharmacy counter?
Really hard to trust the FDA when they let this obvious scam go on for so long.