The economic cost of the continuing war on my sinuses

[Headline ending in a question mark omitted]

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

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

Of course, those wouldn't be the real costs, because lots of people wouldn't be able to take the time for a doctor's visit. So they'd just be more miserable while their colds last. What's the cost of that -- in suffering, in lost productivity?

Perhaps it would be simpler to just raise the price of a box of Sudafed to $100. Surely that would make meth labs unprofitable -- and save us the annoyance of a doctor's visit.

They can still buy cold medicine, protest the advocates for a prescription-only policy. But as far as I can tell, there's really no evidence that the current substitute, phenylephrine, does a damn thing to ease congestion; apparently, a lot of it gets chewed up in your liver pretty quickly, and because the FDA only allows a low dose to start with, the resulting pills don't seem to be any better than placebo. For people who are prone to sinus or ear infections, that's no joke; one of the main ways you prevent them is by taking a decongestant as soon as you feel the first ticklings of a cold -- not four days later, when your GP can finally see you.

Obviously, the suffering of someone caught in a meth lab is much, much higher -- but how many of these people are there? Should we deny millions of people a useful treatment in order to prevent a handful of fatalities? Before you answer that, ask yourself whether you'd be willing to stop driving on the grounds that statistically, you're reducing the chances that someone will die. Or to endorse a policy that involved punching 15,000 people in the head, hard, in order to prevent one death.

As the owner of an incredibly shitty set of sinuses, my solution to Sudafed being a controlled substance is that I buy one box a month whether I need it or not. If they change it to require a prescription, that's going to significantly impact my stockpiling efforts. (Does it ever go bad?)

And I can attest that phenylephrine does exactly two things, "fuck" and "all".

About that "punching 15,000 people in the head" thing: do I get to pick them? Because if so, yes.


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26 Responses:

  1. sclatter says:

    Also, not that this is your problem but it currently is mine, pseudoephedrine is one of the two things you are allowed to take when you are pregnant. The other being Tylenol. Yay. You are not allowed phenylephrine, not that it does a damn thing anyway.

    I just heard on the radio that keeping it behind the counter was actually helping decrease meth lab incidents for a while. Then people came up with this "Shake and Bake" method that involves just making small quantities of meth at a time in a 2 Liter soda bottle. So instead of labs cooking large amounts people just buy a box at a time and cook for their own use. And still, occasionally, blow themselves up.

    • Elusis says:

      Interesting. I was also surprised by the stats cited in the article that meth lab incidents went up after putting PSE behind the counter. My professional association joined the lobbying efforts for that change in Colorado, in part because some Western Slope counties were spending upwards of 80% of their social services budgets on treating meth addicts, putting the kids of meth addicts and cooks in foster or residential care, helping property owners decontaminate after meth lab busts, helping children and adults (and for that matter animals) injured in meth lab incidents, etc. etc. and the last info I had was that the local manufacturing incidents dropped to some tiny fraction of their original percentage after it passed. Meth use only dropped slightly, because the manufacturing went to Mexico, but at least without the cooks and labs, some of the social service expenditures went down, injuries went down, property damage went down, etc. So that's a bummer to read.

      • nooj says:

        "Meth use only dropped slightly, because the manufacturing went to Mexico"

        Indeed. Meth manufacturing went to Mexico, and with it came a huge increase in smuggling, border security issues, and major crimes on both sides of the border. And now we have just as much meth use, plus John Walsh dancing around talking tough about how we have GOT to STOP this new wave of VIOLENT CRIME.

        No one ever goes back and says, "Wow, this was a collossal failure! Who would have thought that people who were already breaking the law would find a way around this new law, and maybe our best-laid plans would have unintended consequences?"

        I'm glad Colorado saw a benefit. South Texas sure didn't.

        • DFB says:

          Also, violent crime is at record lows in the US. Child homelessness, on the other hand, is up 33% over the past three years to 1.6 million: one out of every 45 kids in the US is now homeless. The teen unemployment rate and teen employment ratio are both 25%. Corporate taxes are at record lows. Meth is the least of our problems.

  2. Lun Esex says:

    I used to get the pseudoephedrine medications that came combined with acetaminophin and/or diphenhydramine hydrochloride (labeled things like "Sinus headache" or "Allergy and sinus"), which would save a bit of money and effort over buying and taking multiple separate pills. As far as I can tell they stopped making all these combos when they made pseudoephedrine behind-the-counter. Extra suckage.

    I've taken to buying pseudoephedrine as infrequently as possible, since I'd prefer to have my name and driver's license show up in government records as infrequently as possible. I should probably start stockpiling like you do, though. It really is the only non-prescription sinus medication that works for me, too.

    • Chris says:

      They still make those combos, but perhaps your local pharmacy/pharmacies don't carry them. Sudafed as a single entity is behind the counter (out of convention) in Canada but the combo products are not. It's hard to separate the tylenol and there's too much of it to just leave in when converting to meth; your liver would fall over immediately.

      • Lun Esex says:

        I was hoping they would keep the combos on the shelves in the U.S. for the same reason. In fact I seem to remember only the non-combos being restricted to behind the counter sales initially.

        It may be that it's less hassle for someone in the supply chain to just not offer and/or stock them at all. Plus this way the retail establishments get to sell you both a pack of pseudoephedrine from behind the counter plus that separate pack of painkiller and/or antihistamine you got off the shelves. I actually just picked up some pseudoephedrine today, and the only things that I could see that were available were non-combo Sudafed and the (much cheaper) house brand. I went for two on-sale 24 packs of house brand for $3 each.

  3. john kienitz says:

    It does seem to break down, or become less effective. Before all of this foolishness started, Costco sold a multi-pack that I could not finish for several years. I would throw it out and get a fresh package because it seemed so ineffective. I never did try freezing it to see if that would help.

  4. Michael Dwyer says:

    I've taken to buying meth on street corners, then taking it home and cooking it back down into effective cold medicine.

  5. John Bloom says:

    Washington had a state law restricting its sale before the National law, but even before that store chains had already started putting it behind the counter and restricting how much could be purchased at a time. I used to take loratadine (aka Claritan) with "decongestant" (pseudophedrine). The law basically made it so that I could buy 15 tablets every 14 days, so that wasn't a huge PITA. Also, about the age restriction: seriously, WTF? It's not like people under 18 have chronic allergies. I missed that one by a couple years, but I would have been plenty pissed.

    (PS: Ended up with fluticasone for my nose combined with generic loratadine to dull the edge of my allergies, which is a better combo for me in the end ... as long as one has insurance to pay for it)

    • Pavel says:

      I'm on the same combo, although the other day I noticed that the stuff the doctor prescribed for my feet was the same stuff that I spray up my nose, just in cream form. Made me really miss pseudoephedrine. :/

  6. Jon Konrath says:

    I take Claritin-D daily for horrible seasonal allergies. I'd take a prescription medicine, but when my allergist has tried to write me prescriptions for anything else that's similar, my insurance company (who is not a doctor, and has never examined me) has said "no, you will go buy OTC Claritin-D, and you'll like it".

    As for the "Perhaps it would be simpler to just raise the price of a box of Sudafed to $100" well, prior to it becoming OTC,the price for prescription Allegra-D 12-hour was something like $150 for 60 pills. So if you make this stuff prescription again, it most likely will cost that much. And insurance probably won't cover it. And you'll have to see a doctor and pay a copay to get it. And maybe they'll be real nice and make it a controlled substance like Ritalin, so you'll need a hard copy prescription and it can't have refills, so you'll be required to see a doctor in person twelve times and make twelve copays and leave work twelve times and pay for parking in their stupid lot twelve times and get twelve head colds from the sick kids in the doctor's waiting room.

    I also love the part in the original article on how Mexico has banned pseudoephedrine outright. They've probably also had laws prohibiting decapitating tourists and mutilating their corpses, and that hasn't seemed to slow down that trend much.

    • gryazi says:

      Is that refill cutoff for some particular level of scheduling? I had to navigate that maze once I started getting my one controlled prescription via my GP rather than a regularly-seen specialist, and the restriction turned out to be 'no longer than 6 months without a new prescription,' which doesn't actually require [paying for] a visit and everyone's perfectly happy getting it faxed.

      My usually nice pharmacy did surprise me by getting all bent at me for Not Knowing the Rules, specifically because I wasn't even sure if it was an insurance or DEA restriction. Which is fun when the medication is for social anxiety and you're out of it.

      • Jon Konrath says:

        Yeah, it's based on schedule. Schedule II is no refills; schedule III (where most benzos lie, which I'm guessing is what you had) is limited to up to five refills per prescription.

        • gryazi says:

          You got the square, yeah. I think this increases my respect for how hard prescription addicts have to actually work at it.

        • Eric Will says:

          Most benzos are Schedule IV. Both III and IV are limited to five refills in six months unless renewed by the prescriber. Schedule II cannot be refilled and must be written (no phone ins or faxes) and usually has limits on how long the written script is valid for (in Illinois, you have only seven days to fill a C2, otherwise it must be rewritten).

          Source: I am a PA-C with specialties in pain pharmacology.

  7. andrew says:

    I am in full support of the punching 15,000 people in the head concept.

    • I'm in full support of underlining we're saving a life here.

      Does this guy really is trying to go with a let's deprice people's life argument in northen america?
      Looks like a dog barking in a church.

  8. andrew says:

    Although my dear wife makes the following completely valid point:

    What, only 15,000? Seems light to me. I can think of millions who could use a fist in the face.

  9. Ian says:

    If it ever does go prescription only, I'm sure I'm not the only one who would post a box from somewhere more sensible. Or would that get you into (even more) trouble?

    I find it essential if I'm flying.

  10. ljtourist says:

    I own some occasionally shitty sinuses, and while phenylephrine does get torn apart by your body before it can do anything useful, applying it directly to the sinuses works a treat! My need for the real thing is down to about once a year or less. So if you're looking to stretch your stockpile, or you find yourself stuck without somewhere, give a phenylephrine nasal spray a try.

  11. Eric Will says:

    I used to be in the PSE camp but eventually it starts making me really jittery and crappy feeling. I've switched to oxymetazoline nasal spray, which works waaaayyy better and instantly because it's topical so there's little to no systemic effects.

    Also, yes, all pills have a shelf life of one year after dispensing. If you keep the pills in a dark, dry place they will last longer. They put them in orange bottles to help block light (organic chemistry - more light, more oxidation) and moisture. To that end, in a medicine cabinet in a bathroom is the worst place for pills.

    How do they expire? Usually they just lose potency, but sometimes they can degrade to totally different, and ACTIVE, chemicals that you would not want to take. Pretty rare though.

    Sources: I am a PA-C with specialties in pain pharmacology.

    P.S.: nasal irrigation works wonders for me. I only do it when I'm sick/congested/having allergies, but I feel so much better afterwards. I use a Netipot. If you get distilled water and add the buffering agents they sell with the kits, it's painless and not even uncomfortable really. YMMV.

  12. Worth noting: if you don’t use distilled water, there’s a chance of infection by brain-eating microbes.*

    * Availability of brain-eating microbes is at participating municipal water treatment systems while supplies last, varies by location, and is not guaranteed. No purchase necessary.