Today in "The War on My Sinuses" news

Thanks to the meth wars, cold medicine's effective ingredient isn't

When the Combat Methamphetamine Epidemic Act of 2005 passed, pharmacies moved all cold-medicine with the actually-works ingredient pseudoephedrine, only available on request and with a copy of your ID. In its place, the pharmacy shelves were restocked with phenylephrine, which was alleged to work just as well. It doesn't work at all.

Researchers have long been suspicious of the efficacy of phenylephrine, but studies were mixed. Now, thanks to a University of Florida study published in The Journal of Allergy and Clinical Immunology: In Practice, we know that phenylephrine is useless at the doses allowed over the counter; and may not work even at higher doses.

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29 Responses:

  1. Theodore says:

    Well, it's a stupid countermeasure as establishment, but it's the only one your state could use. There are people who produce meth with cold medicine.

    • jwz says:

      You are everything wrong in the world.

      • Theodore says:

        I am, and I think you people should pay a lot your pseudoephedrine drugs, because of the meth producers demand.

    • It turns out we can actually (weakly) study this.

      Pseudoephedrine-based cold medicines are available off-the-shelf in many provinces of Canada. For example, in Ontario, their sale is governed by this law. (Pseudoephedrine itself is listed under Schedule VI of the referenced federal law.) Buying in bulk will set off some alarms -- pharmacies are expected to report and prevent obvious abuse -- but the standards of sale are far, far lower than in the US.

      Canada's methamphetamine use rates vary depending on who you ask, but most population-wide numbers range between 0.5% and 1% of respondents having used methamphetamine in the last year, heavily weighted towards younger respondents.

      The US' methamphetamine use rates appear to vary over the same range, again depending on which surveys you look at.

      The evidence does not appear to support the proposition that pseudoephedrine availability significantly affects the use of methamphetamines. Restricting its availability may not be a countermeasure at all, though I do suspect that taking the brakes off now would lead to a rise in methamphetamine use, at least for a while, because of defensive adaptation.

      • gryazi says:

        Y'know, meth itself is "problematic" and somehow I doubt the policy-makers thought this through completely - other than that it got noticed as a problem when people kept blowing houses up in the meth-ier states - but technically the effect is making it harder to get the materials to manufacture (at least in 'lab' quantities). So are there any comparative stats on explosions or lab busts?

        It's still a circlejerk and I was amused to catch news recently of buying rings operating somewhere out west - paying hundreds of people to buy the legal limit and buying it back off them for enough over the store price to make it worthwhile (job creators!) - but it'd be interesting to know if there's been any sort of public safety win at all.

        • Elusis says:

          Last I knew, some counties in western Colorado went from spending upwards of 90% of their county budgets on dealing with meth labs (law enforcement, but also foster care/child protective services for the kids living in the labs, plus cleanup, plus treatment/indigent care for the addicts) to a more reasonable (for a rural county) 25-40% once the meth started coming in from Mexico rather than being made locally.

        • There are some stats, but not as many as I'd like.

          The DEA maintains maps of "lab incidents" by state (broadly, the number of methamphetamine labs dismantled by law enforcement). For Canada, up-to-date stats are a bit harder to come by. The Government of Canada published a report covering 2005: it suggests single- and double-digit numbers of labs dismantled in each province.

          Elusis' point about cost-shifting is also interesting, if deeply cynical.

  2. gryazi says:

    I'm like the one lucky schmuck who actually benefits from PE because it has a sort of '30 seconds of decongestant followed by expectorant that actually clears out the clog' effect on me. Still stuck on a mix of fluticasone and cromolyn sprays to try to loosen up some dry-as-glue-and-cement problems I ran into over the past year.

    I would love to know why cromolyn spray is now unobtainium here in the NYC/New England area - I assume just because they wanted 'real medicine' prices for it and OTC Flonase et al. took over the shelf space. But cromolyn is mild and effective and if that shit cost $6 a bottle I'd be going through 2 a week.

    • gryazi says:

      Also oddly, as someone who occasionally does buy Sudafed (for decongestation) or Bronkaid (for 'thank you for forcing me to rely on this to survive certain weeks of late capitalism') reasons ... yes the whole thing is ridiculous, but all they want to do is make it inconvenient to buy more than 3.6 grams in one go or 7.5 per person per month, and if you need that much maybe it's time to consider medical intervention (or at least a neti pot*) rather than constantly nuking your sinuses with a messy vasoconstrictor?

      Appreciate that they have also apparently created a cottage industry of people all buying the legal maximum to resell to the local cartel equivalents for a profit - job creators!

      *Yeah, I've done the neti thing too when I have a vaguely trustworthy water supply, sounds stupid and looks stupid but damn if it doesn't work. At the right concentration of saline you're pulling water out of the tissues and achieving the same kind of vasoconstriction that Sudafed would give you, plus maybe getting enough water the sinus openings enough to gradually to hydrate and break up whatever's causing the stabby headpain. No it doesn't get all get in there and directly rinse the sinuses when done properly, but often enough it sort of 'wicks' into the congestion enough to clear the problem after the first 5 sessions or so. YMMV.

      • Pavel Lishin says:

        That's the luke-warmest review of a neti pot I've ever read, and I've been trying to convince myself to get one :/

        (Also, can't you just boil the water if you're not sure of your supply's safety?)

        • gryazi says:

          Really? Didn't mean for it to come off luke-warm, I'm actually a huge fan of neti, but that's just the reality of how and why it works - you're rinsing the nasal passages, on through wherever one connects to the other in the back of the throat or so (trying and failing to find a diagram of where exactly the flow goes), which moistens the entrances to the sinuses or thereabouts, and the hyperosmolarity of the saline solution does the rest. After a good session, alternating between nostrils a few times, five or ten minutes later suddenly I'm blowing my nose for the third time and those areas finally decongest and drain out - or at worst do it as many times over as needed until they do.

          Boiling the water (and then letting it cool back down to a safe temp) is the current suggestion... and adds that much more inconvenience if you don't normally keep a kettle or such by the sink you prefer to do all this in front of, and tend to go through like a dozen cups of water in a session. I recently found a 'claims to include an anti-all-the-bad-stuff, approved tap water safe filter' "irrigator" at a Walgreens and still need to see how that works out and how it's possible that saline won't clog it.

          While there are Waterpik attachments for schnozzal use, I don't think anything is actually a water chisel that directly attacks the sinuses, because that.. probably wouldn't actually be healthy or safe or good.

          (Oh, and when I said '5 sessions,' I sorta meant something between '5 pots through each nostril,' which is like one 10 minute session for me, and/or repeating that up to like 5 times in about the same hour on a bad day until it all finally comes out.)

          I also recently gave that "Alkalol" stuff a go, which is... a lot milder than questionably healthy things I've mixed up using essential oils that probably weren't rated "for internal use," but still pretty damn good at getting things running and draining, which seems like the point - as far as I can tell neti is more about washing away the crap blocking the openings to the sinuses so they can empty out with their own self-cleaning snot (mixed with what few drops of water and steam and whatnot that make it in to loosen that up), as biology intended, than about getting tons and tons of water directly into the sinuses, which might not be physically possible and only make things worse anyway if it didn't drain back out again anyway.

          Plus the hyperosmolar nature of the saline is sucking water out of the tissue and reducing inflammation that might be enhancing the pain and blockage and all that. Don't try it with unsalted water, that burns like hell and increases inflammation and so on. (Use the right amount of kosher salt - iodized is bad for some reason and plain un-iodized has anti-caking additives that might not be good - or the little premixed packets from the drugstore that have some baking soda in them too for whatever reasons, those are cheap enough.)

      • Jay says:

        My doctors know of no medical intervention that would allow me to not need sudafed and neti doesn't work that well either.

  3. Ah. So it's everyone. I thought that shit just didn't work on me. Might as well be taking powdered applesauce for all the good it does.

  4. In fairness, phenylephrine does "work" in at least one sense: that shit makes it full-on impossible for me to sleep. Doesn't do a damn thing for congestion, but at least I get to stare at the ceiling all night waiting for the nonexistent decongestant effects to kick in.

    (Not that pseudoephedrine was so hot for that either, but at least I'd be wired and breathing.)

  5. joe says:

    Try titrating up as high as five grams of aspirin a day, no joke. A years long battle with sinusitis is not an infection or allergies. It's self sustaining inflammation. I spent a week on about eight grams of aspirin a day and totally cleared up some inflammation that had been driving me nuts for a year.

    Also honestly consider tension myositis syndrome as a possibility.

    • gryazi says:

      Oh yeah, in between all my neti rambling up there, the other thing that's been working in combination for me is a decent amount of ibuprofen - really just the standard 2 tablets, but gotta remember to take it rather than thinking "ugh I just need antihistamines or decongestants and neti when I can get around to it."

  6. bode says:

    Well, duh! I knew this - which is why I now buy pseudoephedrine, and it works fine. Same as it always has! Is the issue you have to give your license? Not sure how exactly that's different than giving my SSN and insurance card for a prescription? Except I thankfully don't need a prescription - that would have been horrible. Anyway, I file this under "no shit, sherlock" - I stopped buying nyquil the day the change happened. I now take pseudoephedrine and tylenol, two pills and not one. I am capable of reading labels and actually knew what was in them before, so I can keep using the effective combination.

  7. Right there with you; PE works, phenylephrine does not. I'm curious to hear your objections to the pharmacy counter regime; I dislike it on principle but in practice it hasn't stopped me from getting the stuff.

    • Nate says:

      This summer, I had a massive sinus problem, fever, etc. Went to the pharmacy, they checked my driver's license, and REFUSED to sell me Sudafed because it was 2 days expired.

      I tried to explain through the fog that your identity doesn't expire when your driver's license does, only your right to drive a car does. The confirmation was that when I did go back to the DMV, they didn't demand some other proof of identity, they just replaced the card.

      So yes, this does prevent you from getting OTC medicine when you need it if you were too sick to go to the DMV and bad timing.

      • jwz says:

        Also I have often found that the time I most needed a refill it was not during pharmacy hours. So I started just stockpiling it: I buy a box a month whether I need it or not, just in case. But I really do like this approach.

  8. Eric Will says:

    So it's no different than a half dozen others in this country. Dextromethorphan replaced codeine for cough and it doesn't work at all as an antitussive. Not to mention the complete and utter lack of any pain medications that work for anything worse than "mild ouchie."

  9. PeterL says:

    Forget the drugs, which have all kinds of nasty side-effects, including rebound ... try this:
    (and it works better than a neti pot, based on my experience).

    • jwz says:

      I use the spray-bottle variant of that on occasion, and it's fine for "I am a bit stuffed up", but when we have already reached DEFCON Daggers-In-The-Forehead, it's not enough.

      • PeterL says:

        The motorized device is much more effective than the spray-bottle. Be sure to sterlize it every week or two. (And use boiled water – it cools to the right temperature in about 20 minutes.)
        You don't need the pricey pre-packaged salt; just use kosher or pickling salt and a pinch of baking soda.

      • gryazi says:

        I dunno why I came back to this thread and I'm already about to post one more dumb comment above, but something I've never looked into - and probably should - is that there's some kind of terrifying migraine/sinus pain axis.

        So like, that migraine-grade daggers-in-forehead feeling... might actually be sorta linked to migraine mechanisms, "or vice-versa" (mild congestion triggering whatever weird vascular event 'is' a migraine, or migraine-event stuff messing up the sinus tissue and making it swell and feel congested). And guess what treats migraines? Caffeine and other vasoconstrictors (Sudafed). And guess what we treat sinus congestion with?

        If you're at the point where you're stockpiling Sudafed maybe migraine meds are actually more available at this point (and aren't some in convenient instant nasal-spray form but not as nasty as oxymetazoline decongestant spray)?

        I sorta get visual migraines (more just static) at times but never had the proper aura and hyper-crippling hours-of-vomiting stuff, and I really need to find a GP who doesn't have a "why are you in my office if you're not dead?" attitude, while neti works well enough for me on the headache front, so never really followed up.

        Filing this under "dumb idea" but this is the Internet so, let no dumb idea go un-shared.

        • nooj says:

          Many migraine meds make you more sensitive to future migraines. This is bad.

        • k3ninho says:

          I get visual migraines when I have terribly imbalanced dehydration. Simply holding salty (well, 5 tsp sugar and 1 tsp salt, preferably the KCl/NaCl mix sold as LoSalt, in 1l) in my mouth is usually enough to sort this. From my frame of reference, that's what your Neti does. From yours, I'm undervaluing the pain you're in -- and I accept that is a flaw in my comment.

    • apm74 says:

      I had awful sinuses as a kid (my fellow schoolmates thoughtfully called me "Darth Vader" for my constant mouth-breathing), so much so I had surgery done on them and I've been mostly fine since then. Thankfully.

      But one of the things I had to endure was having to put a Waterpik up my nose with salty water. Fun times.

      • jacques cousteau says:

        Unbeknownst to you, they were actually simply commenting upon the fact that you sound uncannily like James Earl Jones.

        Because... PLOT TWIST... He is your father.

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