Pseudo-intelligent
Take a good look at the above image. It tells you exactly how much good John Key’s proposal for banning over-the-counter pseudoephedrine will do. By the purest coincidence, it also tells you exactly how much thought has gone into the proposal. Apparently the reasoning behind the suggestion is this:
“Gangs and drug syndicates often use “pill shoppers” to go from one pharmacy to the next, buying the pseudoephedrine-based tablets and turning them into P.”
There is only one problem with this. Almost no “P” is made this way any more, the vast majority is made from pseudoephedrine illegally imported from China. Since pharmacists started asking for ID when you buy pseudoephedrine, only the smallest of operations use pill-shoppers – the risk of being caught is too high otherwise. And importing pseudoephedrine is quite low-risk, so why would you do this?
Almost the entire reason why the National Computer Register never got off the ground was that the expense was far larger than the actual problem. I was in favour of setting it up anyway, because it could have potentially been converted to a national pharmaceutical database, detailing all drugs dispensed to a patient. This would have been actually useful in clinical practice enabling doctors to avoid prescribing drugs that interact badly and also helping them to spot prescription drug seekers.
Ah well, yet another opportunity lost to drag the health system kicking and screaming into the twenty first century.
Back to “P”. As I have blogged before, the whole reason why methamphetamine is so popular with the crims is because it is dead easy to make from an ingredient that carries a low penalty if you are caught with it. Key is proposing a ban on normal use while ignoring this simple fact. If you really want to crack down on pseudoephedrine, make the penalty for importing and illegally selling the drug as harsh as the penalty for peddling “P” itself. Make it extremely risky to import without a proper license.
I have always been a fan of making drug use and possession a crime that carries only community service and mandatory rehab as penalties, preferably without a criminal record, unless there are additional crimes such as burglary and assault attached. I have seen too many people whacked out of their head on drugs (including party pills and cannabis) to be in favour of simply legalising them. However the actual manufacture and supply of said drugs, particularly methamphetamine, should be enforced with fairly draconian penalties. Twenty years for importing pseudoephedrine would be considerably more effective than all the over-the-counter bans you can imagine.
Oh and to Gisborne pharmacist David Moore, who thinks that phenylephrine (the substance that drug manufacturers now substitute for pseudoephedrine) is as effective as pseudoephedrine, let me point you to the latest research that suggests otherwise. Should pseudoephedrine be removed from sale, you would be removing the only nasal decongestant that has any appreciable effect.
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May 26 09 2:47 pm
A politicians knee jerk reaction. it gives every appearance of doing something and being on the ball, at the same time as doing what politicians doing like best – interfering in other peoples everyday lives.
May 26 09 9:01 pm
Your idea of a “national pharmaceutical database” is an invitation to Big Brother and, with all due respect, reflects the paternalistic attitude of the state and most doctors.
The state has no right to tell people what they can and cannot put into their bodies, and there is no scriptural justification for drug control laws. This includes both illegalisation of recreational drugs and state control of access to therapeutic pharmaceuticals.
For the record, I have never used any illegal drugs and I believe that doing so is stupid. I also believe that God provided opiates and cannaboids for occasional medicinal use, just as he provided salicin (from which aspirin was first made) in willow trees for medicinal purposes. Before aspirin was made the bark and leaves of willow was used.
My arguments are detailed here:
http://kiwipolemicist.wordpress.com/2008/09/12/the-pointless-death-of-an-undercover-policeman/
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May 27 09 12:37 am
Kiwi P – you’re missing the point of a national drug database. A goodly number of deaths in hospital are preventable if we only knew what drugs someone was already on. There are a decent number of people who have multiple and complex diseases and therefore complex drug regimes. Those people also fall unexpectedly ill, and end up in hospital. If they are unable (unconscious or forgetful) or unwilling to disclose their current prescriptions, a doctor may give them something that has an adverse reaction, and they die.
It sort of sounds far fetched, but the volume is actually very high. I think the number of preventable deaths in Australia each year from drug-drug interactions is around 1,000, NZ would presumably have a similar percentage. A national drug database would save more lives than some of the screening programmes and vaccines we currently fund. But the health sector for some reason would much rather spend on drugs than base IT (as opposed to the kind of IT they love – big scanners and the like).
May 27 09 12:56 am
Kiwi Polemicist: I think your concerns about a National Database are unfounded. While it is true that any sort of database can be abused, the good of a pharmaceutical database would far outweigh the potential abuse. Most of this information is already available to a determined hacker anyway.
As with most libertarians there are two serious flaws to your “legalise all drugs” argument. The first is that these drugs are not harmless – neither are medical drugs, but at least these a prescribed by professionals who (hopefully) know what they are doing. Most of the illegal drugs cause serious harm both to the user and to innocent bystanders. the typical response to this first argument is that both alcohol and tobacco also cause serious harm to the user and innocent bystanders. This brings me to the second fallacy in the libertarian argument.
There is an enormous difference between attempting to ban a widely-used, legal drug and maintaining a ban on a drug that has always (or nearly always) been illegal. The first produces the behaviour seen in prohibition days because established legal use that is suddenly withdrawn is widely resented. Coupled with an easy to produce drug like alcohol, it is unsurprising that prohibition was not successful.
Maintaining a ban on an illegal drug is not at all the same as prohibition. There is good evidence that illegality minimises use by reducing availability. In the Dutch experiment where cannabis was essentially made legal, the use in young people more than doubled, although older, established users did not change their habits. If we extend this to drugs like methamphetamine or cocaine, the risks to teenagers are frighteningly obvious.
The correct way to minimise drug use is to clamp down hard, not on users, but suppliers. If the risks involved in making methamphetamine become severe, the price of the drug will go up and the use will drop.
May 27 09 4:37 am
MacD: the matter of a database is secondary to the fact that any state involvement in health is illegitimate, i.e. there is no biblical justification for it. Where is the biblical justification for state control of who may practice medicine and state control of who may supply and access therapeutic pharmaceuticals? Where is the biblical justification for the state’s action when it takes your money and uses it to pay for someone else’s health care?
IMHO, the fact that recreational drugs are usually harmful is not a flaw in my argument, and the second fallacy that you refer to is irrelevant to the fundamental issue. The fundamental issue is that the state has no right to tell people what they can and cannot put into their bodies.
I agree that most illegal drugs are harmful, but that does not justify the state saying “This is bad for you, therefore you may not have it”. A parent may say that to a child, but the state has no right to say it it to an individual. Despite what the state thinks, it is not my parent and does not have parental rights.
It’s all about personal responsibility: if someone wants to harm themselves that’s their lookout (and, on the black humour side, it’s also natural selection).
If someone harms another person as a result of their drug-taking, e.g. they go troppo and assault that other person, then that is a matter of criminal liability.
I think that we will have to agree to disagree on these matters.
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May 27 09 9:45 am
How sure of your statistics about the source of pseudoephedrine used in the manufacture of illegal drugs ? My understanding is that a significant proportion, though less than half, comes from local sources, usually through “bent” pharmacists rather than straight purchases.
I don’t see any easy answers in this whole area though, smuggling is very hard to stop especially as the Chinese authorities aren’t all that concerned about their end of the supply chain. How badly do we need a nasal decongestant, is it used clinically much, or almost entirely as an over-the-counter cold remedy ?
KP, I simply can’t get persuaded by someone who wants to use the bible as an authority on medical practices or ethics.
May 27 09 10:41 am
If Pharmacy A sells ten times more Cold Tabs than anyone else, surely it is pretty easy to see that he needs investigating? I would have thought this was a no-brainer. Pharmacies buy theiur product from drug companies who, one assumes, keep sales records.
May 27 09 2:09 pm
Once again MacDoctor you talk an amazing amount of sense. I’m glad I’ve discovered your blog.
Phenylephrine a waste of time. And if you’re intending to fly with nasal congestion, then pseudoephedrine based product is essential to stop your head from feeling like it might blow apart.