No Relief
So John Key is going to make pseudoephedrine only available on doctor’s prescription. And he’s not stopping there, either:
“Mr Key has asked for Medsafe to consider a total ban on pseudoephedrine, which is used to make the illegal drug “P”, pure methamphetamine.”
Unfortunately Mr. Key is being poorly advised on this matter by his science advisor, Peter Gluckman – who has no medical qualifications, BTW
“Sir Peter said pseudoephedrine had been used as a nasal decongestant since the 1940s.
“Phenylephrine could not be used as a precursor for P and was a “generally effective alternative”, he said.
““Anecdotal evidence suggests that phenylephrine will work for at least 80 per cent of people but not for others.””
Once again, I link to a real scientific study on phenylephrine and pseudoephedrine so the Sir Peter can actually read something useful on the subject. There are dozens of others, but this one is freely available to be read in full. All the scientific evidence (as opposed to the anecdotal ones) shows that phenylephrine is essentially useless as a nasal decongestant. If you want relief from your cold, you are going to have to use pseudoephedrine. All that making this a prescription item will do is make the treatment of a cold more expensive for people. It will also move the monitoring of drug seekers from the pharmacy to the GP, who is even less likely to spot the serial script seeker. “Shoppers” for pseudoephedrine will just move from doctor to doctor, gathering scripts.
“The Netherlands, Mexico and the American state of Oregon have eliminated over-the-counter sales of pseudoephedrine-containing medicines without “unacceptable patient inconvenience”, Sir Peter said.”
Sadly, none of these places have reported any inroads into their “P” problem. All of them have a much smaller “P” problem than ours. It is also perfectly possible that their methamphetamine production relied heavily on over-the-counter sales, unlike New Zealand, where the bulk of “P” is made from pseudoephedrine imported directly from China. All-in-all, the argument for doing this is very thin and not particularly related to the evidence.
Additional:
The Dom Post runs a couple of doctor’s opinions today – including mine.
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- Dissent on making pseudoephedrine prescription only | Kiwiblog — [...] very sensible MacDoctor disagrees with the decision. He blogs: Unfortunately Mr. Key is being poorly advised on this matter ...
Oct 8 09 9:01 pm
No medical qualifications?
http://www.pmcsa.org.nz/peter-gluckman
Oct 8 09 9:15 pm
Nathan No medical qualifications?
Well, he’s a paediatric endocrinologist – that’s almost no medical qualifications…
Just goes to show that you should always check your hearsay facts…
Thanks for pointing that out and apologies to Sir Peter.
Oct 8 09 10:58 pm
In Netherlands you can have a joint and in Mexico….well…..what drug can’t you buy there on a side street!
Tamiflu?
Oct 9 09 8:19 am
The situation in Oregon changed with the restrictions, which were partly in response to local clandestine labs producing purer, more active, product from prescription ingredients. The law change resulted in a decrease in local labs, but a major increase in high purity imports from Mexico.
Testing the sewage of 96 cities in Oregon ( 65% of population ) in 2008 all gave positive results for methamphetamine, suggesting the usage hasn’t changed much. Testing sewage concentrations of illicit drugs is one method used to locates clandestine city labs in the USA.
Oct 9 09 9:31 am
What scientist would make a recommendation based on “anecdotal” evidence. He might as well recommend tuning forks, exorcisms and eating your crusts to get curly hair.
I did my own “blind” test on phenylephrine. Years ago I bought sudafed thinking I was getting the usual pills. I didn’t know the formulation had changed. Normally I can take a single pill (instead of the recommended 2 pills) and it relieves symptoms. I took 4 of the new pills and got absolutely no relief. I kept taking them as I was sure they would work. Then I found out I’d been duped into buying that rubbish they replaced the pseudoephedrine with. Phenylephrine is no better than a placebo.
.-= Talia´s last blog ..Free Self Help Gifts every week =-.
Oct 9 09 2:27 pm
I suggest you read Peter Gluckman’s publicly accessible report to check what he actually recommended and whether he’s done any research about it:
http://www.pmcsa.org.nz/news-and-events
(link from 8 October)
Sorry but you are a terribly unreliable source. First the medical qualifications thing, second the fact that you didn’t even bother to read the report before criticizing it.
Oct 9 09 2:56 pm
Tatjana: Sorry but you are a terribly unreliable source. First the medical qualifications thing, second the fact that you didn’t even bother to read the report before criticizing it.
I wasn’t criticising the report, only the conclusions as presented in the article. The report does indicate that Gluckman has done some research on the issue, which is reassuring. However, I don’t agree with his conclusions.
Oh, and I am not a “source”. This is not a news service, this is a blog. Usually, I give a relatively informed opinion, but an opinion it remains. I reserve the right to go off half-cocked. Otherwise blogging would not be fun.
re-Captcha: hawkish double-talk
Oct 9 09 3:11 pm
Well in the blog post you said that Key was ‘poorly advised’ so it wasn’t about the article but about the actual advice–which you had not read (and then you went on to suggest some reading to Gluckman). And I am afraid that willingly or not you become a source as soon as people read and start linking to your blog. Thanks to the democratic nature of Internet!
But you’re right, it’s just your opinion. But, before I leave (never to return), I cannot help but notice how it is always amazing how well people think of themselves and how little credit they give to other people. You’re reassured that Gluckman has done some research! Well of course! What do you think? How do you imagine policy advice happens in any half-decent country?
Oct 9 09 3:35 pm
Tatjana, I read the report previously, and the Oregon comment in the report ( 17 ) doesn’t justify the claim. Oregon made methamphetamine “prescription only” in July 2006.
According to the US DEA, lab incidents by year in Oregon and (USA) were:- 2003 = 375 (17500), 2004 = 322 (17600), 2005 = 189 (12500), 2006 = 55 (8600), 2007 = 20.
The numbers of labs were already dropping in Oregon and also across the USA, because of the advent of more pure product, especially from Mexico. The Oregon change may have further reduced the number of labs as consumers wanted pure product, but there are other US states that had similar reductions to Oregon without imposing the change ( eg Nebraska ).
Oct 9 09 3:46 pm
Tatjana: How do you imagine policy advice happens in any half-decent country?
Mostly it appears that people find a study or two that supports their point of view and build a case around it. Remarkably similar to blogging, really.
Anyway, nice of you to drop by and castigate me. Feel free to do so again.
PS. suggest you avoid everyone in my blog roll – they are all as bad as me or worse
Re-Captcha: Swigs Al’s – spooky! I’m drinking an Amstel Light!
Oct 10 09 8:23 am
There seems to be a general assumption that the same products will be available but via a GP script. It isn’t yet clear whether the current OTC products (containing combinations of pseudoephedrine and other medicines like paracetamol)will remain in the market in NZ, obviously available only on script.
Oct 14 09 3:36 pm
It’s frustrating when individual scientific studies get held up out of context and used in isolation to prove a point, as (above):
“Once again, I link to a real scientific study on phenylephrine and pseudoephedrine so the Sir Peter can actually read something useful on the subject.”
The review you link to caught my attention to when I was doing background research on this topic.
It seems important to note Prof Ronald Eccles’ stated conflict of interest:
“The author has acted in the past as a consultant to pharmaceutical companies that market nasal decongestants (Procter & Gamble, GlaxoSmithKline, Pfizer, Reckitt Benckiser, Boots Health Care and Bayer)”
This may or may not bias his conclusions, but should certainly be taken into account.
I would be surprised if Gluckman failed to come across this study when was putting together his report. It seems far more likely that he considered this study and a wide range of others before making a judgment call based on available evidence.
From my perspective, after looking into this and similar studies, it does seem reasonable to conclude that phenylephrine is likely not effective as a decongestant in small oral doses.
But when you get down to it, the clinical evidence to back up pseudoephedrine use in cold remedies is fairly thin as well, PSE having been largely grandfathered-in from pre-regulatory days.
What is missing in a lot of this debate, I think, is that — no matter how attached people are to them — cold tablets are not “cures” for colds, that many people take them inappropriately for conditions (allergies, chronic congestion) that would be best treated by other means, and that there will still effective OTC decongestants available — albeit in the form of the dreaded nasal spray.
Also — if you read Gluckman’s report, you will see he specifically rejects making GPs the gatekeepers for pseudoephedrine to avoid the problem of “doctor-shopping”. (See Option 4, which he recommends against)
http://www.pmcsa.org.nz/wp-content/uploads/2009/10/Report-to-the-PM-Pseudoephedrine.pdf
His proposal involves some form restricted prescribing procedures, which have yet to been determined by MoH.
The media have not done a particularly good job of reporting this nuance, leading to a lot of commentators jumping to wrong conclusions.
Unfortunately, I could not find Gluckman’s report before posting this, otherwise my comments would have been more measured. And I have a good dozen studies on pseudoephedrine. This is the only one available unrestricted on the net. I still disagree with Gluckman’s conclusions.