CVS ditches common cold meds after FDA advisers say they're useless | Hacker News Reader

CVS ditches common cold meds after FDA advisers say they're useless

arstechnica.com

My understanding is that they are only removing products that ONLY contain Phenylephrine, which means they will still sell it when it is part of multiple-ingredient formulations, which are in themselves kind of a scam.

For example, many OTC "severe cold/flu" formulations contain:

- Acetaminophen. Potentially helpful for the body aches that come with the flu, but a lot of the time when I'm sick, I don't exactly need or benefit from a pain reliever. If you have a fever it can reduce it, but for a minor fever I'm not sure that is necessary.

- A cough suppressant (Dextromethorphan) and an expectorant (Guaifenesin). Most recommendations I've read advise taking one or the other depending on the type of the cough, but not both. For a productive cough, a cough suppressant can be counterproductive.

- For PM formulations, an antihistamine as a sleep aid.

- And of course Phenylephrine as a decongestant, which doesn't work.

People feel sick and they go in and just say "I'll take whatever is strongest" and they get overcharged for these weird formulations that are sort of kitchen-sink type things. I guess they are mostly harmless but you wind of spending $20 for pennies worth of out-of-patent ingredients that might actually make you feel a bit worse.

And yeah, if you are actually congested, go to the pharmacy counter and get Pseudoephedrine. It costs next to nothing and in my experience works.

Not harmless with Acetaminophen of they don't realize it and also take pills at the same time, pretty narrow range to liver damage.

You might be thinking of aspirin, which is toxic at fairly low dosages. Acetaminophen (aka Tylenol) is much, much safer.

I'm pretty sure you have it backwards. Tylenol/Acetaminophen is quite hard on the liver.

https://www.health.harvard.edu/press_releases/acetaminophen_....

This is misleading. Tylenol in therapeutic dosages does not seem to have much ill effect on the liver, it is not like alcohols or other direct liver toxins. Even people with advanced stage liver disease can receive acetaminophen. When it becomes toxic at supratherapeutic doses it is very toxic.

Acetaminophen has a narrow therapeutic index and can cause severe and irreversible liver injury in doses around 10 g. A single tablet usually contains 500 mg, but because it's a component of so many other "combo" cold meds, including some syrups, it's easy for people to overdose while mixing OTC products to get over a flu.

Aspirin has a lower standard dose (325 mg), higher LD50 (probably around 20-25 g), and is generally safer. It has fallen out of favor because it's known to cause an exceedingly rare but deadly syndrome in a tiny percentage of children, and because it can have gastroenterological side effects.

Ibuprofen is probably the safest option? I'm sure it can be overdosed, but it almost never happens, whereas acetaminophen results in tons of hospitalizations every year.

> Ibuprofen is probably the safest option?

Ibuprofen can also be liver toxic, but I believe the LD50 is significantly higher than the other options. I have not been able to find an exact number online.

As has been mentioned by others in this discussion, ibuprofen can also cause stomach upset (my wife has this problem, even when she takes it with food).

> Ibuprofen is probably the safest option?

Are you kidding? Ibuprofen like most NSAIDS is terrible on the GI tract and the kidneys. People with healthy kidneys are usually fine with short courses, but even people with relatively mild chronic kidney disease should avoid NSAIDs.

People in their 20s that overuse NSAIDs end up needing kidney transplants. it's not that uncommon. The most common cause of peptic ulcer disease of this demographic (affluent westerners) after H pylori is NSAID use.

> It has fallen out of favor because it's known to cause an exceedingly rare but deadly syndrome in a tiny percentage of children

This has really nothing to do why aspirin has less common use among adults. Aspirin has poor analgesic effects relative to the doses and the risks of GI complications.

> acetaminophen results in tons of hospitalizations every year.

The impact of NSAID related complications is far greater in terms of kidney transplants and upper endoscopy interventions, and related ICU stays.

> Ibuprofen is probably the safest option?

I've heard it can damage the stomach lining if taken at the wrong time relative to eating. But yeah probably still the least-bad first-resort painkiller.

I didn't know about this and got a nasty ulcer after taking ibuprofen for 6 days in a row while dealing with a disease. I'm not touching this anymore and stick with a max of 2g of acetaminophen per day if I need painkillers

Aspirin and Ibuprofen will tear up your stomach and intestinal linings. Think internal bleeding. Alas I had to push back an epidural I desperately needed for back pain a few years ago by a week or two because I was taking too much Ibuprofen. I had blood in my urine as a result.

Ah, good point. People combine alcohol and other meds with that all the time, which can be not so harmless. We shouldn't be putting that in random meds for people who are stuffed up or have a cough.

> People feel sick and they go in and just say "I'll take whatever is strongest" and they get overcharged for these weird formulations that are sort of kitchen-sink type things.

Well, it doesn’t help that most states require you to go to the pharmacy counter for the stuff that actually works (pseudoephedrine), and in some states you actually need a prescription.

It is true. It created an incentive for people to avoid putting pseudoephedrine in things because most people weren't going to buy a formulation that they had to go to the counter for.

Acetaminophen can help you sleep as well. Less aching == more restful sleep which in my experience is the best cure for most minor illnesses.

> if you are actually congested, go to the pharmacy counter and get Pseudoephedrine

Yes, that's what works for me. And of course it used to be available OTC until the government decided to control access to it because of fears of meth.

Not fears, but actual improper usage.

What does that even mean?

If you try to keep milk cold by putting it in the oven, that’s improper usage. It won’t stay cold.

If you’re saying people are trying to get high and are successful getting high, then it sounds like they’re accomplishing their goal and their usage of the product is proper for their intended use case.

Edit: Oh, you’re saying you don’t like what others are doing, but aren’t actually willing to state the fact that its just like your opinion man.

No, fears that leaving it available OTC would result in lots of people using it to make meth. Which, as far as I can tell, was a fantasy: yes, lots of people were using meth, but there was no real evidence that they were using OTC pseudoephedrine to do it. (And, as others have pointed out elsewhere in this discussion, there is no need to go through all the work of making it from pseudoephedrine when the Mexican drug cartels can provide it cheaper anyway.) Which makes the government's position rather like the old joke about the man who claimed to have invented anti-tiger dust:

Look at this wonderful anti-tiger dust I've invented?

But this is the USA, there are no wild tigers within thousands of miles of here.

See how effective my dust is?

I mean we can see a demonstrable and quantifiable MASSIVE decrease in meth usage and overdose circa 2005 when the Combat Methamphetamine Epidemic Act went into effect.

Also, it's still available without a prescription, last I checked, it was just behind the counter/required an ID to track if you're grabbing a pack from every Walgreens in a 50 mile radius in a single night

> Also, it's still available without a prescription, last I checked,

That's jurisdiction dependent. I had to remember to pack some when traveling for work in Oregon, since it was not available, even behind the counter.

> I mean we can see a demonstrable and quantifiable MASSIVE decrease in meth usage and overdose circa 2005 when the Combat Methamphetamine Epidemic Act went into effect.

Really? I couldn't find any data from that far back, but data from 2009 on shows that meth usage, overdose, and arrests climb pretty dramatically pretty much every year.

> I mean we can see a demonstrable and quantifiable MASSIVE decrease in meth usage and overdose circa 2005 when the Combat Methamphetamine Epidemic Act went into effect.

It’s now synthesized in industrial sized cartel owned labs in Mexico using Chinese precursors and smuggled into the US, there’s no reason to keep pseudoephedrine restricted when it’s easier and cheaper to just buy the plentiful and cheap meth on the street.

Cheap meth can't compete with free shop lifted ingredients in homemade meth.

Do you know it was pseudoephedrine?

I remember you could buy bottles of mini-thins at the pos of pretty much every liquor store in the country in the late 90s/early 00s. Used to be sold in bottles of 100 for like 5 bucks.

Source?

> it's still available without a prescription, last I checked, it was just behind the counter/required an ID

Yes, which effectively makes it the same as needing a prescription because you can only get it if the pharmacy counter is open. Which is more restricted hours than the drugstore or grocery store itself.

My sister is on the short side. She went to the counter to buy some of this stuff and the pharmacist refused to believe her ID that said she was (substantially) older than 18. Granted, it was a California issued ID and the pharmacy was in Illinois, but still, what the hell?

Here in Australia we have the same restrictions on pseudoephedrine, possibly worse ones (you have to show ID and it gets recorded centrally so you don’t just pharmacy-hop)

And it’s done nothing. Hasn’t affected availability. Hasn’t cut down on illicit lab operations. Nothing.

People will say “It has cut down on the amount of pseudoephedrine going to illegal meth operations”, as if that in itself is a useful outcome instead of utterly meaningless.

When I lived in Sydney I had a few friends that frequently bought Rikodeine (dihydrocodeine cough syrup), which is also meant to be tracked via pharmacists recording IDs. My friends knew what pharmacies didn't bother to track it, normally if you were a 'repeat' customer and knew the pharmacist. They were able to buy 10~ bottles in a day from 8 - 10 pharmacies, repeating every few days. This was also in Sydney's central cbd so there's a pharmacy every other block.

I assume the situation is similar with pseudoephedrine, though the drug class/restrictions may be different.

Interesting you can get rikodeine at all, given that even mild (8mg) codeine tablets are now prescription only here. That stuff (from a quick search) appears to still be available OTC.

As someone who has always used low-dose codeine+whatever analgesics when I have had a bad cold or migraine, I resent these being removed from the market recently as well. People can tell me that paracetamol and ibuprofen are just as effective until they're blue in the face, but that little bit of opiate uplift when I'm feeling like absolute shit was very psychologically helpful... Oh well, this is the world we live in.

> until the government decided to control access to it because of fears of meth.

Passed as part of the Patriot Act re-authorization bill in 2005, because everybody knows terrorists and pseudoephedrine go hand in hand.

If I recall correctly, it was the resulting cash flow that needed to be laundered, and the potential of those operations to eventually result in the funding of terrorism, that was the alleged concern.

>If you have a fever it can reduce it, but for a minor fever I'm not sure that is necessary.

I think it's generally good to have a mild fever since it's how your body makes itself inhospitable to viruses

I've heard that but I don't know if it has been borne out in any studies, so I didn't mention it in my original post.

correct. a fever is your body's self-cleaning oven

The market is essentially just one step beyond basic snake oil. Instead companies mix various "approved" ingredients to create some branded concoction that they hope will stick from psychosomatic effects. For example "Excedrin" is just aspirin+acetaminophen+caffeine yet so many people swear by it rather than popping the two simple pills and considering if they really need another cup of coffee. The worst is when brand names are abused with suffixes to mean wildly different drugs, as if affinity for a corporate brand should come before consideration of the active ingredients.

Similar deceit happens with cleaning products, where "Clorox" spray or "Clorox" wipes aren't bleach at all. Rather the spray is just some mild acid (a poorer disinfectant), and the wipes are quat (aka "Lysol", makes your pets sick). This kind of thing should be patently illegal - any brand should be required to have consistent active ingredients.

Of course this isn't even considering the criminalization of well-working pseudoephedrine due to the government's dark ages persecution of drug-users-plus-everyone-else.

I shall mourn the loss of Phenylephrine. It worked for me, but I only ever suffered mild congestion. Not allergy-level super congestion, which I won't contest that it was ineffective against. Where it really helped me was with my post-nasal drip.

For what it’s worth, Afrin and other similar nasal sprays are by far the best decongestant.

The only issue is you can only take them for a few days straight, or you’ll have rebound congestion when you try to quit. There are oodles of stories online of people who didn’t heed that advice and upped their dosages again and again for months.

Here’s the best method: Afrin (etc.) at night so you can sleep, and during the day if you have something particular important going on. The next day, after you wake do a sinus rinse with xylitol. This clears out the Afrin preventing dependence, but xylitol also keeps things somewhat suppressed.

Continue until cold is done. Source: me, a person with a ridiculously bad immune system that has multiple colds a year that last 3 weeks with nearly full congestion.

(Also, Adderall is great for colds)

Afrin is so incredibly addictive that I highly recommend never using it… use it once and you’ll be hooked for years, trust me!

Yeah stick with the safe stuff, Adderall

I use it quite a few times a year (in bursts) and I'm not hooked. I gave instructions in my post as to how. Colds don't last as long for my wife so she just uses it for 2-3 days and then stops.

True. You get used to it after a few days and now can't sleep without it, in a never ending cycle. There are much better drugs now, for example fluticasone (Flonase, Avamys).

> (Also, Adderall is great for colds)

Do not go around saying this, even if it’s true. We’re experiencing a huge Adderall shortage, and the last thing we need is people who were on the fence deciding to get a Rx because it might help them with cold symptoms in the winter.

Well, I doubt many people are going to bother hoodwinking their doctors in order to get a prescription. It is a shame it can't just be sold over the counter though, as it really is the best cold medicine. It keeps your sinuses somewhat clear and gives you enough energy to get through the day.

It's probably a bad idea for anyone with a heart condition, in case anyone out there is getting a not-so-bright-idea.

>>go to the pharmacy counter and get Pseudoephedrine

Thanks DEA, you used to just be able to get that in Nyquil and all the others, but the DEA in their moronic idea that drug dealers are going and buying precursors from the local CVS (not stealing them in bulk) has to abuse millions of law abiding sick people forcing them to sign the "papers please" log book treating them like criminals for wanting to feel better.

There’s some places where you can’t get it at all without a prescription.

Obviously retail pseudoephedrine was never a substantial contributor to methamphetamine production (tell me again why that’s illegal?).

Which raises the question, what what the real goal in preventing people from buying functional medicines?

Frankly I think the specific intent was exactly this. The main effect was to cause human suffering and Occams razor tells me the main effect was probably the intended effect.

> Occams razor

I think Hanlon's razor is more appropriate.

Somewhere there was a team of people in the government who worked untold hours studying this, proposing solutions and ultimately having change enacted. This would have been good for career progression for all involved, not because it was actually good, but simply because they did something. And therein lies government.

Hanlon’s razor is a thought-terminating cliche in most circumstances. Malice exists very frequently, as does profit-seeking or other motives that are indistinguishable from malice, and it's not at all the same thing as occam's "don't say god did it when there's a perfectly good mortal explanation" razor.

It's essentially "memetic mimicry", where a second meme rides on the coattails of the first one, simply by obeying the overall form of the first meme so that its credibility "transfers over" to the second one. Like a common snake imitating a dangerous venomous one.

In the DEAs case it was literally confirmed to be operating on malice since at least the Nixon and Reagan years, when it was overtly and publicly wielded as a weapon to disrupt hippies and black communities, specifically. There is absolutely no reason to assume good-faith when law enforcement is involved, and it is in fact a waste of the openness of your mind to do so. Go be open-minded about something else, literally anyone deserves that more than actual literal drug cops.

> “You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities,” Ehrlichman said. “We could arrest their leaders. raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

https://www.cnn.com/2016/03/23/politics/john-ehrlichman-rich...

> methamphetamine production (tell me again why that’s illegal?

Because it ruins people's lives, that's why.

And the vast majority of people who make it don't have proper chemistry training, lab equipment, PPE, or pure chemicals to make pharmaceutical grade methamphetamine with no impurities or unreacted reagents.

I'm all for medicine that helps people and amphetamines absolutely can, but methamphetamine doesn't help people. It enslaves them.

Get the govt to make it properly, give it out for free in treatment centres where they have to consume it, giving an interface to the addicts for mental health and drug rehab staff (or have a trapdoor that sends the addicts to a gator pond when they walk in the door)

Shall the addicts stay in the treatment center while they are high? Or will the treatment center release them after checking vitals to allow them to go do what they want to when high (which for many addicts is "have as much sex as time will allow")

Maybe they go into the gator pond _after_ getting high and the staff can take bets on it

Over-criminalization of society, and the fall out from the "war on drugs" has ruined far far far far far more lives then illegal drug abuse ever could or would

That is with out getting into the debate on if it is even ethical for a government to regulation what a person consumes, even if you believe it is the current method of criminalization and prohibition is not effective in the stated goal of reducing drug use/abuse, a lesson we should have learned as a society with the passage of the 18th amendment and its repeal the 21st amendment

Of course that is not the real goal but .....

Ah yes, the old criminalization doesn't reduce usage misconception. Prohibition reduced usage of alcohol and is not why it failed. Prohibition failed for all of the other problems prohibition caused. Usage of alcohol declined, by quite a bit actually.

So do alcohol, gambling and bad relationships.

>Obviously retail pseudoephedrine was never a substantial contributor to methamphetamine production

I don't know how it compares to organzied production, but people certainly do cook meth from retail pseudoephedrine. In my neck of woods, it's a fairly popular pasttime, since all ingredients can be purchased in a single trip to a shopping mall.

If the phenylephrine thing is true, that means I placebo'd my way through COVID in addition to every cold I've had in the past 15 or so years.

Going from severely congested to not at all, every four hours, makes me think that it's got to be a "this only works in some people" drug.

Same. It has worked for me, and without the jitters and anxiety from pseudoephedrine (which is available OTC here in Canada still)

If it was a “works for some people” drug, you would expect to see a reproducible effect over and above placebo, but AFAICT that’s not the case with phenylephrine.

Is there something else you’re doing or taking alongside that might explain it?

If not … well, happy placebo-ing to you!

I take severe cold/flu medicine with all of these ingredients. Without it, I can't sleep at night and It takes me much longer to recover.

So to say it 'doesn't work' is nonsense.

For those who haven't seen it yet:

A Simple and Convenient Synthesis of Pseudoephedrine From N-Methylamphetamine

https://archive.org/details/pseudosynth

Such a classic :) Top shelf

I've heard whispers some drug chemist figured out how to whip up dextroamphetmaine (main ingredient of Adderall more or less) from plastic spoons or polystyrene or some shit.

They might have even written a literal scientific paper on it or something to that effect

Wasn't this the one they substituted with a half arsed version because the real deal was being bulk bought and cooked into meth? I guess new version being useless for meth cooking isn't the only thing it is useless at

Yes, and there's been evidence that is was garbage for years.

We literally knew the day they put it in the shelves it was 100% ineffective. The FDA dropped the ball hard on this.

It's a weird intersection of the War on Drugs, security theater and pharmaceutical regulation that brings out the worst of all three.

This is exactly my point although I don't know that I could have encapsulated so succinctly and elegantly. Its unmitigated idiocy all around

and it's done nothing to curtail the availability of methamphetamine.

But, sure, it's put a lot of grandma's in jail

https://reason.com/2009/09/30/put-down-the-cold-pills-grandm...

Heh. I'm at the tail end of either COVID or the worst sinus infection of my life. I asked my wife to grab some (real) Sudafed from the CVS, which they also were not stocking (they are constantly robbed), but the pharmacist recommended "oxymetazoline hydrochloride" (Afrin?) as being just as effective without the side effects.

Gotta say, she wasn't wrong. As a nasal spray it works way quicker than Sudafed pills and without the "tweakiness" (worst was some heart racing, but I could still sleep on it).

Was pleasantly surprised at how well it worked as a decongestant. I don't think there's anything useful to junkies in it but it was still locked up for some reason. A+++ would buy again.

The day before I flew from Europe to South America a few weeks ago I had a completely stopped nose. Solid brick. I was terrified of damaging my ears. I took Afrin and some real Sudafed, starting about six hours before flying, and was careful to start balancing my ear pressure as soon as the plane started to descend (which was about 25 minutes before landing and 10 minutes before they announced descent). Zero problems. One or both of those two drugs is a miracle.

(It probably helped that the second leg of the flight landed in Bogota, where air pressure is less than it is in a commercial jet. But the first leg landed near sea level.)

Works great, BUT easily habit forming. Beware.

My doc gave me a trick that prevents the rebound effect of Afrin (and other addictive vasoconstricting sprays). When you start the Afrin, or about a week before you want to stop it, start using a nasal steroid spray (nasalcort or whatever you prefer). The steroid will prevent the swelling and itself has no rebound period. After a week after stopping the Afrin, stop the steroid as well, and you will successfully be congestion free the entire time.

I prefer this to pseudoephedrine as it’s not a systemic solution to a local problem in the nasal cavity.

Why not just use the steroid spray, then?

Cool hack to get off it, but I would still be wary of being on it too long.

Because the congestion usually starts quickly and there isn’t time to build up the steroid response, which can take a week or more. People with allergies use steroids chronically, so they’re generally considered safe for long term use.

I made this comment elsewhere but I do a sinus rinse in the morning with Xylitol, and do Afrin at night. Rinsing it out helps with dependence and Xylitol helps with congestion too.

I use xylitol rinse daily anyways ;-) helps keep sinus infections at bay.

What do you mean by this? I’ve been using Afrin to deal with nasal congestion when I get a cold for 10+ years now.

Do people continue to use the stuff once they have recovered or something?

Yes. It can fairly quickly feel like you can’t breathe without it.

I feel like @theRealSudafed needs its own ironic Twitter account at this point if the Marvelous Mister Musk wasn't such a glorified shithead

And this means we're going to have an easier time buying the stuff that works...right?

...right?

You will have an easier time inasmuch as you will no longer think, as almost everyone did, that your purchase of phenylephrine is adequate. The hardest pseudoephedrine to buy is the one you don't think you need.

This is a difficult comment to parse

People blissfully treated with placebos because the stuff that actually worked can be kind of hardcore.

My (I’ve learned: unpopular) opinion is that not everything is a cosmic wrongness that demands a 1Hr Photo of a fix. It’s okay to just work through a cold with rest and water and warm beverages.

> It’s okay to just work through a cold with rest and water and warm beverages.

Spot the person with no children and no job responsibilities!

(Has a four and a six year old)

Thought the same thing. I've always been a "better living through chemistry" kind of person, but having kids pushed me straight into "find what pill makes it go away, and take it" as default response, because ain't anyone have time to deal with bullshit like a cold, especially when the rest of the family is down with it again, third time this month.

Pseudoephedrine makes me feel fairly off, but it's really great for nasal congestion to last like 2 days less if that is the price (in addition to 20 cents for the pill or whatever it is).

It's already easy to buy the stuff that works. You just have to go up to the counter and ask. You have to show ID, just like you do for liquor (and, because purchases of psuedoephedrine are rate-limited, they're going to log your purchase). You'll need to get over that, because I don't think the rate limit is going anywhere: psuedoephedrine essentially is methamphetamine, and it's the worst conceivable kind: the kind that you obtain by constructing horrible hazmat labs in garages, mobile homes, and apartments.

This isn't a very constructive response. OP wants it to be easier to buy decongestants, as do I.

It's a minor annoyance but I only need to buy a pack once a year, so the extra time required isn't bad. The downside is that you have to go when the pharmacy is open and in some places those hours can be quite limited, especially for those who work standard business hours. If you need to buy it regularly, it might become a hassle.

When I bought it, my receipt showed the total amount I had bought in the past thirty days (which was also the amount I was buying that day). For my use, the monthly allowed amount is far far beyond what I'd ever use but I could see some people with really bad sinus issues needing more. Perhaps in that situation a doctor could write them a prescription for more than the standard limit.

I think he might have meant this : "Codeine is a widely used analgesic, that is available for sale in pharmacies over the counter (OTC) in a number of countries including the UK, South Africa, Ireland, France and Australia." [0]

[0] https://www.drugsandalcohol.ie/25048/#:~:text=Codeine%20is%2....

Codeine treats coughs.

Sudafed treats sinus congestion.

Different drugs with different uses.

Codeine is great, throw a lil bit in some sprite and hang out.

You'd be missing the promethazine.

Yeah, Oregon still requires a prescription for pseudoephedrine. And it's infuriating.

You haven't needed a prescription to purchase products with pseudoephedrine in them in Oregon since January 1, 2022.

So they decriminalized meth in 2020 but it took them another two years to roll back this mess?

Oregon leading the way, as usual.

>This is fearmongering and sensationalism.[0]

[0]https://news.ycombinator.com/item?id=38008005

They literally decriminalized the possession of meth. Not. Single word of what I said was inaccurate in any way.

Inaccuracy is not a prerequisite for fearmongering or sensationalism.

Fascinating. That is not a well-known fact as my neighbors were just complaining about this a couple weeks ago. I wonder whether our local pharmacy is setup to handle those requests.

It's already easy to buy this thing. Show your papers.

In California, the rate-limit for purchasing pseudoephedrine is insufficient for allergy sufferers. They end up having to go out of their way to stock up during the off-season.

It’s not an appropriate treatment for allergies though.

Are people taking it daily for a season rather than using a medication indicated for longer term use?

It’s the only thing that reliably works after living in Texas for a lifetime. That and Benadryl.

The real pro tip is that the four hour doses are just enough to deal with an exposure event and reduce the side effects to a minimum.

> You just have to go up to the counter and ask. You have to show ID, just like you do for liquor (and, because purchases of psuedoephedrine are rate-limited, they're going to log your purchase)

Up to the counter and ask...when the counter is open that is increasingly a problem as pharmacies close and hours are limited (the two nearest me close at 6pm, right at the end of working hours).

Show ID...that the pharmacist will accept (not all of us drive or have a driver license).

Rate-limited...at a quantity too low for a household that has a sinus infection running around.

So, no, it's not already easy. Canadians can go into a Costco and buy as much as they like and apparently it's not an entire nation of Walter Whites up there so what makes us so special?

> Rate-limited...at a quantity too low for a household that has a sinus infection running around.

I don't think so. I actually buy this stuff for allergies because it's the only thing that works for me and doesn't disrupt my sleep one way or another.

I get 60 pills which are 2x what's in cold medication. I get that it's annoying but for an illness it's more than enough for a large family.

If you have two people who take it everyday for allergies, you've already hit your limit with 60 pills.

And yet still had enough for both of you, and that's if you both don't purchase the meds, and go to a 2nd store, or go to the same store the following day or week. 9 GRAMS every 30 days. The 20cnt box of Sudafed is 120mg pills, so 2400mg total, or 2.4 grams per box, and that's not all phseduo, which I think the 9 grams is only concerned with. So you'd have to look at how much of that 120mg is the limited material if that's the case. Assuming they mean the entire pill. That means every 30 days, each adult in your family can buy 3 boxes each (3.75 technically but I rounded down) from the same store. So 60 bills, to cover 30 days, per adult. How is that not enough for your daily single dose? 3 boxes just you can buy covers 2 adults taking it daily. This is where all the complaints that it's too restrictive fall apart. When you do the math, there is room to stockpile and STILL take it daily...

The rate limiting is just that, limiting the rate, making it more effort to obtain mass amounts so it's more time consuming to gather up for abuse. The goal was never to stop meth production with the limit, it was to seriously slow it down, which it has, which equates to less of it overall on the streets. And the limits as we just calculated are more than a single person should need if taking the pill daily, which is the max allowed dose. So, it's not an issue, and we just proved it with math, now excuse me I have to go beat my own ass for saying we just proved something with math.

> This is where all the complaints that it's too restrictive fall apart. When you do the math, there is room to stockpile and STILL take it daily...

And yet innocent people still get arrested and have their lives upended and/or ruined because they accidentally violated pseudoephedrine regulations.

When that's happening, it's because the regulations are too restrictive.

> And yet innocent people still get arrested and have their lives upended and/or ruined because they accidentally violated pseudoephedrine regulations.

I'm curious to know if you have any examples of this because I can't find one.

This was posted on this submission: https://reason.com/2009/09/30/put-down-the-cold-pills-grandm...

More: https://reason.com/2009/09/28/hoosier-grandmother-arrested-f...

Those two links are the same one person.

I know. The second link contains more info than the first.

It seems that the major pharmacy chains keep records and will refuse to sell it to you before you reach the limit that would trigger a misdemeanor.

But, if a law is never enforced, it should be deleted. Otherwise, one day you decide you don't like someone's political views, and suddenly they are the first case of purchasing 9.1g of Sudafed in a single 30 day period. Dead code is just waiting to be a security incident.

Again, I'm not advocating for the limits. I'm saying it would be very hard to exceed the limits as they exist now.

Step 1, get married. Step 2, have kids. Put your allergy status on your dating profile, I guess.

True enough, but you can also get a prescription for this if you don't want to do OTC/BTC.

At a decongestant dosage this will last two people two months. And of course if the second person is 18+ they can also buy that.

I'm not advocating that the limits are good, just that a single person is very unlikely to hit them for allergies, periodic illness or asthma (it's also available as a prescription for allergies)

The legal limit is 9g per 30 days, and the recommended dose is 7.2g per 30 days (=240mg/day). So if both parents take the maximum dose, there is none for the kids. (3 people would need 21.6g; both parents together could buy 18g.)

Personally, I don't take it at night, so I wouldn't run into this problem, but the existence of 240mg "24 hour extended release" tablets leads me to believe that someone else must. (I'm a little jealous that they can sleep with it in their system. It would be nice!)

> the recommended dose is 7.2g per 30 days (=240mg/day)

30-60mg, and this is not recommended for more than 7 days for sinuses

It's actually a fairly significant dose already.

> Up to the counter and ask...when the counter is open that is increasingly a problem as pharmacies close and hours are limited (the two nearest me close at 6pm, right at the end of working hours).

Probably covered by the FMLA or any boss who isn't an asshole, or since it's OTC, have someone grab it for you, or get it on your lunch, or task rabbit it.

> Show ID...that the pharmacist will accept (not all of us drive or have a driver license).

If you don't have an acceptable state ID the pharmacy not giving you cold meds is the least of your hurdles. Go get an ID, you need it for anything offical that requires proof of ID. This isn't the medication rate limits fault.

> Rate-limited...at a quantity too low for a household that has a sinus infection running around.

My state allows 9 grams every 30 days, which should be plenty. BUT, that rate limiting is not checked/enforced statewide, meaning you can go to one store and get some and down the road to the next store and get some, and so can the other adults in your household. The limits are plenty for intended use. Only people wanting meth manufacture amounts complain that 9 grams in 30 days per store is too low.

> So, no, it's not already easy. Canadians can go into a Costco and buy as much as they like and apparently it's not an entire nation of Walter Whites up there so what makes us so special?

It's pretty easy. When you have an ID like every adult should have, and a normal size household, stepping out at lunch or running to a late night rx place and asking for a box or two of sudafed is literally as easy as buying booze or smokes, show your id, pay the person, leave. And btw if you checkout bluelight or /r/meth, our neighbors up north are having a field day cooking meth a lot of which is coming across the border into the US. No criminal enterprise is going to have unrestricted access to the key ingredient for a super addictive drug and pass on utilizing it.

There are regulations that exist specifically to stop people from buying pseudoephedrine for someone else, anti-"smurfing" laws. Some places make you sign a government waiver that confirms you're only buying Sudafed for yourself, a family member, or someone in your household. There are limits on how much a single person and household can buy or have, as well.

It's not something you can use Task Rabbit for, and anyone that does pick it up for someone else because an app told them to is potentially opening themselves up to criminal liability.

https://news.ycombinator.com/item?id=38007117

I really doubt you could buy pseudoephedrine via taskrabbit, but then again I've never tried it.

Task rabbit, uber eats, door dash, all have offerings where a person will do your shopping on your behalf. It includes over the counter meds afaik.

> What health and wellness items can I order for same-day delivery? We've got you covered on health and wellness items including over-the-counter medicine, vitamins, first aid items, family planning items, feminine care products, home diagnostic tests, and more to help you feel better in a pinch.

https://www.doordash.com/p/medicine-delivery

Just checked and you totally can buy psuedo via door dash ¯\_(ツ)_/¯

https://imgur.com/Juyuvme

Interesting, when I search on DoorDash everything that comes up is phenylephrine. No pseudoephedrine to be found.

What state do you live in?

Not today, officer ╭∩╮（︶_︶）╭∩╮

The only reason I have a state ID is for buying Sudafed. I was tired of "my system won't scan your passport".

I disagree with the person that replied to you, you really don't need a state ID for anything.

Well if you have a passport, which is federal ID, of course you don't need a state ID. But there are plenty of people who have criminal records that would prevent them from getting a passport, as well as plenty of people who just don't want the couple week process and complexity of getting a passport, or don't want to carry a bulky book when all they need is 1 page from it, and who have no intention of leaving the country. State IDs are the default for a ton of people who can't or don't drive.

> or don't want to carry a bulky book when all they need is 1 page from it, and who have no intention of leaving the country

US passports are available in card form for exactly these people. They work the same as a book-style passport within the US, but can't be consistently used for international travel.

https://travel.state.gov/content/travel/en/passports/need-pa...

TIL, thanks!

> Rate-limited...at a quantity too low for a household that has a sinus infection running around.

I know all of this is annoying (and I agree) but many people don't think to stock up when they are healthy. You should! You can avoid a lot of problems with a little preparation ahead of time.

For the first time in my adult life I ran dry of Fisherman's Friend and DXM while dealing with a flu just this last week. Amazingly Amazon Prime will overnight you DXM if you enter your driver's license info at check-out.

> Show ID... [...] (not all of us drive or have a driver license).

Your objection is irrelevant. States give photo IDs which are just like drivers licenses except they don't say "drivers license", you don't have to pass any driving tests, and you can't drive with them. Otherwise they look and work the same and every employee trained to look at drivers licenses will accept them without hesitation.

It's not easy in my state. It goes like this: go to inside counter of an open pharmacy (can't use drive thru for it). Wait, for a long time (aren't all of your pharmacies massively overloaded with 30-60m lines? ours are). Ask for a 96-count sudafed (generic or regular) and hope they have it. If they don't, get 48. If they don't, get 24 (forget that I need 2 tabs every day as prescribed by my doctor -- yet can only buy 1 box/month no matter how many are in it so if I can't get 96 I can't get enough). Provide ID. Hope that the state verification system is up, because in my state it goes down ALL THE TIME and so frequently the process stops here only to be retried at some random future time/place. Do this each and every month as many times as it takes.

Forget that meth use has gone up in the face of all this insanity. It now flows in massively from Mexico. IOW, this isn't stopping meth use. Also forget that for years people like me were told that if we didn't like it we should use the drug that just now got officially tagged as having never worked (duh, we all knew this within one day of the first time sudafed went behind the counter).

Sudafed is one of the hardest to acquire substances out there, and the burden falls on those who really need it. I'm glad it's easy for you, but it's not for many many people.

Man, your state sounds horrible. Only problem with pharmacies around here is they're always out of adderall.

I have talked about this before, but it really all depends on 1) the area you're in and 2) what kinds of class signals you emanate. I'm a well-dressed white guy in Seattle, and I've never had any trouble buying pseudoephedrine: they just check my ID and then give it to me. Meanwhile I have relatives in a depressed part of the midwest who, with the best love in the world, are visibly lower-class, and they say they get hassled and roadblocked constantly trying to get it. It's pretty naked classism and rather fucked up.

But if they have the active ingredient to make meth, there's no need for adderall. Meth is adderall (amphetamine) with a methyl group added to make it cross the blood brain barrier easier/faster. Once metabolised by the body it becomes the same amphetamine as your addys. There are a surprising number of people who dose meth like adderall to treat their adhd symptoms and you'd never know if they didn't tell you.

I'm not advocating anyone do meth, the above was said mainly to crack and easy joke about the pharmacy being out of legal speed but in stock on the stuff to make illegal speed

I asked my doctor to write me a prescription for pseudoephedrine once. They rip open the box (before you get to the pharmacy), dump the pills into a standard pill bottle, and then charge you $5 instead of $11. No ID / signing the ledger required!

But yeah, the whole process is very annoying. I think this news about the ineffective stuff being withdrawn is good for us; with more demand for the stuff that works, pharmacies will have to hire more people to comply with the regulations, driving profits down, and finally a lobbyist that matters will be in front of Congress.

Do you usually take decongestants for 12+ days? I usually just take them a couple of times on the worst days of a cold, maybe 5 pills every time I get sick.

And pharmacies in my city don’t usually have more than 1 or 2 people ahead of me in line.

All males in my family over produce muccous and have perpetual post-nasal drip leading to a frequent cough that is slowdy taking away our voices. Sudafed access would be great!

I've gone to an ENT to try to reduce things but no luck so far.

You could try getting an ADHD diagnosis, adderall is a fantastic decongestant.

(Joking)

i was going to say, what planet are you on where you have to wait 60 minutes at the pharmacy, and what you need more than 24 pills for?

you're either Jesse Pinkman or sicker than a vintage Jimi Hendrix lick

Love that, I’m going to steal it

Honestly depends where you are. I lived in a town of around 100k at one point with probably 250k in the surrounding area and we were severely under pharmacied for how much demand there was. There was always a 20+ minute line. CVS, Walgreens, Walmart, didn't matter.

Now I live in a large metro area and I almost never wait.;

I never had it that bad, but not having the right stock is an obnoxious and frequent occurrence. If you need it that bad and that consistently, you should definitely have your doctor write a prescription and make the pharmacist do the work to fill it properly.

Wild. I just walk up to the pharmacy inside my grocery store. Adds about 5 minutes to my shopping trip.

> Sudafed is one of the hardest to acquire substances out there

What!?? Regardless, this tip might be helpful: you can get it online with a script without insurance for $2.40 [1]

If you need a script you can probably get it from Amazon Clinic Dr chat too for $33 without insurance all via messages only. [2]

For the record I've never used it and haven't considered it much beyond my recent amazement how theres a 'startup' for every prescription med now (and Amazon is entering the market strong too).

[1] https://pharmacy.amazon.com/Pseudoephedrine-Oral-Tablet/dp/B...?

[2] https://clinic.amazon.com/cough-cold-flu-treatment/dp/B0CK3K...

> You'll need to get over that

I'm going to continue bitching about it, thanks.

Enough people pointing of the obvious stupidity of this kind of insipid nanny bullshit (that everyone knew would not solve the problem being address, and said so at the time) might make the next nanny idiot think twice.

And if it doesn't, then they can take the criticism anyway, because they deserve the grief. No, good intentions don't make it OK when you're talking public policy.

I'm never giving up on this as an issue. You don't just have to go up to the counter and ask and wait behind all of the people getting prescriptions filled- you get rate limited, never mind if you are buying it for a whole family, never mind if your previous supply was destroyed. I almost wish it were illegal, as black markets would make it easier to buy.

You can usually get it via personal shopping services. When I had a cold and a passport (and Walgreens/CVS’ systems could only deal with state IDs) I was able to get some by using Postmates.

In my experience (perhaps my state), a pharmacy will now only dispense pseudoephedrine to you they "know you." As in, you regularly fill other medications at that pharmacy.

If you don't take other medications? I don't know, I assume you're fucked.

No pharmacy I have ever bought Sudafed at "knew me". I don't take any other medication. When I want Sudafed, I just go buy it.

Enantomeric imported Mexican meth goes for $40 a gram. No way you can buy pseudoephedrine and shake’n’bake for less. You have to buy expensive lithium batteries and cold packs.

I guess some people will still (try to) make it themselves, but last time it came up here someone posted about how mass production has just moved on to some other synthesis that isn't dependent on buying a precursor in small retail quantities:

https://news.ycombinator.com/item?id=37499106

Again: the issue isn't that you can't mass-produce methamphetamine without pseudoephedrine; at scale, it's presumably far, far easier to produce it without using pseudoephedrine as a precursor. The issue is that pseudoephedrine-based meth production is a particularly damaging kind of production, in the sense of burning down buildings, causing distinctive kinds of crime, and producing an even more dangerous product.

It is far far far easier, less hazardous, and less violent when methamphetamine is just made at an appropriate factory. But this simple approach is incompatible with the self-perpetuating authoritarian impulses of law makers and law enforcement.

Is there reason to believe that restriction on pseudoephedrine is having a larger effect on shake and bake production than the relative cost? I'm not really paying a lot of attention to the issue, I think I bought one small package of pseudoephedrine in the last 5 years and the biggest issue I had is that the pharmacy tech didn't assume that I meant generic when I said I wanted the cheapest one.

Never! We're still fighting a war on drugs, and it's crucial that the government know the names of all allergy sufferers. If people could have as much Sudafed as they wanted then... they might be able to smell all of the marijuana smoke outside, which would make the war on drugs look ineffective. We mustn't have that.

(8 people will reply to me saying that people buy pseudoephedrine and make meth badly and blow up their chemistry lab, killing their neighbors. I'm sure that's happened, but if we want to reduce the number of people that die every year, the truck that delivers the stuff probably has a higher body count. But cars good, drugs bad. I've lived in this country long enough to know how it works.)

No. But the sad joke is you can buy 20 guns without presenting your license or having the state tell you no. But if you got a sinus headache? You’re a dangerous individual. You gotta get registered and in the system so we can track you.

> Under federal law, federally licensed gun dealers, importers and manufacturers must run background checks for sales to an unlicensed buyer. Specifically, a potential purchaser must show identification, complete a federal document known as a Form 4473, and pass a National Instant Criminal Background Check System check.

Any licensed firearm dealer MUST run a background check at ALL times. Stop your misinformation.

https://en.wikipedia.org/wiki/Gun_show_loophole

If the seller is a licensed firearm dealer, they are required to run a background check, no matter whether they’re at a gun show or not. Whereas if you’re purchasing in a private sale, you don’t have to be at a gun show. I can walk over to my neighbor’s house right now and purchase his gun without showing him my ID

This is fearmongering and sensationalism.

I assume GP is talking about face-to-face private sales, which doesn’t require any background check on the federal level and in many states. In some states, you can go on Armslist and buy 20 guns without having to show an ID. And worse, running a background check isn’t even an option in most states unless you pay an FFL to intermediate the sale.

And you can absolutely buy meth in a private sale without doing a background check. Now, the whole buying meth part isn’t legal - but the lack of background check is.

I wonder if there are any states where you can buy Sudafed privately from someone without an ID. Probably.

Serious question. Did you do a background check for every gun you own? Most people simply don't.

Vitamin C and rest? They will still carry that

Its annoying how the biggest consideration in whats get OTC'd is how useless it is (only slightly above homeopathic level useless) or how painful the overdose is (more painful -> sure, knock urself out) and little recreational potential it has (see point 2 + again, knock urself out) with a few radical exception(s)

Edit: if its pharmacologically active and effective for "an" indication, its fun/euphoric, and super safe? --> illegal or controlled vs snake oil, no fun, narrow or easily surpassed and potentially catastrophic therapeutic window --> sure, knock urself out

Its almost like they dont give a fuck about safety or efficacy and "they" just don't want you getting high

Edit: meth is technically legal, with the caveat its only the levorotatory isomer

*small caveat

Finally, phenylephrine has been known for a long time to be ineffective and no better than placebo in trials.

Shareholder lawsuit in 3... 2.... 1...

Is drug uselessness a defense for the management if it's profitable?

This sucks. I rarely take any of this stuff, but phenylephrine can do a lot to relieve pain.

Are you sure you're thinking of the right drug? I haven't heard that it possesses any analgesic properties.

For many it does indirectly since it relieves sinus pressure.

Does it? I thought it was no better than a placebo? Are you sure you're not thinking of pseudoephedrine?

It does work if you spray it directly in the nose. It does not work orally. I wonder if they think that CVS will be removing the spray.

Would the article line the FDA to regulate more things? or is it just pointing out irony

Since homeopathy is still legal I think I'll launch a series of treatments based on your astrological sign (and perhaps the time when you get sick). Take this pill if you're a fish, have a cold, and it's October.

Make sure you put "Invented by a scuba diver!" on the package like the old Airborne boxes.

Might get bought for $150M just like they did.[^1]

[1]: https://www.businesswire.com/news/home/20120402005634/en/Sch...

psuedoephedrine is the only one that works.

And it works really well.

I have some debilitating allergies during the summers and it's basically benadryl or pseudoephedrine. If I want to stay remotely functional, I need pseudoephedrine.

What's your experience with the more recent non sedating antihistamines?

I find that Allegra is pretty helpful with minimal to no side effects, Zyrtec doesn't have a lot of side effects but isn't as helpful, and then Claritin is about the same benefit as Zyrtec with a bit of fogginess.

In Soviet Russia, sudafed methylates you!

*turns you to Meth

But they leave the homeopathic junk mixed in as if it was actual medicine.

Homeopathic stuff is placebo, that's what it is. And placebos work very well. Who cares if they are not medicines? Sometimes all you need a placebo.

You should not discount just how effective placebos actually are!

Although I do recognize the potential for fraud here - they disclaimers they put on there should be more prominent.

Because people don’t know they’re “placebos” and use them as real medicines and you end up with dead kids. Homeopathy is probably one of the worst things to come out of Germany (yes, amongst other things even though I love you Germany).

How do you know placebos work? You can’t do a randomized placebo controlled trial to test them.

Why not? Give a bunch of people actual placebos, half are told it won't work, half are told it will, see what happens?

Which half is the placebo?

The literature on the effectiveness of placebo's is extensive and not in doubt: https://en.wikipedia.org/wiki/Placebo#Effects

Considering that link points directly to a paragraph the says

> A 2001 Cochrane Collaboration meta-analysis of the placebo effect looked at trials in 40 different medical conditions, and concluded the only one where it had been shown to have a significant effect was for pain.[14] That's because placebos do not appear to affect the actual diseases, or outcomes that are not dependent on a patient's perception

I'd consider that a somewhat misleading citation for your assertion.

And? If you take a placebo for a cold, and you feel better than you would without the placebo - what's the issue?

If you notice they don't make these things for any serious illness, they are all for things where the goal is simply to feel better, while the disease runs its ordinary course.

Yes, this was half the article.

Wishful thinking, but next up should be homeopathic snake-oil.

No company should have a homeopathic product sitting on the shelf next to an actual medicine.

I was at a Walgreens years ago and there was a rack of impulse-buy items at the checkout counter. One of them was a homeopathic cold "remedy." I had the same thought as you -- Walgreens is hurting their reputation as a trustworthy pharmacy, but then I realized that behind the counter was a wall of cigarettes. That resolved the tension for me: if they are willing to sell cancer causing agents, selling homeopathic meds is tame in comparison. Their goal, of course, is to make money, not to make you better.

CVS doesn't sell tobacco products for that reason.

This is what the entire latter 2/3 of the article is about.

> Wishful thinking, but next up should be homeopathic snake-oil.

It sounds like it's serving a useful purpose.

> "I know so many people… hell, I've done this myself, I've bought [a homeopathic] product by mistake," Little said. In a trip to the drug store while sick or as a weary parent of a miserably ill child, it's easy to mistakenly pick up a homeopathic product in haste or the fog of infection.

If folks are going to irresponsibly take some random drug without having any idea what's in it, it sounds like funneling them toward something that won't harm them is a good thing. I mean would you really rather have them giving their kids something like tylenol without reading the dosage instructions?

We should give kids aspirin just like we used to and stop believing a ridiculous paper that claims that it causes some kind of rare disease.

> like we used to

We haven't given aspirin to kids for like half a century.

I know this, because my uncle died from Reye syndrome from aspirin when he was two years old right before the recommendation changed.

I'm guessing a decent number of unexplained child deaths from back then can be attributed to Reye syndrome from aspirin.

If you're assuming that the homeopathic stuff is incapable of harming anyone, you're mistaken. https://arstechnica.com/health/2023/08/fda-warns-amazon-to-s...

The reason to remove such products is because they contain dangerous agents that aren't being disclosed. The same would be said of any scientifically well-validated product that was tainted. If bottles of paracetamol/acetaminophen were contaminated with toxic mold, those should be removed too I think.

I personally think the FDA should be more focused on these kinds of things — contamination and labeling fraud — and less on regulation of efficacy or access. We need more access and competition in the US, not less.

I'm definitely not assuming that homeopathic medicine is incapable of harming people, but for the sake of this specific argument I think it's reasonable to assume that we could find something that isn't especially harmful to fill the role of giving people who don't read the labels something to take.

I've mentioned this story before, but homeopathic medicine doesn't funnel people towards net-neutral treatments, it pushes them towards harmful ones. Like the time I was at a family meeting and a distant cousin's baby was crying (as babies often do). Another cousin offers a homeopathic tincture they bought earlier to calm the baby and when I took a look at the label, it was random spices and largely alcohol.

I'm more surprised Sudafed was shown as an OTC. Isn't that one of the ingredients in meth? Not really the subject of the article but it struck me as odd.

Not real Sudafed. Real Sudafed isn’t OTC because it is pseudoephedrine—in fact that’s where Sudafed got its name.

Real sudafed is OTC, you just need to ask for it at the counter. No prescription is required. They just don't have it on shelves, because they require you to show your ID when purchasing it. I'm assuming this is so they can track how much a person is buying to track people who are using it for illicit purposes.

Behind the counter (BTC) is the specific term for these OTC medicines.

Oregon requires a prescription.

Oof, remind me not to move there. I wouldn't survive an allergy season. Though to be fair, I imagine most GPs would write a prescription pretty quick.

You can move here - prescriptions have not been required since January 1, 2022.

You can just buy hard drugs there instead, it's Oregon!

But you will have to go to a shady place since they only decriminalized them...

If it seems stupid it's because it is.

This category of drugs are referred to as Behind the Counter, https://www.fda.gov/drugs/information-drug-class/legal-requi...

Interesting, today I learned it had a more specific term. Still, saying something "isn't OTC" implies you need a prescription to most people. At least in my experience.

Wow, I have legit never made that connection.

Sudafed (edit: also) makes (or at least made) products with phenylephrine, the useless drug in question. Those products don't contain pseudoephedrine, which can indeed be used as a precursor to making meth.

Edit: I did not say that Sudafed did not also make products containing pseudoephedrine. They do, obviously, it's where their name comes from. They just also make products with useless phenylephrine.

Actually, Sudafed continues(d?) to make both, you just have to ask for the one with pseudoephedrine which is usually locked behind the counter. Not a meth chef here, but do I have allergies and get migraines, the only thing that seems to help is pseudoephedrine. When they introduced this crap however long ago I could immediately tell it did nothing compared to the 'original' version. Not surprised at all by this revelation/confirmation years later.

Sudafed also makes pseudoephedrine HCl, which works. That’s why their name is a contraction of ‘pseudoephedrine’.

> Isn't that one of the ingredients in meth?

Not an ingredient -- a precursor. Methamphetamine, pseudoephedrine and and phenylephrine are very closely related:

https://cen.acs.org/content/dam/cen/83/13/8313govpol1imgs.gi...

To convert pseudoephedrine to meth you have to remove a hydroxyl (-OH) group in a way that leaves the resulting molecule in a specific isomer. Doing this at high yield is challenging, but it turns out that if you're willing to live with lots of horrible impurities, you can do it in a cola bottle. PE has the same structure as pseudoephedrine, but in a different isomer, so it cannot be converted with the simple approaches.

Unfortunately, PE is also useless for decongestion, because -- surprise! -- the isomer matters a lot for effectiveness.

A fun fact is that both Ephedrine and PE are naturally derived from the Ephedra plant. During WW1 and WW2 there was a lot of research into how we can make these chemicals more potent and that's basically how we ended up with meth. Many soldiers came home after WW2 still addicted to meth and for a few years you could actually buy meth at your local drugstore as an OTC.

Yeah, Benzedrine inhaler tubes ("bennies") were banned in 1965.

You can still get it over the counter, but you have to ask at the counter for it

There's the Sudafed on the shelves, made with phenylephrine, and the Sudafed behind the counter, made with pseudoephedrine. (Technically both OTC.)

The Sudafed behind the counter actually works (really really well), but due to what you've described, you need to present ID and affirm that you'll abide by certain federal laws. Oh, and there's a low hard limit on how much you can buy at a time, which is fine if it's just you in your household but not so fine if absurd levels of congestion run in the family and you all live together.

That picture shows "Sudafed PE". The product "Sudafed", which contains Pseudoephedrine, still exists.

As per https://nida.nih.gov/publications/drugfacts/over-counter-med..., "Over-the-counter (OTC) medicines are those that can be sold directly to people without a prescription.". Sudafed—the real Sudafed—is still OTC, by that definition.

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