Medical community should weigh in on pseudoephedrine debate
As we approach the 2014 legislative session, the prescription status of pseudoephedrine is again being debated. It is imperative the medical community lend its voice to the debate to ensure this decision is based on the facts. This initiative has been sidetracked in the past by a mirage of public outcry and economic shell games that do not take into account the societal costs of methamphetamine abuse and addiction.
Pseudoephedrine is one of two oral decongestants indicated for the temporary relief of nasal congestion associated with allergic rhinitis, sinusitis and upper respiratory infections. It is not a curative medication. It does not reduce the duration of any illness and does not prevent any long term complications. A meta analysis to determine its efficacy suggested a 6 percent decrease in symptoms with one dose and less response with subsequent doses. Studies done in patients with sinusitis failed to show consistent efficacy.
Pseudoephedrine, like most medications, has contraindications and side effects. It is relatively contraindicated in patients with hypertension. It should be used with caution in patients with heart disease, cerebral vascular disease, diabetes, hyperthyroidism, glaucoma and prostatic hypertrophy.
Obviously many individuals should avoid this product due to possible side effects and equivocal benefit. Common side effects include nervousness, insomnia, palpitation, urinary retention and elevations in blood pressure.
Pseudoephedrine is also the only essential ingredient in the manufacturing of methamphetamine. The manufacturing process utilizes toxic and flammable materials. This process endangers those around the manufacturing process and those who are forced to deal with the toxins left behind. This group includes innocent children and our first responders. Recent efforts to limit pseudoephedrine availability have done nothing to curtail the manufacturing of methamphetamine. Lab seizures increased with recent law changes. In states that have enacted “prescription only” laws have seen a dramatic decrease in methamphetamine production.
I had the opportunity to participate with the Kanawha County Drug Task Force. This group consisting of pharmacists, physicians, educators, law enforcement and business representatives made recommendations for curbing our current drug abuse problems. This group was overwhelmingly in favor of making pseudoephedrine prescription only, except for tamper resistant products. This is the same recommendation provided by the governor’s task force.
Arguments against this policy change center around mythical public sentiment against a change. I say mythical, because my practice takes care of approximately 4,000 patients and I have yet to hear any concern. The exemption of tamper-resistant products still allows for nonprescription access for these products. Another argument concerns the economics of sales and tax revenue losses. This does not take into account the costs of lab cleanup, law enforcement costs and the societal costs of addiction. In addition, I would conservatively estimate that over 50 percent of current sales are for illegal activity.
Drug abuse and addiction are at epidemic levels in this state and this country. This is one of many steps that need to be taken to turn this epidemic around. This is an easy and necessary step to curb this growing problem. Time is no longer on our side. Action needs to be taken now.
Dr. Bradley Henry