Pubdate: Tue, 27 Mar 2007
Source: Alameda Times-Star, The (CA)
Copyright: 2007 ANG Newspapers
Author: Candace Murphy, Staff Writer
Bookmark: (Methamphetamine)


Nikole Wilson-Ripsom and her son were stuffed up.

Not just any stuffed up, either. They were major league, big time, 
plague of locusts, Bay Bridge at rush hour, congested.

So she tried her usual tricks, one by one. She gave her son some 
Delsym. On herself she used a water-cleansing neti pot. Then a 
menthol and eucalyptus steam. Then a little dab of Vicks under the 
nose. Then a bit of Euphorbium, a homeopathic nasal spray. Then Afrin 
Extreme Congestion 12 Hour Spray.

None of it worked. For either of them.

So congested that she couldn't even swallow chicken soup, 
Wilson-Ripsom brought out the big guns: the Sudafed.

She took one and waited 20 minutes, then 30 minutes, then 40 minutes, 
then an hour. But it didn't work. So then she took another. And 
still, no relief.

On a lark, Wilson-Ripsom looked at the box. Something wasn't right. 
This wasn't Sudafed. This was Sudafed PE. Instead of pseudoephedrine, 
which used to be the active ingredient in Sudafed and other cold 
meds, this stuff contained phenylephrine. She looked at her son's 
cold medicine and found it had phenylephrine, too.

It didn't take a chemistry degree for Wilson-Ripsom to figure out 
what was wrong.

"The new decongestants are crap," says Wilson-Ripsom, of Oakland. 
"They're appallingly ineffective."

Indeed, with the cold, allergy and flu season under way, the growing 
consensus is that the nation's reformulated cold medicines don't work.

And that's not even the worst of it. Though pseudoephedrine can still 
be purchased legally -- by showing identification and abiding by 
monthly federal quantity limits of the drug -- pharmacies are 
inconsistent in how they choose to dispense the medicine, sometimes 
restricting consumers to amounts well below what they're entitled.

Credit this mess to methamphetamine addicts who figured out that meth 
could be made with just about any pseudoephedrine-containing product. 
And it was about as easy as taking a trip to the local Rite-Aid: Just 
stockpile a pseudoephedrine-powered product like Sudafed, add a few 
more ingredients, and presto -- the home chemist has just concocted 
the nation's most addictive street drug.

But that was before Congress passed the Combat Methamphetamine 
Epidemic Act of 2005 -- part of the Patriot Act -- and President 
George Bush signed it into law in March 2006. Now sales of cold 
medicines that contain pseudoephedrine, ephedrine or 
phenylpropanolamine are strictly regulated and sold only from behind 
pharmacy counters, while over-the-counter versions -- ranging from 
Actifed to Zyrtec-D -- have been reformulated using phenylephrine, a 
substance that cannot be extracted and converted to meth.

For what it's worth, the Combat Methamphetamine Epidemic Act seems to 
be working. Quest Diagnostics, a drug screening firm, recorded a 31 
percent decrease in treatment for meth addiction in the first six 
months of 2006. And Casey McEnry from the San Francisco office of the 
Drug Enforcement Administration adds that most of the methamphetamine 
seen in the Bay Area is coming from Mexico rather than being made locally.

So that's all well and good. But as for the new cold medicines? Those 
don't seem to be working so well.

"I got a cold and asked my husband to bring home some Sudafed. He 
unsuspectingly picked up some Sudafed PE," says Michele Rabkin of 
Berkeley. "It didn't work at all. I don't mind showing my ID, but 
that faux Sudafed is a joke."

Dr. Simon Lee, an internist and assistant clinical professor of 
medicine at University of California, San Francisco, says consumers 
are not just imagining things.

"Phenylephrine is a similar type of drug to pseudoephedrine, but it's 
not as effective. It's less potent," says Lee, adding that it doesn't 
help to take higher doses of the drug in hopes that it will work better.

The one saving grace in this pharmaceutical debacle, though, is that 
pseudoephedrine is still available for purchase without a 
prescription. Followed to the letter, the anti-meth bill requires all 
pseudoephedrine to be sold from behind a pharmacy counter, with sales 
limited to 3.6 grams per adult per day, and 9 grams per adult per 
month (the limit is 7.5 grams per month if purchased from a 
mail-order pharmacy).

A 9-gram quantity of pseudoephedrine equals about 360 individual 
30-milligram tablets, but varies slightly depending on a cold 
medication's particular ingredients. One dose for adults and children 
age 12 and older is typically two 30-milligram tablets every four to 
six hours, not to exceed four doses (eight tablets) in 24 hours.

But here, the plot thickens: Pharmacies are implementing the law differently.

Wilson-Ripsom found that out when she tried to get 
pseudoephedrine-containing products when both she and her son were 
sick. Rather than explain to her the number of grams she could 
legally purchase, a Longs pharmacy in Oakland said she could only buy 
one box per day, regardless if she was buying a box of children's 
formula that clearly came in under the 3.6 gram daily limit, and a 
total of two boxes per month.

That wasn't a problem for the colds she and her son suffered. But it 
was going to pose a big problem for her husband, Troy, who suffers 
from chronic congestion and requires two Sudafed a day to breathe properly.

"Not one of the pharmacy staff I've encountered when buying 
pseudoephedrine products has ever mentioned a gram limit, but rather, 
an item limit," says Wilson-Ripsom, who found that Wal-Mart in San 
Leandro allowed her to buy two boxes in one visit, while the one in 
Oakland would only allow one. "In December, when I did buy two 
bottles of Pediacare on two different days for my son so I was 
stocked up for the next cold, when I tried to buy a box of Sudafed 
for me, they told me I'd already purchased my two for the month."

When a newspaper staffer bought some Sudafed with pseudoephedrine 
from a Kaiser pharmacy clerk, the clerk did attempt to explain the 
allotment in grams using a printed excerpt of the law, but seemed 
confused by it. Kaiser also has purchasers sign a log book that 
notifies them that entering false statements or misrepresentations 
may subject the purchaser to a maximum fine of $250,000 and a term of 
imprisonment of five years.

Lee, the doctor at UCSF, says the different protocols at different 
pharmacies are confusing consumers. Not only should consumers be told 
about the legal limit they can buy in grams, but also that amounts 
purchased for minors should not count against an adult's allotment.

He blames the confusion in part on the way the news about the new law 
was disseminated.

"I don't think many people know about the new law or the restrictions 
on the quantity they can purchase," Lee says. "The government should 
have announced it on national TVs or in newspapers, so more people 
would be aware."

But that won't help visitors to Longs Drugs. A call to the company's 
Walnut Creek headquarters revealed the drugstores' "one box per day, 
two boxes per month" rule is based on an internal information 
technology glitch that wasn't really noticed by the public until this 
last round of colds and flu swept through the state.

"Our IT people were already aware and working on improving our POS 
(point of sale) terms to count the grams of pseudoephedrine rather 
than our ultra-conservative approach of packages of products with 
pseudoephedrine," says Longs public relations spokesperson Farra 
Levin. "This should occur in the next couple of months or so."

In the meantime, Wilson-Ripsom has found her own solution.

"I started ordering from Canada," she says. "I truly feel like a 
criminal, because in order to ensure that I have enough in the house 
for me, I have to resort to ordering online -- and hoping that my 
order doesn't get confiscated."
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MAP posted-by: Beth Wehrman