We Need A More Controlled Administration, Thanks
It's a big enough pain in the ass to get the drugs you legitimately need now -- without the administration worrying that somebody might be having a little addictive fun on painkillers, and taking steps to meddle in yet another area. More on that below.
As probably a lot of you know, I take Ritalin, and thank goodness I now have a prescribing doctor who gets me: who gets that I am not selling it on playgrounds but taking it so I can write -- and gives me an ample supply so I don't have to kill a writing day every month to come get more.
The point is to make me productive, yet the last shrink I had wanted to make me come in once a month to see him. Not that he had word one to say to me (in a psychologically helpful sense).
At the prescribing psychiatry appointments, they don't really talk to you about anything -- they just ask you these really stupid standard questions (for prescription of controlled substances), like, "Do you want to fly a plane into the White House?" (The guy I saw before the last shrink used to ask me that, which I thought was hilarious in its specificity, and a dipshit question, because you have to be a pretty dim crazy person to answer in the affirmative.) He knew it was a crazy question, too, because he always rushed through it and almost didn't wait for my answer, but rules are rules are rules.
About the latest in government meddling, Barry Meier and Abby Goodnough write in The New York Times that the administration will seek legislation requiring doctors to undergo training before being permitted to prescribe painkillers like OxyContin:
Proponents of the training argue that it would help doctors better identify patients who would benefit from treatment with long-acting narcotics, and help them unmask patients feigning pain to get drugs they then abuse. Opponents say a training requirement will reduce the number of doctors prescribing pain drugs and hamper patient care.
That's probably what it's about -- reducing the number of drugs prescribing these. Already patients in extreme and prolonged pain have a hard time getting them, which is really sick. Sullum at reason has written about a number of these cases:
Last May a Kentucky physician reported that a former patient, a paraplegic with severe chronic pain, had killed himself. The man's new doctor, alarmed by official warnings about the prescription painkiller OxyContin, had drastically reduced his dose, leaving him in agony.Stinginess with pain medication is not a new phenomenon. For decades pain experts have complained that many doctors are so worried about getting into trouble with state regulators or the Drug Enforcement Administration that they err on the side of letting patients suffer.
This government meddling is precisely the bullshit that prevents me from feeling secure about using my doctor as a doctor, lest I get identified as some sort of druggie, and not just a girl who wants to get her brain to sit down at the computer and pay attention. This guy I have now is pretty great, but he's the third doctor I've had in not a lot of years, and if he goes, I'm worried about having it on my chart that I'm taking something in an off-label way.
I'm thinking that because I was taking Mucinex this past week for a cold and found that pseudoephedrine (in this 12-hour release form) was fantastic for my ADHD. While Ritalin (Methylin or Methylphenidate generic) help me focus, the 120 mg. of pseudoephedrine in the Mucinex-D (combined with guaifenesin, 1200 mg.) gave me really even all-day concentration.
I need to find out if there are longterm side-effects for using pseudoephedrine (for a healthy person like me with a healthy heart), and whether I can find a 12-hour release form of it that doesn't have this other stuff in it (I'm worried I might damage my sinuses or something with longterm use of guaifenesin). I haven't done the research on it yet in any substantive way.
P.S. If anybody here is a researcher who knows anything about ephedrine and/or pseudoephedrine or knows of a solid meta-analysis on them, please let me know. I love that I'm trying to get medical advice from my blog commenters (I mean, you're a smart lot, and I love that about you, but this is a little ridiculous). Thanks, govern-nanny!
How on earth did you purchase pseudoephedrine (in any form) in California without opening a DEA file on yourself.
The last time I went to a pharmacy to purchase real Sudafed (pseudoephedrine hydrochloride), I had to fill out forms and show my driver's license.
And, what's worse, they didn't have the little red 4-hour pills that actually work, they only had the 12-hour pills.
The government removed pseudoephedrine drugs from the shelves because pseudoephedrine hcl, once boiled down, is the basic ingredient in homemade meth.
That may be why the pseudoephedrine is having that effect on you.
By the way, guaifenesin is an expectorant. It's used to loosen phlegm. Basic Robitussin - the one without cough suppressants - is guaifenesin.
Conan the Grammarian at April 20, 2011 9:05 AM
Ever increasing restrictions on drug prescriptions are one of the subtle pernicious effects of the war on drugs; the mentality of regulators that anything that anyone might possibly use to get high needs to be as restricted as possible.
The problem is that these restrictions make it hard for people who legitimately need these medications to get them, and some of them simply give up. I gave up trying to get medication for my insomnia – the hurdles were too annoying. I know Ambien works, or Xanax, but the doctor insisted on a path that involved trying OTC sleep aids (which don't work), and then taking a class about insomnia (which I don't need and don't have time for), and then finally he might prescribe it. I was worried that if I kept on insisting I needed it, I might get tagged as a drug seeker, with complications for all further medical treatments, life insurance, etc. So I just quit asking. I'm currently in a great deal of pain because of muscle spasms in my back, but I can't simply call and request a prescription, I need to go in and see the doctor to get muscle relaxants, wasting precious hours of my work day. Because again, they might have some minor psychotropic effects.
But at least I can't get high! Right? It's not as though illegal drugs and black market prescription drugs are relatively easy to come by...
Christopher at April 20, 2011 9:15 AM
Amy Alkon
http://www.advicegoddess.com/archives/2011/04/20/we_need_a_more.html#comment-2060871">comment from Conan the GrammarianIt's in 12-hour Mucinex-D, Conan.
What I'm wondering is whether taking this on a daily basis would have a negative effect on me longterm -- with or without guaifenesin. Daily phlegm loosening a problem? Pseudoephedrine a problem? I'd only need about a pack a month -- 24 in a pack. I could buy two packs at once...assuming there aren't longterm neg effects.
Amy Alkon at April 20, 2011 9:18 AM
All in all, Amy Alkon has topped herself with this post, which manages to convince readers both that drugs should be tightly controlled and totally unregulated.
The thought that someone is determining what psycho-active drugs they should take based on daily whims is a bit scary.
On the other hand, why should the government keep any of us away from drugs that we think improve our moods or mental abilities?
It is a bit offputting that no one has tried placeboes on Amy Alkon, but then she is not a rat in a maze, although the analogy may be fitting.
BOTU at April 20, 2011 9:22 AM
You can get just sudafed (which is just pseudoephedrine)in a 12 hour pill. It also comes in a 24 hour pill. Behind the pharmacy counter, of course. Long term issues, I don't know. I know it can temporarily raise BP but that shouldn't be a worry for you.
momof4 at April 20, 2011 9:37 AM
With long term allergy issues, I used to love Sudafed - but it doesn't mix well with a high BP. I used to take it occasionally when my sinuses were really bad, but the side effects - racing heart rate, high BP, sweats - convinced me that it wasn't a good idea. This wasn't even regular usage, every few weeks or so at most.
There's a reasonable case for GP screening of those who need to take it. It's actually seriously dangerous for me. Then again paracetamol is too for anyone if you overdose, and that's over-the-counter as well. Who knows what the answer is.
Stinginess on pain medication, on the other hand, given the well-known increasing tolerance chronic pain sufferers have and the minimal side effects, is just stupid.
Ltw at April 20, 2011 10:04 AM
Oh, and the nightmares. Don't remind me about the Sudafed nightmares!
Ltw at April 20, 2011 10:06 AM
The reported adverse effects of pseudoephedrine seem to be mainly cardiovascular in nature, so try searching Google Scholar under "pseudoephedrine cardiovascular" & "pseudoephedrine cardiomyopathy".
Martin at April 20, 2011 10:07 AM
Not really trying to distract from the discussion about the over-regulation of drugs, but have any of your doctors suggested Strattera to you? It's a non-stimulant medicine for ADHD.
My boys took it for a few years after it came out (they do ok without, now, so I don't want to force it on them, even though it would probably help), and they seemed to do pretty well on it, except that my youngest said it bothered his stomach.
Before that, though, we were going back to the doctor every month for a prescription for the other drug they were taking, and I REALLY hated having to pay the doctor just so I could go pay again to get the medicine.
WayneB at April 20, 2011 10:11 AM
@ltw: My husband can't take Sudafed for the same reasons. It gets me through the allergy season and I have a rush of annoyed libertarian impulses every time I have to provide driver's license number, home address, etc. to get it.
Not sure why Amy would not just take Sudafed instead of Mucinex. It's the pseudoephedrine you want I presume.
Astra at April 20, 2011 10:29 AM
I can't take anything like Sudafed- it amps me up like a crackhead. When I was a teenager I hallucinated like crazy the one time I took a Contact cold medicine.
Eric at April 20, 2011 10:39 AM
Amy Alkon
http://www.advicegoddess.com/archives/2011/04/20/we_need_a_more.html#comment-2061312">comment from AstraDoes Sudafed have the same drug, same mg (does anyone know offhand)? Also, extended release is important. I just discovered this about Mucinex. And for ADHD people, stimulants focus us rather than amping.
Amy Alkon at April 20, 2011 10:46 AM
Original Sudafed (still available in Canada) contained 120 mg of pseudoephedrine in a 12-hour time release capsule. In the States, over-the-counter Sudafed now substitutes phenylephrine (which is less effective) thanks to meth hysteria. You'll have to go through the whole show-us-your-papers thing if you want the original stuff.
Martin at April 20, 2011 11:23 AM
@ Amy
I knew that! One of my sisters is ADHD. My mom used to say that she knew the one was really ADHD when she'd give her a Mountain Dew, and rather than go crazy on the sugar and caffeine, she'd get really focused. Eventually she did get on ritalin, which helped much more, without all the sugar.
Jazzhands at April 20, 2011 11:32 AM
Amy Alkon
http://www.advicegoddess.com/archives/2011/04/20/we_need_a_more.html#comment-2061604">comment from MartinWow, thanks, Martin. Maybe I can have Gregg go over to Windsor to get some when he's there. I might have some old Sudafed here. Wish I'd known - could've gotten some in France, I'm sure. I can get all sorts of things without a prescription there. They infantilize you economically, but in the pharmacy, you're a grownup.
Amy Alkon at April 20, 2011 11:44 AM
http://www.nytimes.com/2011/04/20/us/20drugs.html
Lisa Simeone at April 20, 2011 11:45 AM
How'd they sneak that by the nanny state?
Now all the tweakers are going to be buying up the Mucinex-D.
The little red 4-hour Sudafed pill remains the best thing for clearing your sinuses during allergy season. But, the government has decreed that because a bunch of meth producers bought the stuff in bulk, I can no longer buy a box of it when I need it.
Conan the Grammarian at April 20, 2011 12:52 PM
I stopped buying any OTC medications at Target because they want to swipe my license to buy Ny-Quil. Uh, excuse me, I'm obviously well over 21, if I wanted alcohol I'd just buy it. I don't have an issued with them carding me to verify my age, but I draw the line at them swiping my license. I don't buy video games there anymore for the same reason. I did have to have my driver's license number recorded to fill a prescription for phenabarbital for my dog. That was weird, but I was willing to make that concession so he could get the medication he needs. But can you imagine someone taking their pet to the vet and claiming they were having seizures just for a Pb prescription? Although I suppose if you're desperate enough...
sara at April 20, 2011 2:05 PM
Amy Alkon
http://www.advicegoddess.com/archives/2011/04/20/we_need_a_more.html#comment-2062141">comment from saraHmm...I just went looking in my medicine cabinet for Sudafed (I think I have a few of the pills but no box), and I found a box of Pseudoephedrie 60 mg. tablets -- 50 of them -- that say "relieves nasal and sinus congestion due to colds and allergies." I think Gregg bought it for me last year when I was sick. 50 tablets to a pack. Generic - made by "Contract Pharmacal Corp, Hauppage, NY" CPCHealth.com
But, I wonder whether they're "time-release" like the Mucinex, and what that means, exactly...some kind of suspension that dissolves in your stomach over a period of hours? Or is it BS?
Amy Alkon at April 20, 2011 2:17 PM
If you put a soluble drug inside some insoluble plastic perforated with tiny holes, the good stuff will ooze out over a period of time. Here's a quick time-release primer:
http://en.wikipedia.org/wiki/Time_release_technology
If your pack of pills doesn't have some sort of indication that they're time-release/extended-release, they probably aren't.
Martin at April 20, 2011 3:12 PM
Thanks, Martin -- and everybody. You are all a wealth of information!
Amy Alkon at April 20, 2011 3:19 PM
Amy, I'm leaving for Paris this weekend for a week. I'll see what I can purchase OTC there. I just had to jump hoops to get ambien, which I like to have when I travel. And this stuff is advertised extensively on TV; Lunesta, too. But just try to get it without an inquisition.
Also, I had breast reduction surgery last year, and discovered the nice effects of pain-pills...but it's so mild and harmless.
Is there anything I can pick up for you there and send it to you from here when I return in May? I love French pharamacies.
Also, I remember a post you had about a shop where one could get very nice bras in Paris. Can you remind what it's called and where it is?
Ally at April 20, 2011 4:05 PM
My youngest daughter is ADHD and ODD. She has gone through molestation and the child abuse that public schools do. She has a high IQ and I love her to death. She's my ...shhhhh.... favorite.
Strattera works wonders.
Ariel at April 20, 2011 4:19 PM
I've used the "twelve hour" pseudoephedrine for years. One of my family members has used the four-hour dose on a daily basis for over a decade.
I've only ever had good effects, but I have a lower than average heart rate and blood pressure.
I can only take 1 Concerta every three days, even at the lowest dose - but I can take the pseudoephedrine every day just fine. The twelve-hour dose lasts about 10 hours for me.
The blister packet reads "pseudoephedrine hydrochloride extended release tablets 120 mg. Manufactured by Perrigo Allegan, MI 49010."
Here's a recent article on what the restraints on the sale of pseudoephedrine have done to the meth market:
http://www.creators.com/opinion/debra-saunders/the-war-on-users-of-cold-allergy-drugs.html
Michelle at April 20, 2011 5:27 PM
Amy, I used to take Sudafed all the time for sinus congestion. I probably popped one or two a day for several years. (Wheat elimination cured me of the need for the stuff, but that's neither here nor there.) As far as I can tell, I didn't suffer any side effects. Maybe your fan Dr. Eades knows a pharmacologist or otolaryngologist who can tell you for certain about any side effects of long-term use. As you probably know, though, any drug-company-funded studies that showed side effects are sitting in a file drawer, or the side effects split into so many categories that none has many entries in it, or sufferers were removed from the study.
Nevertheless, if you wish to proceed, try CanadaPharmacy.com for your Sudafed.
Lori at April 20, 2011 6:25 PM
Stattera might as well be suagr pills. I take Adderall as well, but oddly, I don't much like Sudafed. My Dr. Knows thestory, and thus, I don't have to appear so often.
I wish the state of CA would ease up about eyeglass Rxs.
KateC at April 20, 2011 9:01 PM
Amy Alkon
http://www.advicegoddess.com/archives/2011/04/20/we_need_a_more.html#comment-2062753">comment from AllyAlly, regarding bras, for girls with big'uns, Empreinte is the absolute best. The best place to buy them is either Le Bon Marché in the 6th Arrondissement or Galeries Lafayette (Haussman). Go at a time when it is not crowded, during the day. Unfortunately, they only have sales, really, in France, in Jan/Feb and around June/July. State-run thing. But, sometimes there's some promotion. Still, these bras are of such high quality that they last far longer and work far better than cheaper bras you'll get.
Amy Alkon at April 20, 2011 11:46 PM
Pseudoephedrine? Miss Alkon, I'd have to say it wouldn't be my first choice, though of course I can't speak to your circumstances. I remember using Tylenol Sinus, which contained pseudoephedrine, years ago; it cleared up the sinus headache and put me into a good mood. But my blood pressure does run a little high, and after an atrial fibrillation put me in the hospital for a couple days, my doc told me to avoid taking sinus decongestants. At the risk of sounding patronizing, I'd be kind of leery about taking them for any reason beyond their intended purpose.
Old RPM Daddy at April 21, 2011 10:19 AM
Amy Alkon
http://www.advicegoddess.com/archives/2011/04/20/we_need_a_more.html#comment-2063624">comment from Old RPM DaddyActually, you shouldn't be advising me to take or not take medicine based on your own health information. I have a healthy heart and blood pressure and take speed -- prescribed speed, Ritalin -- daily.
I realize you mean well, but advising me based on your own situation and body makes no sense.
The reason I like pseudoephedrine, by the way, is because it SLOW ME DOWN. Speed works differently on people with ADD/ADHD. If I take too much and drink too much coffee, I get too speedy, but I realized that I needed to get my Ritalin prescription upped when I couldn't concentrate unless I laced my pot of morning coffee with the equivalent of three espressos (from a stovetop espresso maker). I now take 15 mg. about twice daily and another 10 at the end of the day, if needed. I'm going to try writing on 30 mg. pseudoephedrine today and see if it increases my focus. The cold meds had 120 extended release. I might have to take more doses if this doesn't extend or work that well in a smaller dose.
Amy Alkon at April 21, 2011 10:36 AM
Just left this question on the website of the company that makes Mucinex -- after buying it last night at Kaiser and finding that they've diminished the dose:
I'm writing about Mucinex and notice that the dosage in a standard pack has changed (from 120 mg to 60 mg). I want to know if this is due to worries by the Feds about people who'd use the ingredients for illegal drug manufacture. Was there pressure by the FDA to take the dosage down from 120 mg to 60 mg? Rather disgusting if they did pressure you. Also, can you tell me about off-label usage of the product for ADD/ADHD? Are there known side-effects, for people who already use stimulants by prescription, for longterm use of pseudoephedrine and guaifenesin? I had a friend pull some studies for me and there doesn't seem to be, but I'd like your researchers' take on this. Thanks, -Amy Alkon
Amy Alkon at April 24, 2011 12:50 PM
Guafenesin is a mucus thinner orignally from an herbal source, no long-term side effects or drug interactions. Especially good to help loosen chest congestion. Won't hurt you to take it every day long-term.
Psuedoephedrine is a nasal/sinus decongestant originally from an herbal source. May cause heart palpatations (fast, irregular, fluttery beats) that stop when you stop taking it. May raise blood pressure a bit, only important if pressure is actually already high. Also increases pressure inside the eye, but not enought to cause a problem unless you already have glaucoma. May cause trouble breathing if you haave asthma or COPD.
I have high BP and asthma and take both these meds every day for sinus problems and chest congetion under my doctors' care (along with BP and asthma meds). I see them every three months.
My only caution would be, try to find plain psuedoephedrine; best to spare your body from any drug you don't specifically need, even a rather harmless one like guafenesin.
Jennifer at September 6, 2012 1:35 PM
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