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NEWS ROUNDUP: Janice Hopkins Tanne Methamphetamine epidemic hits middle America BMJ 2006; 332: 382-b [Full text]

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Phenylephrine an ineffective replacement for pseudoephedrine in response to the methamphetamine problem in the USA

Ronald Eccles   (22 May 2006)

Phenylephrine an ineffective replacement for pseudoephedrine in response to the methamphetamine problem in the USA 22 May 2006
Ronald Eccles, Professor and Director Common Cold Centre, Cardiff University, Cardiff CF10 3US Send response to journal: Re: Phenylephrine an ineffective replacement for pseudoephedrine in response to the methamphetamine problem in the USA	Pseudoephedrine is currently being replaced by phenylephrine as the active ingredient in most oral decongestant medicines in the USA. This move by the pharmaceutical industry is in response to legislation that will be effective from September 30th 2006. The ‘Combat Methamphetamine Epidemic Act of 2005 has been incorporated into the ‘Patriot Act’ signed by President Bush on March 9th 2006. The act bans over-the-counter (OTC) sales of colds medicines that contain pseudoephedrine. Sale of pseudoephedrine will be limited to ‘behind the counter’ and individuals will be required to present a photo identification to purchase any products that contain pseudoephedrine. The amount that an individual can purchase each month is limited and the buyer will be required to provide personal information about purchases in a log which will be kept by the seller for at least two years. These draconian and restrictive measures have been brought in to force to curb what is described as an ‘epidemic’ of methamphetamine abuse in the USA[1] , with claims that up to half a million Americans use methamphetamine every week [2]. The loser in this war against methamphetamine abuse will be the American public as it is doubtful if the legal restrictions on the sale of pseudoephedrine to the public will reduce the availability of methamphetamine, as there is little evidence that medicines containing pseudoephedrine are used by large scale producers[3]. The American public will be deprived of access to an effective nasal decongestant pseudoephedrine as pharmaceutical companies switch to an ineffective decongestant phenylephrine as the only alternative available open to them. There is little if any clinical support for the efficacy of phenylephrine as a nasal decongestant[4] and since the medicine is subject to gut wall metabolism its absorption is erratic [5]. In contrast the efficacy of pseudoephedrine as a nasal decongestant is much stronger and its absorption from the gut is uncomplicated [6]. It is to be hoped that the UK regulatory authorities do not follow the US example and restrict the sale of pseudoephedrine as it is the larger scale illicit laboratories that need to be targeted rather than the public sale of pseudoephedrine [3]. [1] Tanne JH. Methamphetamine epidemic hits middle America. BMJ. 2006;332(7538):382. [2] Roehr B. Half a million Americans use methamphetamine every week. BMJ. 2005;331(7515):476. [3] Cunningham JK, Liu LM. Impacts of federal ephedrine and pseudoephedrine regulations on methamphetamine-related hospital admissions. Addiction. 2003 SEP;98(9):1229-37. [4] Eccles R. Nasal airflow and decongestants. In: Naclerio RM, Durham SR, Mygind N, eds. Rhinitis Mechanisms and management. New York: Marcel Dekker 1999:291-312. [5] Kanfer I, Dowse R, Vuma V. Pharmacokinetics of oral decongestants. Pharmacotherapy. 1993;6:116S-28S. [6] Eccles R, Jawad MS, Jawad SS, Angello JT, Druce HM. Efficacy and safety of single and multiple doses of pseudoephedrine in the treatment of nasal congestion associated with common cold. Am J Rhinol. 2005 Jan-Feb;19(1): 25-31. Competing interests: Act as an occasional consultant to pharmaceutical companies but am not involved in any current consultancy work on nasal decongestants