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The Uselessness of Phenylephrine (2022)

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Re: The Uselessness of Phenylephrine (2022)

#201

Post by tptacek »

cyberax wrote: post #75
jimmaswell wrote: post #60

Earlier quoted context omitted.

And now we've got a fentanyl epidemic filling the void and even more power handed to Mexican cartels since meth got harder to produce domestically. Drugs continue to win the war on drugs.

Meth is not harder to produce. It's now mass-produced from P2P, with chiral purification using various methods (like pulling one enantiomer with tartaric acid).

Yes. But now it's produced in para-industrial labs, mostly in other countries, rather than in apartments and back yards, where those ad hoc labs were actually real public safety problems.

Re: The Uselessness of Phenylephrine (2022)

#202

Post by tptacek »

lazide wrote: post #159
tptacek wrote: post #71

Earlier quoted context omitted.

Right, but this particular database presumably doesn't have anything especially sensitive in it, apart from your Sudafed consumption. I don't mean to dismiss that point, it's a valid point, I'm just considering it closely.

Sudafed usage, probably a copy of the drivers license, your address, any phone number you give them, and how often you buy a drug the DEA considers a precursor to something really terrible. Usually no one even looks at it (so why have it even?!?), but when they do it’s a potential intro to a full on Brazil situation. Luckily the whole thing is generally considered a waste of time, so usually nothing comes of it. But…

Well, it seems pretty obvious why they have it: so they can match purchases of Sudafed at different retail outlets at different points in time. And it's obvious why they want to do that: because there really was a huge epidemic of people making straw purchases of Sudafed to feed large numbers of low-volume amateur meth labs.

In the years after this policy was put into place, there were news stories about how effective it had been in eliminating backyard meth production. You don't see those stories anymore. I suggest, with weak confidence, that the reason you don't isn't that backyard meth has roared back, but rather that it's so decisively not a part of the equation anymore that stats about it don't really matter. Meth comes from overseas now, not from backyards.

That doesn't solve the meth consumption problem, but it does eliminate one significant meth externality.

Re: The Uselessness of Phenylephrine (2022)

#203

Post by lazide »

tptacek wrote: post #198
lazide wrote: post #156

Earlier quoted context omitted.

[flagged]

Respectfully, I don't believe you. This is another one of those cases where the Bayesian Base Rate Fallacy suggests that the "scary" version of this supposed DEA policy, where they pursue marginal cases of people with extra-stuffy noses, can't possibly work.

https://www.justice.gov/archive/ndic/pubs36/36407/36407p.pdf

Legit extra-stuffy-noses? Sure. But that isn't a Brazil type situation. A Brazil type situation is where you get mistakenly caught in the gears of a no-win bureaucracy just trying to survive.

Not a super high risk IMO, but definitely not ZERO risk. The DEA hasn't always been known to give the benefit of the doubt, or ask questions before shooting.

Re: The Uselessness of Phenylephrine (2022)

#204

Post by tptacek »

lazide wrote: post #203
tptacek wrote: post #198

Earlier quoted context omitted.

Respectfully, I don't believe you. This is another one of those cases where the Bayesian Base Rate Fallacy suggests that the "scary" version of this supposed DEA policy, where they pursue marginal cases of people with extra-stuffy noses, can't possibly work.

https://www.justice.gov/archive/ndic/pubs36/36407/36407p.pdf Legit extra-stuffy-noses? Sure. But that isn't a Brazil type situation. A Brazil type situation is where you get mistakenly caught in the gears of a no-win bureaucracy just trying to survive. Not a super high risk IMO, but definitely not ZERO risk. The DEA hasn't always been known to give the benefit of the doubt, or ask questions before shooting.

None of this supports the argument you made? It's just a DOJ report talking about the smurfing-to-lab pipeline, which was obviously very real, until we made it annoying enough to get Sudafed that smurfing became irrelevant and production shifted offshore.

No, this is an instance where I won't hedge, because I think my cards in this hand are strong enough: the risk of what you said earlier, of DEA getting bored and looking for marginal cases of Sudafed acquisitions in the logs to trigger enforcement work, is zero. Absent some important other high-signal source to correlate with, that tactic is mathematically guaranteed not to work.

Re: The Uselessness of Phenylephrine (2022)

#205

Post by lazide »

tptacek wrote: post #202
lazide wrote: post #159

Earlier quoted context omitted.

Sudafed usage, probably a copy of the drivers license, your address, any phone number you give them, and how often you buy a drug the DEA considers a precursor to something really terrible. Usually no one even looks at it (so why have it even?!?), but when they do it’s a potential intro to a full on Brazil situation. Luckily the whole thing is generally considered a waste of time, so usually nothing comes of it. But…

Well, it seems pretty obvious why they have it: so they can match purchases of Sudafed at different retail outlets at different points in time. And it's obvious why they want to do that: because there really was a huge epidemic of people making straw purchases of Sudafed to feed large numbers of low-volume amateur meth labs. In the years after this policy was put into place, there were news stories about how effectiv…

I love how we're still stuck not being able to buy Sudafed normally though. :(

Re: The Uselessness of Phenylephrine (2022)

#206

Post by wrs »

From the referenced paper:

“Other examples of scientifically proven ineffective OTC medications include guaifenesin as an expectorant, dextromethorphan as a cough suppressant, and chlorpheniramine for cold symptoms.”

Re: The Uselessness of Phenylephrine (2022)

#207

Post by lazide »

tptacek wrote: post #204
lazide wrote: post #203

Earlier quoted context omitted.

https://www.justice.gov/archive/ndic/pubs36/36407/36407p.pdf Legit extra-stuffy-noses? Sure. But that isn't a Brazil type situation. A Brazil type situation is where you get mistakenly caught in the gears of a no-win bureaucracy just trying to survive. Not a super high risk IMO, but definitely not ZERO risk. The DEA hasn't always been known to give the benefit of the doubt, or ask questions before shooting.

None of this supports the argument you made? It's just a DOJ report talking about the smurfing-to-lab pipeline, which was obviously very real, until we made it annoying enough to get Sudafed that smurfing became irrelevant and production shifted offshore. No, this is an instance where I won't hedge, because I think my cards in this hand are strong enough: the risk of what you said earlier, of DEA getting bored and lo…

Dude, that report was written AFTER the laws which required it to be moved behind the counter, people to take IDs, etc. 2 years after.

Smurfing was the response to that.

They used those databases to identify it and target folks. That's the whole point.

Re: The Uselessness of Phenylephrine (2022)

#208

Post by tptacek »

lazide wrote: post #205
tptacek wrote: post #202

Earlier quoted context omitted.

Well, it seems pretty obvious why they have it: so they can match purchases of Sudafed at different retail outlets at different points in time. And it's obvious why they want to do that: because there really was a huge epidemic of people making straw purchases of Sudafed to feed large numbers of low-volume amateur meth labs. In the years after this policy was put into place, there were news stories about how effectiv…

I love how we're still stuck not being able to buy Sudafed normally though. :(

You mean, by walking into the drug store and asking for it?

Re: The Uselessness of Phenylephrine (2022)

#209

Post by joe5150 »

cyberax wrote: post #80
kstrauser wrote: post #42

Earlier quoted context omitted.

That's legitimate. The FDA's issue with oral phenylephrine is that it's metabolized in the gut before it gets to the sites where you want it to work.

I wonder if it will work as a suppository.

Phenylephrine is a popular topical and suppository treatment for hemorrhoids.

Re: The Uselessness of Phenylephrine (2022)

#210

Post by wrs »

rscho wrote: post #108
orangepurple wrote: post #67

Earlier quoted context omitted.

The Dutch take this to the extreme, where the actually effective anti-cough medication dextromethorphan is completely unavailable, but complete bullshit herbal mixes which claim to help are a dime a dozen on every store shelf. I can't even imagine the amount of needless suffering people with chronic cough go through in the Netherlands.

The effectiveness of dextrometorphan is... underwhelming in most people. But you are correct that no effective cough suppressant is available OTC in Europe.

Dextromethorphan is one of the other “scientifically proven ineffective” OTC products mentioned by the authors.

Once when I had a quite severe cough I did some (highly motivated) research and my conclusion was that there is no such thing as an effective cough suppressant. At least, none that isn’t also a consciousness suppressant.

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