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Physician supports pseudoephedrine by prescription

Posted on Monday, September 2, 2013 at 2:21 pm



The methamphetamine problem is pervasive and ruinous to individuals, families and our communities. As a physician, I fully support the efforts of the Fayetteville, Winchester and Manchester city councils to make decongestants such as pseudoephedrine available by prescription only. To be an effective change, however, the policy needs to be statewide; better yet, nationwide.

Methamphetamine (aka meth) is manufactured from pseudoephedrine in over-the-counter cold virus remedies. It is easy to make meth with these precursors. It is very difficult to make meth without these precursors. Making the precursors unavailable is a good strategy to control production.

In 20 years as a family and sleep medicine physician in this community, I can remember very few instances in which I recommended a decongestant. I know that they can do far more harm than good. Decongestants work by constricting blood vessels everywhere in your body, thus driving your blood pressure up. At the same time, they make the heart more susceptible to arrhythmias and heart attacks. Decongestants do “dry up” your nasal passages, but may dry secretions to the point that mucous becomes trapped in the sinuses that can no longer drain properly. This stagnant mucous eventually grows germs and causes sinus infections. Therefore, decongestants can increase one’s risk for sinusitis.

Decongestants are drugs which stimulate the brain and cause insomnia, robbing people of their necessary restorative sleep. Decongestants can cause the muscles in the prostate to contract, causing obstruction of the urinary flow, increasing risk of urinary tract infection.

People can become addicted to decongestants. Decongestant nasal sprays temporarily constrict the nasal passage’s blood vessels, but this is followed by a rebound dilation which makes the congestion even worse. Thus, the victim is consigned to a never-ending cycle of decongestant use. The Latin term for this is rhinitis medicamentosa.

And decongestant medicines serve as the raw material to manufacture methamphetamines, a substance that is ripping our social fabric apart in many, if not all, of our communities. Making these drugs more unavailable is a step in the right direction. I have never thought decongestants should be available “over the counter.” They can certainly be dangerous. I urge my colleagues to avoid prescribing them, and never prescribe them for prolonged periods. Some argue that local control of pseudroephedrine would be ineffective because so much meth comes from Mexico. That argument is just wrong. Importation of these substances is illegal and against federal law. Decongestants are much easier to obtain locally because they are legal, easily obtainable and cheap.

We must do all we can as a community to limit the raw material distribution. I use “community” in the broadest sense, and I call on our Tennessee and United States representatives to enact effective laws to hinder the manufacture of methamphetamine. Fayetteville, Winchester and Manchester are off to a good start.