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January 29, 2006

War on Sniffles roundup

Grits for Breakfast has a good roundup of commentary on the the War on Sniffles--the legislation to put pseudoephedrine-containing cold meds behind the counter in the hopes of deterring would-be meth cooks.

I'm not surprised that the new rules didn't reduce the supply of meth on the street. I just took it as a given that if you cut off one source of meth, another would take its place. However, I was willing to go along with the War on Sniffles because it seemed that any policy that curbed home cooking was a form of harm reduction. Home meth labs endanger not only the DIY chemist, but everyone around her. I'd much rather see people buying from professionals (even professional gangsters).

Unfortunately, overdoses are up because the new Mexican meth is a lot purer than the homecooked equivalent. I suspect that this is a temporary uptick. Users aren't stupid. If professionally produced meth becomes the norm, people learn to titrate their doses.

I don't like the idea of sequestering cold medicine behind the counter. Allergy sufferers don't deserve to be treated like criminals for the sake of social engineering. However, if there is solid evidence that the WOS generates a sustained reduction in home cooking and associated injuries, I will grudgingly acknowledge the legitimacy of the policy.

That said, I'm not sure the WOS will even accomplish that much over the long term. People who want to cook their own will find ways around the problem and go back to their old habits. If these rules stay in place long enough, new black markets in pseudoephedrine will probably spring up. Criminals will get organized about heisting or diverting pseudoephedrine to sell to the home cooks. If they manage to supply black market precursors cheaper than the pharmacies did, we'll be worse off than we started.

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I would be extremely surprised if putting the meds behind the counter had any serious long-term effect on homecooking levels. That said, I'm completely unpersuaded by the "treating people like criminals" argument. Anyone whose dignity is deeply insulted by having to ask for cold medicine needs to just buck the fuck up and deal with it. It's no more treating people like criminals than giving people drivers' tests is treating them like reckless endangerers - or requiring prescriptions for prescription pain meds is treating people like criminals.

Hey I have an idea! We could decriminalize drugs! Now why didn't I think of that before?

I'm still curious to hear people's pilot plans for legal or decriminalized recreational meth. The problems presented are a good deal more complicated than just boinking it with the legalization wand.

Lindsay--

I'm with Eli in saying that the "treating people like criminals" rhetoric is overblown. My mother has to get prescriptions to stay alive, and she doesn't whine about it.

The "war on sniffles" label is just dishonest. Obviously, the target is meth, not decongestants. It would be like calling the ban on heroin "the war on cough medicine."

I fill prescriptions on a regular basis, too. That's not being treated like a criminal. That's just completing the transaction: Doctor authorizes controlled substance for patient, pharmacist verifies prescription and fills it. There's no presumption that anyone is doing anything wrong.

I even feel okay about having to ask the pharmacist for the high-grade iron supplements, which aren't even a controlled substances. It has to do with the reason for the rule. There's no patient-centered rationale for putting the pseudoephedrine behind the counter. It's not like the iron supplements which are behind the counter because someone decided that it would be a good idea to make patients talk to a pharmacist before purchasing supplements that have potentially serious side effects. Arguably, having to ask for those every time is being treated like a child, but not like a criminal.

But the only reason to keep pseudoephedrine behind the counter is because someone might be tempted to do something illegal with it. It's not because of side effects that the pharmacist needs to talk to you about. It's because the authorities want to keep an eye on people who are buying pseudoephedrine.

If a policy has very large public health benefits, then I think it's sometimes justifiable to "treat people like criminals."--e.g., airport security, 24-hour waiting periods to buy guns, etc. I just don't think the War on Sniffles meets that standard.

Well, you seem wedded to your "war on sniffles" rhetoric, perhaps because saying "I just don't think the War on Child Abuse meets the standard" would sound overly cold. Here's what the state of Arizona has to say about the risks that drug labs pose to children:

http://www.azag.gov/DEC/HowEndangesChildren.html

http://www.azag.gov/DEC/

http://www.azag.gov/DEC/AnnualReport2004.pdf

Given the risks to public safety, it's not very surprising that states with liberal Democrat governments like Arizona and Oregon are taking the lead on this issue.

If the legislation really deters home cooking over the long term, I have no objection to keeping the cold meds behind the counter. I'm just worried that we'll end up creating a meta-black market in pseudoephedrine with nothing to show for it.

Lindsay - what about putting cigarettes behind the counter? There's no legal-smoker-centered rationale for that. If I wanted to buy cigarettes right now, I'd have to go and ask for them and show the clerk my ID, and the only reason for that is that they're worrited I might be a minor looking to buy them illegally, or that I might steal them if I could.

The "very large public health benefits" standard seems excessive when the only harm is this vague dignity offense that only even arises when one knows the explicit policy rationale for putting the product behind the counter. Is that a very large public cost? It doesn't seem like it. It also seems like a very avoidable public cost, since the only thing anyone has to do to not experience the injury is just be remotely reasonable about the situation and understand there's no personal accusation involved. So if the cost is both low (momentary offense for the easily offended) and easily avoidable (maybe a self esteem workshop?), why would you need a very large public health benefit to justify the policy?

Sorry to chime in again, but I just saw that you posted a response while I was typing.

Aren't those two different arguments? The black market argument seems correct to me, and doesn't require any kind of "treating people like criminals" inquiry at all.

When I complain about laws that treat innocent people like criminals, I'm objecting to a several different things: inconvenience, coercion, unfairness, and social stigmatization.

In the case of cold meds, it's a hassle to have to ask for the medication. It's a relatively small inconvenience if you just have to ask the clerk, as for cigarettes. It's a slightly bigger hassle if you have to stand in line at the pharmacy to buy your cold meds before you pay for the rest of your groceries at the general checkout. The inconvenience escalates if the pharmacy stops carrying the medication because they don't want the hassle. (Grits for Breakfast links to bloggers whose local stores have already dropped brands in response to the law.)

Of course all this is coercive. Sometimes coercion is justified, but it's still something we should avoid if we can.

The unfairness is that we're shifting the burden of drug control onto a small subset of sick people who, through no fault of their own, happen to need a medication that can also be used to make crank. These people may justifiably wonder why they are being asked to put up with this inconvenience for the greater good. They may justifiably ask why they are being treated like criminals when they haven't done anything wrong. These burdens aren't literally punishments, of course, but the inequity remains. They are still losing some freedom in exchange for some alleged social good.

Social stigmatization is what comes to mind first when we complain that people are being treated like criminals. Morally, it's probably the least important of all the drawbacks of this policy. However, it's still irritating and somewhat degrading to be treated with suspicion. One reason why cigarettes are behind the counter is to stigmatize and inconvenience smokers. Society has decided to make it just a little harder to buy cigarettes in order to discourage smoking, even amongst those who are legally entitled to do so. Condoms used to be exclusively available from behind the counter for the same reason.

Being able to buy cold meds off the shelf isn't a fundamental human right. There's nothing in the Constitution that prohibits treating innocent people like criminals in a purely social or metaphorical metaphorical sense. So, if there's some important social good at stake, it might be acceptable to do so. However, it has to be a pretty big benefit to offset the unfairness of making a small group of innocent sick people shoulder the burden of the policy.

Is anyone asking where the Mexican drug makers are getting their supplies of pseudoephedrine?

And as always, trying to just cut off the supply of a desired substance is never going to be very effective if there isn't also a concerted effort to fight the addiction, both with rehab and prevention.

Actually it is as simple as finding a source for ephedra to cook your own meth with greater purity (probably how the Mexicanos do it) and simplicity. One need only do several washes, I don't recall what with to achieve relatively pure ehedrine, knock off a hydrogen molecule to achieve amphetimine and with a little ourification you have meth. It is still a nasty process but the end result would be a lot cleaner. I imagine that it would be challenging to get large quantities of ephedra in this country but it wopuldn't be impossible. A friend of mine with allergies still gets it from an Asian herbalist in small quantities every week.

Decriminalising it (and most illicit drugs) makes a hell of a lot more sense to me. Sure there are many factors that would need to be addressed before decrim would be feasible but the tax benifits alone (not including the savings from a forshortened war on drugs) make it an attractive idea. Lessening the burden on our prison system, law enforcement and health care system would be a massive bonus. Focusing on honest education about the dangers of using various drugs instead of scare tactics and strict enforcement of legal age limits would allow for a drastic reduction in teen (and younger) drug use.

Is anyone asking where the Mexican drug makers are getting their supplies of pseudoephedrine?

They don't use it. They use either mini thins or generic pharma produced ehedrine. Some likely use ehpedra instead, it is native to central Asia but it can likely be cultivated in mountainous regions of south and central America.

That said I have mixed feelings about going to the pharmacist for pseudoephedrine. I happen to be way over sensitive to it so I don't use it but the libertarian part of me gets pissy about such legislation. On the flip side I have seen what the home labs do to people - worse, children in those homes. A couple at my church adopted twins who spent the first 1.5 years of their lives in a meth lab, I work in the childrens department and while they are doing much better now they have serious life long problems due to the exposure.

Well this discussion is all well and good, but is it ethical for Pfizer to call pseudoephedrine-free medication "Sudafed"? Shouldn't it be "Does Not Contain Sudafed"?

I'm not sure about the meth overdoses that you mention, but there has long been much uninformed or disingenuous notice of "drug overdoses," by stupid police, stupid pundits, lying police, lying pundits, etc. Television programs and movies are key offenders.

Most common, and most resilient, has been the many-decades-long fiction about heroin "overdoses" due to "excessive purity."

In fact, this is and always has been largely nonsense. Users most often "overdose" and/or die because of the impurity of the cut, not so the purity of the heroin.

(The heroin overdose scene in Pulp Fiction, while immensely entertaining, was totally ludicrous: one sniff, and she's dying? Well, that was just a farce, although lots of naive people probably found it plausible.)

When a heroin user dies almost instantly, and the lungs fill with fluid, that is generally caused by quinine, but not by heroin.

All manner of vile things can be put into the cuts of recreational drugs, and very often are. Most of the drug "overdoses" are caused by the cuts, not by the ostensible drug that the users think they are taking.

My guess is that is also the case with many meth "overdoses."

Of course, people could "just say no."

But that doesn't happen in the real world.

A final note about uninformed drug reporting regards the persistent idiocy of those who refer to cocaine, meth, various hallucinogens and even marijuana as "narcotics."

Whatever they are, they are not narcotics, and have nothing in common with narcotics.


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