I've certainly found it useless, and when I need a decongestant I make certain I'm getting actual pseudoephedrine. The 12 and 24 hour slow-release versions are fantastic. I've never done a proper blind trial on myself, but I feel quite certain that I could tell the difference.
I suppose people must be buying it, and given how strong placebo effects are in general I guess it's doing something for them.
Same, Sudafed is a silver bullet for me. The 12 hour release absolutely works to clear my sinuses and relieves the sinus pressure headache (almost completely when combined with ibuprofen).
My wife insists Phenylephrine works for her and thats all she will take. She has offered it to me a couple times when we didn’t have any Sudafed and Phenylephrine had 0 noticeable effects for me.
Edit: I forgot to add that Alavert-D 12 also has Pseudoephedrine and works for me too and is what I take when my congestion is allergy related.
Keep in mind this doesn't say that it's not effective. It's just not more so than the placebo effect, which is quite real even on physiological matters.
from pseudoephedrine. You can just oxidize PE with potassium permanganate and purify the product... No need to risk blowing yourself up the way you would making methamphetamine.
The Wikipedia article they link to [0] has a pretty long list of brandnames. Many of them are the "-D" version of whatever the thing is. Claritin-D, Zyrtec-D and so on. I think the version without the "-D" doesn't have Pseudoephedrine?
In those cases, Claritin and Zyrtec are allergy medicines. The -D indicates that this allergy medicine comes along with a decongestant. The version without the -D will just be the allergy medicine.
Specifically, drugs with -D indicate that they come with pseudoephedrine. In the US, they (like the non-PE version of Sudafed) are only available behind the pharmacy counter.
It is sold over the counter in most US pharmacies under the Vicks inhaler brand. The active ingredient label conveniently uses a spelling that most people will not recognize which is probably effective in preventing alarm from customers who aren't familiar with the dramatic difference in the effects of the two enantiomers.
I didn't say I wasn't interested in the [headline] I said it wasn't news to me. It's a topic I find interesting, and as it turns out, by an author I already enjoy.
The article was not informative [to me], but it was fun reading. Since it was not informative to me (as I deduced correctly from the headline) I could have easily read the comments and not the article.
The problem with this advice (which gets posted to all of his articles) is those posts aren't meant to all be read at once. They're basically all the same thing, which is why he hasn't written any new ones recently.
My assumption has always been: people know pseudoephedrine works, so that's what they want to buy, but you can no longer sell pseudoephedrine over the counter. However, you can offer phenylephrine, which still lets you reasonably name the drug "Sudafed PE" or whatever. Customer browses the shelves, sees "PE" in the drug name, this triggers a vague impression that it contains pseudoephedrine and thus will actually work well.
The lack of availability of proper pseudoephedrine in USA led to situation where there are papers describing how to turn methamphetamine into pseudoephedrine, not the other way around.
With explanation in abstract that its easier to buy meth than pseudoephedrine.
"While N-methylamphetamine itself is a powerful
decongestant, it is less desirable in a medical setting because
of its severe side effects and addictive properties... Other side
effects may include violent urges or, similarly, the urge to be
successful in business or finance."
> With explanation in abstract that its easier to buy meth than pseudoephedrine.
People may laugh at this, as they should since it is an absurd situation, but this isn't entirely wrong.
Neither my wife or I drive and during the pandemic she gave up her license after getting an appointment at the DOL was difficult. Both of us carry US passport cards as our ID.
This has resulted in several situations where we've been turned down for purchasing restricted items like alcohol or drugs containing pseudoephedrine, particularly the latter, because a passport card can't be scanned by the usual point of sale systems. There are a couple of places in Seattle that are happy to accept a passport card but even at them it's sometimes been dependent on who is working the counter that day.
> she gave up her license after getting an appointment at the DOL was difficult.
I'm not sure what DOL is a reference to; however I now many individuals struggled to get appointments at the Secretary of State (SoS) and that is also where one (at least where I live) would need to get a non-motorist ID. Same amount of frustration / time spent to get a non-motorist ID as it would be to renew your driver license.
In Illinois, it's the Secretary of State's Driver Services office. In Texas, it's the Department of Public Safety, and your plates may be in one building/location and your driver's license/state ID in another part of town.
Maybe the most honest state is Missouri, where plates, stickers for them, and your driver's license are all handled by the state's Department of Revenue.
But why get one? A passport/passport card is a _better_ ID document in almost every way. State non-motorist IDs should really cease to exist and we should increase access to passport cards
Except for the way of not being scannable at point of purchase machines that was clearly stated. So if the one point qualifying for "almost every way" is hitting right out of the gate, then it doesn't seem to be that viable of an option.
Don't they presumably have a US alien ID (Green Card or otherwise) and/or a foreign passport? What other documents could they use to establish identity to be able to get a State ID?
My wife is foreign-born, but was in the US as a non-resident when our hearts turned proximity into much more. Since she was already here the whole application process took place in the US. It was just under two years from when we married until she had a green card. (And note that there is also a delay from being granted a green card to actually having one in one's possession.)
Foreign passport and non-driver's ID were her only options--and passports are a nuisance to carry around and a PITA if lost/stolen.
(And, yes, I think that just under two years bit was not by chance. They were definitely looking for signs of fraud and I'm sure they finally approved it just before the point where they would have had to issue a permanent one rather than a conditional one.)
>Don't they presumably have a US alien ID (Green Card or otherwise) and/or a foreign passport
There are millions of visa-holders who live in the US but don't have green cards. Carrying around a foreign passport for everyday identification is an absolutely terrible idea because of the risk of theft or loss. Losing a visa-containing foreign passport can necessitate getting an emergency travel document from your foreign-country consulate, traveling back to your home country, getting a new passport, getting an appointment at the US embassy in your home country, getting a new visa issued in your new passport, then finally traveling back to the US. The whole process could take weeks or months and cost thousands of dollars.
We are aware of these. The reason is: Because unless you get the "enhanced" version, due to the ridiculous REAL ID situation you have to have another card anyway. For me in particular, where I work operates a medical clinic in a facility owned by the federal government so a non-enhanced card doesn't get me in the door, but a passport card does.
For my wife, it's because she has even less tolerance for paperwork than I do and it's easier to just go to the pharmacies we know have their heads bolted on straight than it is to gather up all of the stuff and go to the overworked and harried DOL.
Would that not still require an in-person visit that they've already stated was not possible? I'd assume the state would require a new photo for a new ID at the least to make an in-person visit required. Probably need new fingerpritns as well (if that's something WA does).
Not really sure what you're on about here. There's a time and place where bending the rules is possible. Attempting to get a government issued ID and not following the basic rules of showing up in person is not really one of them in my book.
Many Americans have difficulty obtaining ID, because they cannot afford or cannot obtain the underlying documents that are a prerequisite to obtaining government-issued photo ID card.
Underlying documents required to obtain ID cost money, a significant expense for lower-income Americans. The combined cost of document fees, travel expenses and waiting time are estimated to range from $75 to $175.
The travel required is often a major burden on people with disabilities, the elderly, or those in rural areas without access to a car or public transportation. In Texas, some people in rural areas must travel approximately 170 miles to reach the nearest ID office.
Scraping together the required documentation for proving her address was problematic. I set up the utilities, I'm the one that deals with them, they're just in my name. She doesn't like dealing with that sort of stuff and at the time most of it was done her English (she learned her first word of English at 43) would have added needless complexity.
Even the property records are problematic on that--we put our house into an estate-planning trust. The correct titling of the property has the trust and then both of our names--but the system only *displays* two lines. Thus it shows the trust and then my name, hers gets omitted.
The county in California where I was born charges $32 for a birth certificate. Most (all?) of the proof of address documents also require you to spend money. If you already have multiple utility bills in your name it's NBD, but if you live with someone it could be a pain in the ass.
Then a DL itself is another $40. A non-driving ID is like $30, although there's discounts depending on age and income.
I ran into a guy online that couldn't obtain an ID, period. The only form of ID he had was a driver's license. His doctor pulled it (legitimately, but needlessly--there was no question he was incapable of driving) leaving him with nothing. Where he lives that left one option--get a birth certificate. The application must be signed--something he's no longer capable of doing. The only other route would be to show up in person at the right office--multiple states away, a trip that would be medically ill-advised.
Note that he's educated and not poor, this is purely a problem of the system not handling the oddball cases. That state needs to be clobbered with a clue-by-4, if you pull a driver's license you should issue the person a non-driver's ID!
We have also run into a problem. When my wife was naturalized a hyphen got inserted in her name on her naturalization certificate, it wasn't noticed at the time. Almost everything is in her name as intended but social security saw the hyphen and would not relent. Even after we legally changed her name to rid it of the hyphen they were digging in their heels on changing the records. At this point we *think* the Real ID stuff is going to work, but the virus interfered. For the occasional place that won't accept her expired ID we use her passport card. (She doesn't drive, there's no issue of driving on an expired license.)
As someone who moved to Seattle during the pandemic, I knew when you mentioned getting an appointment with the DOL that it was probably WA. I had to go out to Wenatchee (2 hour drive each way) to get my license because everywhere else was booked.
Gotta chime in on this.
Seattle (in general a great place) has some pretty horrible things re: purchasing alcohol. Idiot/mis-placed store/bar-workers who only want a state ID. My U.S. passport=NO. My U.N. passport=NO.
Freakin' weird.
Edit: I worked at Boeing for eight years, very often in a sec/reserved area. My passport was good there. Buying booze down the street from [Boeing] plant 2, no.
I wouldn't blame a regular store clerk for not knowing what a UN Lassiez-Passier is, especially since it doesn't have the word "passport" in the name. But a passport, especially one from their own country, definitely ought to be recognized.
Weird. Even during covid when I was wearing a mask, I never got ID checked at a store in WA. It seems much laxer here than in other states I've lived in.
Seared into my head is my experience of trying to buy alcohol in Boston back in 2009, when I was in town for a wedding. I had just turned 21 so buying alcohol was still novel and exciting. I had multiple bars and liquor stores refuse my valid Illinois license, forcing me to hand alcohol to my father to purchase, and find shady bars that wouldn’t card me. It was extremely frustrating to have to rely on such tactics despite being legally allowed to purchase alcohol.
When I lived in downtown Seattle in 2010 I had no problems using a passport to buy alcohol. (Unfortunately, routinely carrying around my passport resulted in me losing it, and replacing a lost passport is a giant pain in the ass)
A divers license or state issue ID (much easier to get if you get it before you surrender/expire you DL) is just a defacto standard in the US.
The people who check IDs for medications and alcohol are trained to check DL cards, not passports. It's not surprising that using an ID different from 99.9% of other people causes issues. Although my friend who was a student from Germany never had any issues...
Yeah, many years ago my wife had a fair problem at a bank because the teller didn't like being presented with a passport. "Just bring your driver's license!" Hey, you've already seen and rejected her non-driver's ID (at the time the non-driver IDs didn't have expiration dates and the bank wouldn't take any ID without an expiration date) and here you can't have both a driver's license and a non-driver's ID. It took getting a manager involved.
Now, had this happened a few years earlier before she was naturalized.... While her passport did have the standard English labels it was mostly written in bird tracks.
You don't just ask the pharmacist for it. You have to produce an acceptable form of identification that can be used to record the transaction in the universal database. It's unavailable to anyone who doesn't have one of those.
He’s definitely wrong. Sometime last year I had a cold and I know pseudoephedrine helps me.
I ran out and wanted to buy some at the local cvs. Now, I’m not a US citizen but I’ve been here a few years already and am a permanent resident. I do not have a US state ID or a US driving license, and in my many years it has _never_ been a problem. Everyone was always happy with my green card as my ID - bars, domestic flights, international flights back to USA, bank account openings etc. But not for purchasing pseudoephedrine at CVS…
I literally stood there with my green card and my European passport and was begging the cvs clerk to sell it to me, but the told me it’s impossible, system doesn’t accept those IDs (and they tried, even showed me their computer screen). And so I had to leave empty handed and with a runny nose, and came back later with an American friend to buy it…
Around here, you pick up a card from the shelf with a picture of the product you want, then wait in line for the pharmacist. Then they say "Sorry, we're out of that one, what else do you want", "I don't know, what do you have", "sigh... here's what we have left...".
Then you show your drivers license and the pharmacist records it and you pay and finally walk out with your sudafed. If you want to buy several boxes because it's allergy season, well too bad, you can't buy 2 boxes today, you have to come back tomorrow for the second one.
It's actually easier to buy as a prescription, then the Dr can write you a prescription for any amount you need/want.
Which means it's not available outside of the pharmacist counter's more-limited hours. And there's often an additional line to wait in before acquiring. And, as another thread points out, extra ID requirements.
So how exactly do the costs/benefits on this "public policy" sum out?
Benefits:
• some grandstanding politicians enjoy the superficial appearance of being "tough on meth"
Costs:
• Americans waste $billions on an ineffective placebo decongestant
• Legitimate manufacturers of a working medicine, pseudoephedrine hcl, lose sales due to extra cost/effort/stigma associated with the purchase. They shift real productive resources – inputs & worker hours – to making & marketing placebos instead.
• Larger cross-border criminal organizations – of the kind that regularly murder politicians south-of-the-border – grow in market-share, sophistication, & power.
• Meth continues to be available at high volume, & low costs, unaffected by the pseudoephedrine limits.
If we don't listen to 'grad students having a laugh' who are pointing out the wasteful absurdities of 'public policy', we'll keep such nonsense destructive rules indefinitely.
The 'serious folks' among politicians & suited 'public-policy' types are derelict in their duties.
> Larger cross-border criminal organizations – of the kind that regularly murder politicians south-of-the-border – grow in market-share, sophistication, & power.
Are you suggesting my neighborhood friendly drug dealer could hook me up with some real sudafed? Might be nicer than trying to get it from the pharmacy when I need it.
Not sure if you're joking, but he's suggesting that if bulk pseudoephedrine were still available, cartel meth wouldn't have 99% of the market like it does today.
Because yeah, your neighborhood dealer would make his own meth and would probably have lots of Sudafed.
In my state, I'm able to walk down the road to a 24/7 chain pharmacy and buy pseudoephedrine whenever I want. The pharmacy, in combination with the state, uses ID to regulate how much an individual may purchase over some time frame(s).
Most doctors will just write you a prescription and you can get it delivered to your home. Super easy.
Same here. But I think the edge cases are worth listening to as well. Green card residents, for instance. Sudafed is kind of a lifesaver for me at times and I feel fortunate to be able to buy it relatively easily.
My state attempted to make pseudoephedrine require a prescription. One of the state lawmakers that was opposed was a doctor and he cited studies where phenylephrine was less effective than placebo. I wrote to my representative, who called me after voting for the bill to tell me that some sheriff told him phenylephrine is equally effective.
Every time you buy the stuff from the pharmacist, they're logging the purchase in a national DB and you're signing an acknowledgement that it's a huge felony to go beyond the limit. But they never tell you where you are vs the limit, and the limits aren't clearly stated. End result: chilling effect.
My mom timed her purchases incorrectly (family of 5 with mom shopping for all at the time) and went past the limit. After that she was flagged and had to have an actual doctor's prescription in order to purchase pseudoephedrine for 6-12 months. That is a HUGE hurdle for most people, and doctors don't want to see people who have cold symptoms. Heck, I was turned away from a CVS Minute Clinic recently because I had COVID like symptoms in the last 7 days. As in refused to see me, even though I had recently tested negative for COVID and had a fever + persistent cough.
Good to see your representative was getting his information on the effectiveness of medicine from a cop and ignoring the doctor. Emblematic of modern America.
“I asked a cop about how effective an OTC medicine is” is an absolutely insane thing for anyone to say, let alone a legislator. Sadly it does not seem like such behavior receives the social opprobrium it deserves.
It would be interesting to see if there were any reliable stats on how many, if any, people were caught by the ID check laws trying to manufacture from pseudoephedrine, because even at the height of the meth panic that engendered the laws something like 95% of pseudoephedrine outside of a handful of high-risk areas was very obviously not being used for any illegal purposes.
I doubt it caught people. That wasn't the purpose. Rather, it deterred them from buying up a bunch of it and thus got rid of the meth labs. And I think that's a good thing--while I am solidly on the side of drug legalization I don't want amateurs making hazmat sites all over the place.
I don't about anywhere else but the only thing you have to do is walk up to the pharmacist and show an ID. I couldn't care less. I'm buying like a couple of weeks worth. I've had the same process in two different states, and not sure why it's a big deal? We can't have nice things because meth cooks were coming with shopping bags and stealing it all.
The US would elect a baby-eating space alien from Tau Ceti VI as president if Zbleqq'takkx's primary platform plank was "make it so you can buy real Sudafed without a lot of hassle and faff."
Yeah, US voters do seem to like electing presidents for things only Congress has the power to do. Of course, presidents also like proposing things they can't do.
Presidents' main differences are on foreign policy which is the one thing nobody asks them about.
Phenylepherine has excellent "not being easily convertible into meth" properties, if only it had actual decongestant properties to go along with them...
It's not super effective on me either, except for triggering crippling anxiety, but remember that we are outliers, and it's a very effective medication for most folks.
I wonder how difficult it would be to get the restrictions on pseudoephedrine rolled back now that it appears unlikely they're accomplishing their original goal of limiting the methamphetamine supply. Concern (legitimate and otherwise) over ability to breathe is a popular topic in politics lately.
Every time she's mentioned, there's something to make me dislike Feinstein more than I already did. It does seem likely her strong opposition would be a high bar to clear, though as the oldest current senator, she may not be a factor for a long time.
This means that either your calibration mechanism for 'wrong side' is flawed, or the system is rigged in a way that it consistently produces bad outcomes.
Speaking for myself, am shocked and outraged that red senators and other congresscritters are consistently on the wrong side of seemingly everything, yet they keep getting elected. Of course, my political calibration mechanisms are quite in tune.
Feinstein is weirdly not aligned with the left or the tech industry given where she's from. Her strong anti-drug and anti-encryption stances are easy examples.
If I had to pick a single organizing principle to describe her positions it would be a bureaucratic sort of authoritarianism (as distinguished from the strongman authoritarianism of someone like Donald Trump).
I do believe the system is rigged in a way that consistently produces bad outcomes. The US Senate is structured to reward voters for keeping incumbents in office, and plurality voting virtually guarantees two dominant parties.
Feinstein's hard authoritarian and surveillance state preferences haven't endeared her to many people who are also shocked and outraged by the usual collection of utterly repugnant red senators, so option B there.
> the system is rigged in a way that it consistently produces bad outcomes.
Yes. That one.
"Real" change (ie, still a useless liberal democracy, but at least a bit more in service to the people) would start with voter reform and getting rid of FPTP entirely.
You wouldn't like the results of either of those if you like "extreme" positions.
- The most popular replacement for FPTP (which is biased away from centrism) is RCV (which is biased towards it).
- FPTP does turn it into a two-party system, but US parties are weak. They don't control who joins them, who gets elected, or how anyone votes. In the UK you can actually get fired from the party for voting wrong.
I don't care about "extreme" positions in the context of liberal democracies. I can confidently say that there are great improvements we can make within them while also supporting abolishing them entirely. I like to be at least somewhat pragmatic.
RCV/STV is absolutely an improvement on FPTP in almost every way.
As far as strong vs weak parties, that seems to be an issue with the UK. FPTP and weak-parties are separate sets. You could have FPTP with closed party membership, or RCV/STV with weak parties.
> the system is rigged in a way that it consistently produces bad outcomes.
The system doesn't have to be rigged to produce bad outcomes. Most outcomes are bad, so only a system which is nearly perfect has any hope of producing good outcomes.
For a long time, I've had the idea in the back of my mind that all laws should have expiration dates, and the maximum duration shouldn't be very long (12 or 18 years would be two or three senate terms in the US). Ideally, it would be combined with something to keep the scope of each bill narrow.
It wouldn't work because what would happen would be a mass reapproval of all regulations.
What I'd like to see is a constitutional amendment that the total body of federal laws and regulations can't be any longer or more complicated than a person of average intelligence can be taught in a week.
> It wouldn't work because what would happen would be a mass reapproval of all regulations.
Sunset provisions are an idea I tentatively like until I consider what happens with the fucking stupid, pointless "debt ceiling" crap Congress has decided to make themselves do. I imagine how fun it'd be watching months of idiotic brinksmanship over keeping murder illegal, because one group of legislators wants to grand-stand about abortion. Then repeat for practically everything else.
I used to think a limit on the total size of the law like that would be a good idea, but some areas of regulation are inherently complex. I still hold a related position: an adult of reasonable intelligence should be able to easily learn all the laws that they're likely to encounter, and learn which fields are subject to detailed regulation.
To give an example, the regulations governing design of commercial aircraft can almost certainly be simplified from their current state without killing people, but probably cannot be simplified to the point that someone who isn't already an expert on aircraft design can learn them in a week without killing people. Knowing that field is subject to special rules is enough to avoid accidentally violating the regulations.
Currently there's no limit to the complexity that governments can inflict on us. Since there's no garbage collection process for laws/regulations, we wind up with an enormous body of legislation and regulation which almost nobody understands or adheres to. It's terrible for the rule of law.
Sunset provisions are popular actually. Jimmy Carter put that idea on his platform in '76, and it was carried out to some extent, and his own state was the example that sold people on it. I sense that they have waned since.
I believe there are restrictions on the breadth of laws but they are not honored very effectively.
That's actually evidence they're good, since nobody's built a country with so many successful industries and no regulation. They wouldn't be able to solve the coordination problems.
Pessimistic me says not likely. Once these regulations are put in place, it is nearly impossible to get them removed. It takes a literal act of Congress. Now you have to spend useless energy against attacks of "soft on crime/drug abuse/etc" types of nonsense for suggesting removing an item from the list. Don't bother resorting to facts. Those are useless in the emotional knee jerk reactions that will ensue.
Pseudoephedrine restrictions were recently was rolled back in Oregon, where you had to have a prescription to get it. Now we're able to buy it over the counter with ID. So it can happen!
It's happening slowly. Oregon had pushed it all the way to requiring a prescription to get pseudoephedrine. It does still require a visit to the store pharmacy and showing your ID to prove you are an adult, but at least you can buy it without a prescription now. I think only a couple states ever went that far. But at least it is a step back in the right direction.
The ID check isn't for age verification. Federal law requires IDs to be recorded* to enforce restrictions on the maximum quantity that an individual is permitted to purchase per month.
* Edit: Where the word "recorded" appears, this comment previously said "scanned and submitted to a central database". While most states use a central database, the comment reply below pointed out that this goes beyond the minimum that federal law requires.
I am not aware of a centralized federal database. My understanding is that federal regulations stipulate that the pharmacy must see photo ID and take note of who bought the pseudoephedrine, when, how much, and keep that information logged either on paper or electronically. To be available to law enforcement on request.
The Oregon law does have a central database requirement, however I believe this is in all cases a decision made by each state individually.
You are correct, I was conflating two separate steps of the process. Federal law only requires keeping records and these could technically be done on paper. In practice, more than two thirds of the states participate in a central electronic database called the National Precursor Log Exchange.
It probably still makes it a lot more difficult to make meth in a "homelab", as alternative synthesis paths are probably a lot harder. So they're leaving it to the "clandestine pros", ironically ;).
Also, in legislation, it seems like making things illegal passes several orders of magnitudes more easily, than anything that gives normal citizens more rights.
The restrictions the state places on us largely function as a one way ratchet, alas. There is a lot about American drug policy that is wildly unpopular, and yet here we are.
A huge portion of the issue is that we’re largely ruled by people who don’t need to deal with any of the inconveniences they cause; if any senator or rep has a runny nose I’m sure they can get an aide to sort it out for them. The rest of us are not so lucky.
Citation? Dextromethorphan works very well for me. (Also DXM is a recreational drug which is why it's always sold OTC with either Tylenol in it or as an extended-release formula)
In the vast majority of cases for my family, Dextromethorphan is a miracle drug. We're in the middle of cold and allergy season here, and my kids (and I) stop coughing within 5-10 minutes of taking an appropriate dose.
Once every 3-4 years I'll get a cough so bad that DXM won't fix, and when that happens my doc gives me a prescription for a codeine based cough syrup that fixes it (and renders me useless as a human being).
Mucinex (Guaifenesin) fixed all my illness cough problems. It makes your mucus thinner and produces more of it to make your coughs "more productive" which means you finally get that junk out of your throat. Eliminates tickly throat coughs and also is useful in pretty much all situations that involve coughing. It's a genuine magic bullet for me, where no cough suppressant has ever worked, through my entire 30ish year existence.
Tylenol (acetaminophen) does nothing for me. Advil (ibuprofen) does usually work. I used to get more headaches when I was younger, but I rarely get them now. Two things that have changed that might be related: I no longer use CRT screens, and I no longer drink diet soda (used to drink 4-6 cans a day, most days).
Aside from headaches, Advil does better on other aches and pains than Tylenol, which does almost nothing. And it's better for the liver.
better for the liver, worse for the stomach. It's a sliding scale, you have to decide how much you care about whatever hurts not hurting anymore versus damage to organs you can't even see.
Also i used to get wicked headaches from diet soda when i was younger, too. Is it possible to be "slightly" Phenylketonuric? I had to google the spelling, and it's interesting that "hyperactivity and behavioral issues" is listed as one of the symptoms. I doubt "slightly" is possible, that was tongue-in-cheek.
Also as an aside, for pain that the standard dose of ibuprofen doesn't seem to help, emergency medicine studies have found that an additional standard dose of acetaminophen alongside the ibuprofen has greater pain reduction efficacy than vicodin.
There is a significant amount of evidence supporting the efficacy of NSAIDs. Note that they are more effective for some types of pain than others, due to the mechanism by which they work.
NSAIDs and Tylenol definitely work differently on different people and on different types of pain ime. The stronger ones, like Torodol, can be very effective on even quite serious pain, but you can't even get it _with_ a prescription anymore in the USA.
This. Derek has missed that spray is rather effective. Also other agents, such as oxymetazoline is used. They all have a rebound effect, so their use should be limited to 7 days at most.
Also, this is mostly for comfort. There is no really reason to go back to pseudo-effedrive and risk side-effect (high-blood pressure etc.). Also people value their comfort a lot, they are not so good with assessing risks. Apparently that is the reasoning to continue selling phenylephrine because people want to get something even if it is not distinguishable from placebo.
Spoken like someone who has never had severe nasal congestion. A week or two of not being able to sleep, taste, or speak with your normal voice would change your view of the importance of good decongestants.
When i lived in california, this was a yearly ordeal. I also found out that when a bottle says "do not use for more than 4 days" they mean that. I very nearly choked on my tongue because i couldn't move it in my mouth due to the insane dryness, i didn't think it was even possible to accomplish that level of dry.
I discovered "neti pots" because in a bout of panicked rage i snorted nearly an entire can of saline nasal wash, had immediate relief, and went and bought my first plastic neti pot. I never use deionized or whatever water, the chances of toxins in my water is extremely low, and i usually just do it in the shower anyhow, where there's hot water right there. Sodium Bicarb + NaCl just works.
More recently for the sort of dry allergy nasal stuff i started putting mentholated petrolatum jelly directly in and around my nose. I'm sure in 10 years i'll find out that i'll get nostril cancer or something, but whatever, i can breathe, thank you very much.
I totally understand. That is two weeks of discomfort but not medically dangerous to your life. Whereas high blood pressure especially for people who already have elevated blood pressure and don't know it, can damaged your heart with long-term effects on your heart and possibly shorten your life by some non-trivial amount.
I haven't really been able to take pseudoephedrine for a number of years now due to getting heart palpitations with even a small dose. Luckily fluticasone is available without a prescription and I've had success with that.
It is sad that society has gone into such a protectionist stance. In our great grandfathers day you could buy opiums and cocaine you name it. Now everything is so locked up heaven forbid someone abuses drugs. The problem with a useless drug like this is people won’t get the desired effect and start compounding more drugs into their system. Like what I had to do with an abscesses tooth. I don’t abuse drugs, I no longer drink and don’t smoke marijuana I don’t even drink coffee anymore. But when my tooth went bad all I was allowed was Acetaminophen and ibuprofen which didn’t even come close to touching the pain. So I took extra acetaminophen and ibuprofen anyways despite the risks out of desperation. Then I started using copious amounts of oral gel tooth numbing medicine which has benzocaine I believe which can also increase heart rate I believe. I was so desperate for any form of relief while I waited to get to the dentist that I was forced to abuse anything I could get for relief that one narcotic medication would have easily treated. I have often wished I could return unused narcotics I have been given to show the doctors “look I’m returning drugs I don’t have an abuse problem I only use them for pain control please continue being generous with them in the future”.
It's interesting how many younger people in the US aren't even aware that the only useful decongestants are behind the counter. I assume they just think there isn't a useful treatment for the symptoms.
I remember when the over the counter stuff just seemed to stop working. I just assumed that something about my body changed. Took me a year or so to find that the ones behind the counter still worked very well.
I think I'm lucky, in that I don't really need too much help that often. I can only imagine if my sinuses were as bad as they were back in the day, though.
My drug of choice for colds is NyQuil. It's always been great for opening up my nasal passages enough to let me breathe easily and then knocking me the fuck out so I could sleep off most of the cold.
I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo.
Only a couple years later did I make the connection that this was right when they passed the law restricting pseudoephedrine. I got my hands on some NyQuil D and everything was back to normal and I had a functioning cold remedy again.
NyQuil is a combination medicine. The cough, cold and flu formula contains Tylenol (fever/pain reliever), DXM (stops cough) and an antihistamine (dries out your runny nose/postnasal drip).
NyQuil can be a great all-in-one product when it's what you need. It's useful to know what it is composed of and why. All of the medicines in it treat symptoms, not the underlying cause, which will be fought off by your immune system. If you have only one or two symptoms, you can always buy each drug separately - doing so allows you to more precisely control dosage and timing as well.
FYI, two other common symptoms not covered above are sinus congestion - which can be treated with Sudafed - and chest congestion (e.g. a phlegmy cough) - which can be treated with Mucinex.
Prior to the regulation of pseudoephedrine, NyQuil also contained pseudoephedrine and since the nasal congestion from a a virus can often be the most disruptive factor for sleep (at least, in my personal experience, that's the case) it's considered by some to the be most important component.
NyQuil with pseudoephedrine included is now marketed as "NyQuil D" and is available behind many pharmacy counters with the same restrictions as other pseudoephedrine products. However, it could also rightly be called "NyQuil Classic" (to borrow branding from Coca-Cola).
While true, the cocaine is processed out of the leaves themselves and sold to pharmaceutical companies. The remaining leaf product is used in the flavoring.
I’m not sure if it is still legal, but importing “coca tea” - that is, tea bags filled with shredded coca leaves - was legal at some point and a few enterprising folks imported a few kilos of it and processed it into the drug.
It's still legal to buy decocanized coca leaves but I think the odds of getting anything worthwhile out of it would be slim and probably more expensive than a plane ticket to Peru.
Antihistamines do not directly dry up your runny nose/post nasal drip. Rather, they reduce the histamine response, which is helpful when something is caused by allergies. It's usually not that helpful with an actual cold (but allergic rhinitis is often mistaken for a cold).
Sudafed is what the parent was referring to with Pseudophedrine; a decongestant. This works by shrinking blood vessels, causing swollen passageways to open back up. It doesn't actually do anything to reduce the runny nose or post nasal drip, but by opening the passages more can help them drain more efficiently, preventing that feeling of congestion (hence the name).
Guaifenesin (Mucinex being the name brand) is an expectorant; it causes you to generate more mucus, and reduces the viscosity, allowing you to cough/sneeze/etc your mucus/phlegm based congestion out more easily.
Otherwise I totally agree; it is worth understanding what each of these do so you can pick and choose what you need. Nyquil includes DXM (dextromethorphan) to reduce cough severity, but the acetaminophen is not helpful unless you have a fever or headache, and the Doxylamine Succinate and Phenylephrine (both antihistamines; the Doxyl is added to Nyquil because it's also a sleep aid) aren't particularly helpful unless your cold symptoms are actually allergy related.
Better to buy DXM separately usually; fewer side effects, cheaper, and you can pair it with what else will help you (if you need something to help you sleep, you can add Doxyl or Diphenhydramine if you want; YMMV as to how effective they are)
Don't take Guaifenesin before bed (the increased mucus/phlegm production will make it harder to sleep), but it's good during daytime.
A common side effect of Sudafed is trouble sleeping; if you don't have this side effect it can be helpful in reducing congestion while you try and sleep, but if you do have this side effect, obviously, don't take it before bed.
Do any of these compounds actually do what they say? I have always found all cold medicines to be entirely worthless. Supposedly a study found guaifenesin to be no better than a placebo:
So the treatment of symptoms, in general, leads to some really inconsistent results, as it's really hard to measure them. Some studies have definitely found guaifenesin to not be helpful (others have), but the way all of them measure it is...questionable. Ultimately, what a user wants is a subjective experience of "I feel better", but what is being tested for is stuff like "what concentration of inhailed capsaicin leads to them coughing".
So generally my take is "hey, this is what it's been found effective for, and it's generally regarded as safe to take. Is it going to help here, for you, in this situation? Who knows! Give it a whirl if you got the money and want to try".
Guaifenesin is mostly useless and only approved so that they can stick it next to your dextromethorphan as an emetic to stop you from abusing it. I was vomiting from COVID and I was incredibly pissed off when I found out it was actually just because they poisoned my cough syrup on purpose.
Sort of! There isn't consistent evidence that -any- antitussive is more effective than placebo. A majority of studies show a statistically significant result for DXM, but not all, and they aren't fully replicable which definitely calls it into question. But that's true of every purported cough suppressant, and there's understandable reasons for that; coughing is a voluntary response to irritation, so there's definitely a lot going to determine whether you cough or not on beyond a purely autonomous system response. Plus there's not really much clarity in how to measure improvement (reduction in frequency may not actually be a reduction in irritation; reduction in severity is hard to measure. Etc).
So, really, for a given incident, try it, see if it helps. If it does, great, if it doesn't, stop taking it.
NyQuil also contains alcohol and pseudo (in some formulations).
My pet theory is that NyQuil's biggest effect is simply to make you mildly "faded" so all your symptoms are more tolerable. DXM, the antihistamine, the pseudo, and the alcohol are all drugs that would definitely do that if taken in larger doses. While NyQuil doesn't have those larger doses, the combination of all of them may amplify the otherwise weaker effects into a general buzz/haze that helps you go about your day/night.
In Canada you can find cough & cold medications in both the Phenylephrine and Pseudoephedrine formulation, often under near-identical labels (IIRC one can buy "Tylenol Cough and Cold" with either active ingredient, for example - carefully checking the label is the only way to tell). I didn't realize there was a difference until one day after running out of Phenylephrine-based medication I bought the Pseudoephedrine-based one - it was a night and day difference! Now I tell everybody with a cold to check the labels and buy the good stuff.
Interesting case study in being able to sell a low-quality product (one of the most important active ingredients doesn't work!) side-by-side with a much better product and most people won't ever notice that one is better.
In US, same deal, but you have to show your ID at the counter to obtain the pseudophedrine version. Phenylephrine is so useless. Nothing worse than getting to a store after pharmacy hours and being forced to only get the useless garbage.
I believe you're just not supposed to drink alcohol on Pseudoephedrine because you'd be combining an upper with a downer, and it's very easy to go overboard with the downers when you're on an upper (tolerance to alcohol increases dramatically and increases overdose risk along with all the other side effects and risks.)
So a small amount of alcohol won't really have much of an effect, I'd claim.
I don't know about this medication in particular (since I don't live in the US), but I see it contains DXM (dextromethorphan), which is a dissociative (such as ex. ketamine), which probably causes the effects you described. I'm seeing it also contains acetaminophen, which probably makes it hard on your kidneys, if you take too much, so that is probably why people don't abuse it more (I guess or hope).
in the US Robitussin DM is the one you get if you aim for disassociation(?) - NyQuil is explicitly a sleep aid with some other stuff mixed in, I'd have to go dig a bottle out but i think the active ingredient is an anti-histamine (diphenylhydramine i think) - as a sleep aid, mind you. It is true that NyQuil used to have alcohol, and didn't have DXM or acetaminophen. If the liquid you are looking at is Orange, that's the "daytime" stuff, and that's overpriced garbage.
One could buy generic "tussin DM" (or pill form of dextro), mucinex (for guafenasin), and benadryl (or generic diphenylhydramine) to get the same usefulness that a bottle of liquid NyQuil has.
From what I've read, d-amphetamine[0] was the decongestant of choice for much of the 20th century. It's just that the counterculture weirdos were abusing it and that led to its restriction. Compared to pseudoephedrine its way more useful with minimal side effects like drinking a cup of coffee.
That's dangerous to think it's the same as coffee. You can have a daily coffee when pregnant but we don't know about a daily dl-amphetamine. Not even close to the same side-effect profile. Coffee doesn't dilate your eyes, for starters. It's just not the same as a dopaminergic
Well, it's not the only study, it's just an example. I think it was already generally considered safe but doctors were worried it might be passed on through breastfeeding.
Sure but I would not equate with coffee which empirically we know can be well-tolerated by most of the population basically from birth to death.
Adderall (dl mixture) is just not the same. We know Adderall tends to exacerbate acne and some forms of dermatitis but we don't know how much. We don't know if the pupil effects contribute to driving incidents. We don't know if dry mouth from Adderall is worse for dental health than the dry mouth that some people get after heavy espresso or other stimulating substances, like pseudoephedrine. We don't think the risk of paranoid behavior is high but it is higher than coffee, of course.
And of course some not insignificant portion of the population can tolerate coffee or pseudoephedrine, but we're not too sure about Adderall. Schizophrenic, bipolar, OCD individuals, those with tics, tachycardia, etc, need to tread carefully with stimulants, even maybe sudafed.
I mentioned in my last comment that Sudafed had effects in treating my ADHD.
Ultimately I couldn't use it this way more than a few days a week or I'd get lower back pain. I've also tried steeping ephedra tea but did not notice any effects on concentration.
Later on when I was formally diagnosed and prescribed proper meds I was placed on Adderall first and had similar unwanted side effects after a time. Ultimately, I settled on Dexedrine and no more side effects (other than insomnia if I take it too late) and haven't felt a need to up the dose for years now. It does still have decongestant effects like the other two.
Considering I'm caffeine dependent and can't cycle off daily intake without crippling headaches, where I cycle Dexedrine off on the weekends/holidays without any withdrawal effects, I'd have to agree: So long as it's a therapeutic dose it's on-par or safer than coffee.
Didn’t they also drop the alcohol percentage? It’s 10% now (I know this because post Covid I seem to be catching EVERYTHING), I could have sworn it was 14% or higher growing up.
This may be regional, but it's been 10% here for as long as I can recall - although the alcohol free version is much more prevalent than it used to be.
This works for one or two nights with me, and then it feels like I've built up a tolerance to it and I think that it actually keeps me awake. I'll use it if I have a cough which keeps me awake, and, if I time it right, I'm pretty good at recovering within a day or two.
On one hand, we're decriminalizing drugs. Pot is widely legal now. Other states are allowing mushrooms and LSD. Cocaine and heroin are not legal, but have all but been decriminalized on the West Coast.
Meanwhile it's harder than ever to get pain killers from your doctor, even when you have a demonstrated need for them. Same with ephedrine -- a very useful drug -- it's very difficult to get even when in need. And if you mention enjoying tobacco products, you're treated as a leper.
I wish we had a self-consistent view of the issue.
I just finished reading The Urge: Our history of Addiction. If you're interested in some background on how we got here, the author does a great job of laying out the historical, legal, and social constructs that have resulted in the inconsistent mess.
There is probably some truth to this but it is worth noting the opiod epidemic is largely why it's hard to get pain killers now. A few of the pharma companies have settled that they sort of knew people were taking them from pharmacies and selling them on the black market.
In several cities they are now citations. You may get a fine for possession but you will not be arrested. In Portland for example the ticket is around $150, which is about the same as the fee for an expired vehicle registration. This change in policies has basically stopped enforcement. As you can imagine it is not a profitable practice to ticket the unhoused.
It's not inconsistent to treat different things differently and different drugs are radically different in their individual health and societal effects.
I live in Seattle where marijuana is legal. Alcohol and marijuana are widely consumed and I rarely see any large-scale problems from it. Obviously, there are many people who can't handle either of those, but their failure to handle it well seems to not impinge on others as much. And, compared to them, there are a huge number of people able to consume alcohol and marijuana in a safe, healthy, non-problematic way.
I also live next to a couple of homeless encampments. Many of the people living there are clearly addicted to opioids and/or meth. In just this month and within a mile of my house:
* I saw a woman, topless, brandishing an umbrella, wandering between the sidewalk and into the street screaming at no one.
* A man was shot in the stomach in front of a food bank.
* Another man was shot in the neck at an encampment.
* A drive-by shot up an RV and car. (The people inside fortunately weren't hit.)
There's more I'm sure but these are just the ones I know about in the last few weeks.
It's entirely consistent to say that we should treat drugs that lead to the latter behavior differently from drugs that don't. Opioids and meth are incredibly destructive. I'm not saying what specific policies I advocate for them, just that it is reasonable to have different policies for those drugs compared to others.
Essentially by rules a patient asking for higher dosage of an addictive drug is automatically seen as a sign of addiction, even if sometime it might just be that the current dosage is too low.
You don't see anyone who is using opioids in the privacy of their own home who aren't out on the streets, so your sampling is massively biased.
And the way we should look at drug addition with opiates isn't by looking at the homeless users, but consider the fact that we're all potentially one bad car accident away from getting hooked on pain killers, and asking what kind of support we would need to avoid winding up homeless due to that.
Punishment via the criminal justice system is what is likely to wind up with you losing your job and winding up out there in that camp with them. So how should you be treated if it happens to you?
And the glib answer of "put a bullet in my head" or whatever isn't an acceptable response. Treat the problem seriously and propose how society helps you help yourself to get clean without at trip through a homeless camp. And the people who refuse to deal with the reality that it could happen to them or engage with the problem are likely those most at risk of lacking the self-awareness to recognize when it starts happening to them.
> You don't see anyone who is using opioids in the privacy of their own home who aren't out on the streets
I also don't see anyone who is using alcohol and marijuana in the privacy of their own home.
My sampling is biased in that it doesn't accurately reflect the percentage all people using those various drugs. But it is (I believe) relatively unbiased in that it shows that of the people whose drug use concurrent with homelessness a much higher fraction of them are using opioids or meth compared to booze and pot.
I think there is a reasonable inference there that using opioids or method is much more likely to result in homelessness than using booze or pot.
Again, I'm not making any claims about what our policies should be for opioids and method. All I claim is that it's entirely reasonable to have different policies for them versus booze, pot—hell, caffeine—because while, sure, they are all technically drugs, they are radically different in how they affect individuals and society at large.
I'll also point out that I didn't suggest criminalizing hard drug use. Also, of the four epidodes I described, only one is about drug use itself. The other three were violent crimes whose victims were homeless people.
Alcohol, marijuana and caffeine aren't anywhere near as likely to lead to someone losing their job.
You've observed that the most highly criminalized drugs are used by the people who have probably been the most affected by trying to use the criminal justice system as our drug treatment program.
You need to disentangle the effects of the drug from the effects of how we treat the users of the drug. You can't look at the end product at attribute it entirely to the inherent properties of the substance. You're not observing it in a sociological vacuum.
The fallout from the over-criminalization of opioids, meth, etc is a big reason that you're observing these behaviors. Stigmatizing drug use perpetuates the punitive approach to this problem. If the law treated addiction and the abuse of hard drugs with compassion rather than the draconian approach that we have in place currently you'd be seeing a lot less of this stuff.
This post could have easily been written about alcohol in the prohibition era. We've since learned that criminalizing alcohol makes its impact on society worse rather than better. We can't strip drug users of their autonomy and their ability to lead any sort of normal life and then act surprised when they turn to crime or turn back to drugs when they have nothing left.
> This post could have easily been written about alcohol in the prohibition era. We've since learned that criminalizing alcohol makes its impact on society worse rather than better.
> Across the Hudson River, in Manhattan, the number of patients treated in Bellevue Hospital’s alcohol wards dropped from fifteen thousand a year before Prohibition to under six thousand in 1924. Nationally, cirrhosis deaths fell by more than a third between 1916 and 1929. In Detroit, arrests for drunkenness declined 90 percent during Prohibition’s first year. Domestic violence complaints fell by half.
Of course, one can still find Prohibition objectionable, or think that the costs outweighed the benefits. But there is strong evidence that Prohibition succeeded in reducing some of the negative impacts of alcohol use.
Interesting, thanks! I think I mostly took issue with the idea that throwing drug users in jail is the best course of action, and the condescending/judgemental tone of the original comment. I think we can dissuade substance use and abuse through other means (better drug education and rehabilitation, taxation, non-felony level criminalization) that will be a good middle ground between no drug laws and the draconian life-ruining ones that we have in place right now.
Phenylephrine is utterly useless on me. Maybe it works for some people but it may as well be Pez for all the good it does me.
I make it a point buy a pack of actual pseudoephedrine from my pharmacist every 6 months or so, to ensure I have a stock when I need it. Fortunately, I don't need it too often, but there's no good substitute when I do.
The article comes so close to explaining a way to make it work, likely due to his hesitancy to recommend exceeding the recommended dose:
> Why is oral phenylephrine so useless? It is extensively metabolized, starting in the gut wall. You can find a bioavailability figure of 38% in the literature, but that appears to be the most optimistic number possible, and you can also find studies that show 1% or less. Overall, the Cmax is highly variable patient-to-patient, and the lack of cardiovascular effects at low doses argues for very low systemic effects (and expected low efficacy as a decongestant). The bioavailability increases at higher doses as you apparently saturate out some of the metabolic pathways, but at the 10mg dose typically used for decongestants, you can forget it.
Phenylephrine has variable Bioavailability. The bioavailability doubles if you take it with Tylenol, which is actually common in the context of colds. (Source: https://pubmed.ncbi.nlm.nih.gov/25475358/ ) The maximum dose was probably chosen based on worst-case scenarios, whereas the average person who complains it doesn't work is probably absorbing much less.
Always consult with your doctor, but I've found that taking a second dose of phenylephrine if the first one hasn't worked within about 30 minutes usually does the trick. Or just take it with Tylenol. It's worth checking your blood pressure to make sure you haven't started entering the realm of side significant side effects, though.
Also I should point out that pseudoephedrine isn't available behind the counter everywhere. It's prescription-only in some places.
Note that Figure 3 also mentions the Tylenol combination effect and even shows how 10mg Phenylephrine + Tylenol performs somewhere between 10mg and 45mg of phenylephrine.
The article author just cherry-picked the one study where phenylephrine performed the worst. Cherry-picking a single study to support a conclusion and ignoring meta-analyses would normally get someone torn apart in the HN comments but apparently everyone loves pseudoephedrine so it gets a pass.
"Data from 7 crossover studies involving a total of 113 subjects were reanalyzed and then pooled for meta-analysis"
This is a huge red flag - I've read too many of Derek Lowe's blog posts to take that kind of study very seriously as medical advice. Much more promising leads than this have utterly bombed in clinical trials, it happens all the time.
Read the whole abstract. They showed which studies reached statistical significance on their own.
You could just read those studies and ignore the meta-analyses if you want.
I honestly don't understand this current trend of assuming meta-analyses are inherently incorrect and cherry-picking the worst study as the source of the truth.
It's not the meta-analysis part that's the biggest red flag, it's "a total of 113 subjects". That's the size of a Phase I trial, and the road to Phase III and clinical approval has a crazy high attrition rate.
612 comments
[ 4.3 ms ] story [ 331 ms ] threadI suppose people must be buying it, and given how strong placebo effects are in general I guess it's doing something for them.
My wife insists Phenylephrine works for her and thats all she will take. She has offered it to me a couple times when we didn’t have any Sudafed and Phenylephrine had 0 noticeable effects for me.
Edit: I forgot to add that Alavert-D 12 also has Pseudoephedrine and works for me too and is what I take when my congestion is allergy related.
Keep in mind this doesn't say that it's not effective. It's just not more so than the placebo effect, which is quite real even on physiological matters.
https://en.wikipedia.org/wiki/Methcathinone
from pseudoephedrine. You can just oxidize PE with potassium permanganate and purify the product... No need to risk blowing yourself up the way you would making methamphetamine.
[0] https://en.wikipedia.org/wiki/Pseudoephedrine#Brand_names
The article was not informative [to me], but it was fun reading. Since it was not informative to me (as I deduced correctly from the headline) I could have easily read the comments and not the article.
Hope that helps!
I still want to know what isocyanide smells like.
Totally useless as a decongestant for me.
Stick with pseudoephedrine.
With explanation in abstract that its easier to buy meth than pseudoephedrine.
People may laugh at this, as they should since it is an absurd situation, but this isn't entirely wrong.
Neither my wife or I drive and during the pandemic she gave up her license after getting an appointment at the DOL was difficult. Both of us carry US passport cards as our ID.
This has resulted in several situations where we've been turned down for purchasing restricted items like alcohol or drugs containing pseudoephedrine, particularly the latter, because a passport card can't be scanned by the usual point of sale systems. There are a couple of places in Seattle that are happy to accept a passport card but even at them it's sometimes been dependent on who is working the counter that day.
> she gave up her license after getting an appointment at the DOL was difficult.
I'm not sure what DOL is a reference to; however I now many individuals struggled to get appointments at the Secretary of State (SoS) and that is also where one (at least where I live) would need to get a non-motorist ID. Same amount of frustration / time spent to get a non-motorist ID as it would be to renew your driver license.
Maybe the most honest state is Missouri, where plates, stickers for them, and your driver's license are all handled by the state's Department of Revenue.
State non-motorist IDs are some of the only IDs available to non-citizens who live in the US and don't drive
Foreign passport and non-driver's ID were her only options--and passports are a nuisance to carry around and a PITA if lost/stolen.
(And, yes, I think that just under two years bit was not by chance. They were definitely looking for signs of fraud and I'm sure they finally approved it just before the point where they would have had to issue a permanent one rather than a conditional one.)
There are millions of visa-holders who live in the US but don't have green cards. Carrying around a foreign passport for everyday identification is an absolutely terrible idea because of the risk of theft or loss. Losing a visa-containing foreign passport can necessitate getting an emergency travel document from your foreign-country consulate, traveling back to your home country, getting a new passport, getting an appointment at the US embassy in your home country, getting a new visa issued in your new passport, then finally traveling back to the US. The whole process could take weeks or months and cost thousands of dollars.
For my wife, it's because she has even less tolerance for paperwork than I do and it's easier to just go to the pharmacies we know have their heads bolted on straight than it is to gather up all of the stuff and go to the overworked and harried DOL.
Underlying documents required to obtain ID cost money, a significant expense for lower-income Americans. The combined cost of document fees, travel expenses and waiting time are estimated to range from $75 to $175.
The travel required is often a major burden on people with disabilities, the elderly, or those in rural areas without access to a car or public transportation. In Texas, some people in rural areas must travel approximately 170 miles to reach the nearest ID office.
I find it a credible claim. There was a story a few years back which made the rounds that ... turned out to be a case of fraud.
http://www.miamiherald.com/news/nation-world/national/articl...
https://www.inquirer.com/news/mark-damico-johnny-bobbitt-kat...
That said, given frictions of obtaining ID and necessity of having same, I could well believe that this is an issue.
Err, no they don't. At least not with any of the IDs I've gotten in California for the past several years....
Scraping together the required documentation for proving her address was problematic. I set up the utilities, I'm the one that deals with them, they're just in my name. She doesn't like dealing with that sort of stuff and at the time most of it was done her English (she learned her first word of English at 43) would have added needless complexity.
Even the property records are problematic on that--we put our house into an estate-planning trust. The correct titling of the property has the trust and then both of our names--but the system only *displays* two lines. Thus it shows the trust and then my name, hers gets omitted.
Then a DL itself is another $40. A non-driving ID is like $30, although there's discounts depending on age and income.
- It’s Federal law.
I don’t know why people keep forking over money for state ID. It’s a state government scam.
I ran into a guy online that couldn't obtain an ID, period. The only form of ID he had was a driver's license. His doctor pulled it (legitimately, but needlessly--there was no question he was incapable of driving) leaving him with nothing. Where he lives that left one option--get a birth certificate. The application must be signed--something he's no longer capable of doing. The only other route would be to show up in person at the right office--multiple states away, a trip that would be medically ill-advised.
Note that he's educated and not poor, this is purely a problem of the system not handling the oddball cases. That state needs to be clobbered with a clue-by-4, if you pull a driver's license you should issue the person a non-driver's ID!
We have also run into a problem. When my wife was naturalized a hyphen got inserted in her name on her naturalization certificate, it wasn't noticed at the time. Almost everything is in her name as intended but social security saw the hyphen and would not relent. Even after we legally changed her name to rid it of the hyphen they were digging in their heels on changing the records. At this point we *think* the Real ID stuff is going to work, but the virus interfered. For the occasional place that won't accept her expired ID we use her passport card. (She doesn't drive, there's no issue of driving on an expired license.)
Freakin' weird.
Edit: I worked at Boeing for eight years, very often in a sec/reserved area. My passport was good there. Buying booze down the street from [Boeing] plant 2, no.
I wouldn't blame a regular store clerk for not knowing what a UN Lassiez-Passier is, especially since it doesn't have the word "passport" in the name. But a passport, especially one from their own country, definitely ought to be recognized.
Seared into my head is my experience of trying to buy alcohol in Boston back in 2009, when I was in town for a wedding. I had just turned 21 so buying alcohol was still novel and exciting. I had multiple bars and liquor stores refuse my valid Illinois license, forcing me to hand alcohol to my father to purchase, and find shady bars that wouldn’t card me. It was extremely frustrating to have to rely on such tactics despite being legally allowed to purchase alcohol.
Not to spoil the joke, but the paper by "O. Hai" and "I. B. Hakkenshit" is satire--I would be absolutely gobsmacked if anyone is actually doing this.
Here's a copy of the paper, if anyone is interested:
https://maggiemcneill.files.wordpress.com/2012/03/synthesizi...
The people who check IDs for medications and alcohol are trained to check DL cards, not passports. It's not surprising that using an ID different from 99.9% of other people causes issues. Although my friend who was a student from Germany never had any issues...
Now, had this happened a few years earlier before she was naturalized.... While her passport did have the standard English labels it was mostly written in bird tracks.
Let’s not turn grad students having a laugh into an actual statement on public policy.
I ran out and wanted to buy some at the local cvs. Now, I’m not a US citizen but I’ve been here a few years already and am a permanent resident. I do not have a US state ID or a US driving license, and in my many years it has _never_ been a problem. Everyone was always happy with my green card as my ID - bars, domestic flights, international flights back to USA, bank account openings etc. But not for purchasing pseudoephedrine at CVS…
I literally stood there with my green card and my European passport and was begging the cvs clerk to sell it to me, but the told me it’s impossible, system doesn’t accept those IDs (and they tried, even showed me their computer screen). And so I had to leave empty handed and with a runny nose, and came back later with an American friend to buy it…
Then you show your drivers license and the pharmacist records it and you pay and finally walk out with your sudafed. If you want to buy several boxes because it's allergy season, well too bad, you can't buy 2 boxes today, you have to come back tomorrow for the second one.
It's actually easier to buy as a prescription, then the Dr can write you a prescription for any amount you need/want.
Not to put too fine a point on it, but... at least this you can't stop me from doing.
So how exactly do the costs/benefits on this "public policy" sum out?
Benefits:
• some grandstanding politicians enjoy the superficial appearance of being "tough on meth"
Costs:
• Americans waste $billions on an ineffective placebo decongestant
• Legitimate manufacturers of a working medicine, pseudoephedrine hcl, lose sales due to extra cost/effort/stigma associated with the purchase. They shift real productive resources – inputs & worker hours – to making & marketing placebos instead.
• Larger cross-border criminal organizations – of the kind that regularly murder politicians south-of-the-border – grow in market-share, sophistication, & power.
• Meth continues to be available at high volume, & low costs, unaffected by the pseudoephedrine limits.
• Recent meth formulations – likely prompted by the limits on the pseudoephedrine-process – seem to create a stronger & more-destructive addiction among abusers: https://www.theatlantic.com/magazine/archive/2021/11/the-new...
If we don't listen to 'grad students having a laugh' who are pointing out the wasteful absurdities of 'public policy', we'll keep such nonsense destructive rules indefinitely.
The 'serious folks' among politicians & suited 'public-policy' types are derelict in their duties.
Are you suggesting my neighborhood friendly drug dealer could hook me up with some real sudafed? Might be nicer than trying to get it from the pharmacy when I need it.
Because yeah, your neighborhood dealer would make his own meth and would probably have lots of Sudafed.
Most doctors will just write you a prescription and you can get it delivered to your home. Super easy.
Every time you buy the stuff from the pharmacist, they're logging the purchase in a national DB and you're signing an acknowledgement that it's a huge felony to go beyond the limit. But they never tell you where you are vs the limit, and the limits aren't clearly stated. End result: chilling effect.
My mom timed her purchases incorrectly (family of 5 with mom shopping for all at the time) and went past the limit. After that she was flagged and had to have an actual doctor's prescription in order to purchase pseudoephedrine for 6-12 months. That is a HUGE hurdle for most people, and doctors don't want to see people who have cold symptoms. Heck, I was turned away from a CVS Minute Clinic recently because I had COVID like symptoms in the last 7 days. As in refused to see me, even though I had recently tested negative for COVID and had a fever + persistent cough.
Presidents' main differences are on foreign policy which is the one thing nobody asks them about.
Sigh.
https://www.drugcaucus.senate.gov/press-releases/feinstein-g...
ironically, OR and MS, the states listed in that report, are so far the only 2 that are starting to roll back the restrictions.
Our elected officials seem adverse to admitting something doesn't work well and rolling it back, unfortunately.
Speaking for myself, am shocked and outraged that red senators and other congresscritters are consistently on the wrong side of seemingly everything, yet they keep getting elected. Of course, my political calibration mechanisms are quite in tune.
If I had to pick a single organizing principle to describe her positions it would be a bureaucratic sort of authoritarianism (as distinguished from the strongman authoritarianism of someone like Donald Trump).
I do believe the system is rigged in a way that consistently produces bad outcomes. The US Senate is structured to reward voters for keeping incumbents in office, and plurality voting virtually guarantees two dominant parties.
Yes. That one.
"Real" change (ie, still a useless liberal democracy, but at least a bit more in service to the people) would start with voter reform and getting rid of FPTP entirely.
- The most popular replacement for FPTP (which is biased away from centrism) is RCV (which is biased towards it).
- FPTP does turn it into a two-party system, but US parties are weak. They don't control who joins them, who gets elected, or how anyone votes. In the UK you can actually get fired from the party for voting wrong.
RCV/STV is absolutely an improvement on FPTP in almost every way.
As far as strong vs weak parties, that seems to be an issue with the UK. FPTP and weak-parties are separate sets. You could have FPTP with closed party membership, or RCV/STV with weak parties.
The system doesn't have to be rigged to produce bad outcomes. Most outcomes are bad, so only a system which is nearly perfect has any hope of producing good outcomes.
IIRC, early attempts to repeal failed stalled. (I presumed due to some pharm lobby)
I wonder if Covid and focus on flu like symptoms led to it getting “fast tracked.”
Looks like pseudoephedrine OTC products became available for sale January 1st 2022. https://www.statesmanjournal.com/story/news/politics/2022/01...
I made the drive from Portland to Vancouver, WA multiple times over the years (usually while sick) to resupply with something that worked.
Glad that is done with.
What I'd like to see is a constitutional amendment that the total body of federal laws and regulations can't be any longer or more complicated than a person of average intelligence can be taught in a week.
Sunset provisions are an idea I tentatively like until I consider what happens with the fucking stupid, pointless "debt ceiling" crap Congress has decided to make themselves do. I imagine how fun it'd be watching months of idiotic brinksmanship over keeping murder illegal, because one group of legislators wants to grand-stand about abortion. Then repeat for practically everything else.
No thanks.
To give an example, the regulations governing design of commercial aircraft can almost certainly be simplified from their current state without killing people, but probably cannot be simplified to the point that someone who isn't already an expert on aircraft design can learn them in a week without killing people. Knowing that field is subject to special rules is enough to avoid accidentally violating the regulations.
I believe there are restrictions on the breadth of laws but they are not honored very effectively.
But more seriously, the FDA ends up regulating something like 30% of the economy and getting them to deregulate something is near impossible
Likely a non-starter until the FDA revokes phenylephrine's designation as a decongestant.
* Edit: Where the word "recorded" appears, this comment previously said "scanned and submitted to a central database". While most states use a central database, the comment reply below pointed out that this goes beyond the minimum that federal law requires.
The Oregon law does have a central database requirement, however I believe this is in all cases a decision made by each state individually.
Also, in legislation, it seems like making things illegal passes several orders of magnitudes more easily, than anything that gives normal citizens more rights.
A huge portion of the issue is that we’re largely ruled by people who don’t need to deal with any of the inconveniences they cause; if any senator or rep has a runny nose I’m sure they can get an aide to sort it out for them. The rest of us are not so lucky.
Once every 3-4 years I'll get a cough so bad that DXM won't fix, and when that happens my doc gives me a prescription for a codeine based cough syrup that fixes it (and renders me useless as a human being).
Aside from headaches, Advil does better on other aches and pains than Tylenol, which does almost nothing. And it's better for the liver.
Also i used to get wicked headaches from diet soda when i was younger, too. Is it possible to be "slightly" Phenylketonuric? I had to google the spelling, and it's interesting that "hyperactivity and behavioral issues" is listed as one of the symptoms. I doubt "slightly" is possible, that was tongue-in-cheek.
Also as an aside, for pain that the standard dose of ibuprofen doesn't seem to help, emergency medicine studies have found that an additional standard dose of acetaminophen alongside the ibuprofen has greater pain reduction efficacy than vicodin.
Also, this is mostly for comfort. There is no really reason to go back to pseudo-effedrive and risk side-effect (high-blood pressure etc.). Also people value their comfort a lot, they are not so good with assessing risks. Apparently that is the reasoning to continue selling phenylephrine because people want to get something even if it is not distinguishable from placebo.
Spoken like someone who has never had severe nasal congestion. A week or two of not being able to sleep, taste, or speak with your normal voice would change your view of the importance of good decongestants.
I discovered "neti pots" because in a bout of panicked rage i snorted nearly an entire can of saline nasal wash, had immediate relief, and went and bought my first plastic neti pot. I never use deionized or whatever water, the chances of toxins in my water is extremely low, and i usually just do it in the shower anyhow, where there's hot water right there. Sodium Bicarb + NaCl just works.
More recently for the sort of dry allergy nasal stuff i started putting mentholated petrolatum jelly directly in and around my nose. I'm sure in 10 years i'll find out that i'll get nostril cancer or something, but whatever, i can breathe, thank you very much.
the "war on drugs" push to restrict pseudoephedrine created more problems than it's worth. "the new meth" has been even worse.
https://crimeandjusticenews.asu.edu/news/chemically-differen...
There's a really good Atlantic article about it as well (google "the new meth" Atlantic) but it's behind a paywall.
I think I'm lucky, in that I don't really need too much help that often. I can only imagine if my sinuses were as bad as they were back in the day, though.
And weed.
I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo.
Only a couple years later did I make the connection that this was right when they passed the law restricting pseudoephedrine. I got my hands on some NyQuil D and everything was back to normal and I had a functioning cold remedy again.
Phenylephrine is completely useless.
NyQuil can be a great all-in-one product when it's what you need. It's useful to know what it is composed of and why. All of the medicines in it treat symptoms, not the underlying cause, which will be fought off by your immune system. If you have only one or two symptoms, you can always buy each drug separately - doing so allows you to more precisely control dosage and timing as well.
FYI, two other common symptoms not covered above are sinus congestion - which can be treated with Sudafed - and chest congestion (e.g. a phlegmy cough) - which can be treated with Mucinex.
NyQuil with pseudoephedrine included is now marketed as "NyQuil D" and is available behind many pharmacy counters with the same restrictions as other pseudoephedrine products. However, it could also rightly be called "NyQuil Classic" (to borrow branding from Coca-Cola).
Antihistamines do not directly dry up your runny nose/post nasal drip. Rather, they reduce the histamine response, which is helpful when something is caused by allergies. It's usually not that helpful with an actual cold (but allergic rhinitis is often mistaken for a cold).
Sudafed is what the parent was referring to with Pseudophedrine; a decongestant. This works by shrinking blood vessels, causing swollen passageways to open back up. It doesn't actually do anything to reduce the runny nose or post nasal drip, but by opening the passages more can help them drain more efficiently, preventing that feeling of congestion (hence the name).
Guaifenesin (Mucinex being the name brand) is an expectorant; it causes you to generate more mucus, and reduces the viscosity, allowing you to cough/sneeze/etc your mucus/phlegm based congestion out more easily.
Otherwise I totally agree; it is worth understanding what each of these do so you can pick and choose what you need. Nyquil includes DXM (dextromethorphan) to reduce cough severity, but the acetaminophen is not helpful unless you have a fever or headache, and the Doxylamine Succinate and Phenylephrine (both antihistamines; the Doxyl is added to Nyquil because it's also a sleep aid) aren't particularly helpful unless your cold symptoms are actually allergy related.
Better to buy DXM separately usually; fewer side effects, cheaper, and you can pair it with what else will help you (if you need something to help you sleep, you can add Doxyl or Diphenhydramine if you want; YMMV as to how effective they are)
Don't take Guaifenesin before bed (the increased mucus/phlegm production will make it harder to sleep), but it's good during daytime.
A common side effect of Sudafed is trouble sleeping; if you don't have this side effect it can be helpful in reducing congestion while you try and sleep, but if you do have this side effect, obviously, don't take it before bed.
http://rc.rcjournal.com/content/59/5/788
So generally my take is "hey, this is what it's been found effective for, and it's generally regarded as safe to take. Is it going to help here, for you, in this situation? Who knows! Give it a whirl if you got the money and want to try".
So, really, for a given incident, try it, see if it helps. If it does, great, if it doesn't, stop taking it.
My pet theory is that NyQuil's biggest effect is simply to make you mildly "faded" so all your symptoms are more tolerable. DXM, the antihistamine, the pseudo, and the alcohol are all drugs that would definitely do that if taken in larger doses. While NyQuil doesn't have those larger doses, the combination of all of them may amplify the otherwise weaker effects into a general buzz/haze that helps you go about your day/night.
Interesting case study in being able to sell a low-quality product (one of the most important active ingredients doesn't work!) side-by-side with a much better product and most people won't ever notice that one is better.
So a small amount of alcohol won't really have much of an effect, I'd claim.
Back in my college days you could replicate it with one 30mg Sudafed and a shot of Jagermeister. =)
I don't know about this medication in particular (since I don't live in the US), but I see it contains DXM (dextromethorphan), which is a dissociative (such as ex. ketamine), which probably causes the effects you described. I'm seeing it also contains acetaminophen, which probably makes it hard on your kidneys, if you take too much, so that is probably why people don't abuse it more (I guess or hope).
One could buy generic "tussin DM" (or pill form of dextro), mucinex (for guafenasin), and benadryl (or generic diphenylhydramine) to get the same usefulness that a bottle of liquid NyQuil has.
> Q: How much alcohol is in NyQuil?
> A: NyQuil Liquid contains 10 percent alcohol. NyQuil LiquiCaps does not contain alcohol. Alcohol-Free NyQuil Cold & Flu Nighttime Relief Liquid does not contain alcohol.
https://vicks.com/en-us/safety-and-faqs/faqs/vicks-nyquil-fa...
[0]https://www.theatlantic.com/health/archive/2012/04/the-lost-...
eg https://journals.sagepub.com/doi/10.1177/1087054719896857
Adderall (dl mixture) is just not the same. We know Adderall tends to exacerbate acne and some forms of dermatitis but we don't know how much. We don't know if the pupil effects contribute to driving incidents. We don't know if dry mouth from Adderall is worse for dental health than the dry mouth that some people get after heavy espresso or other stimulating substances, like pseudoephedrine. We don't think the risk of paranoid behavior is high but it is higher than coffee, of course.
And of course some not insignificant portion of the population can tolerate coffee or pseudoephedrine, but we're not too sure about Adderall. Schizophrenic, bipolar, OCD individuals, those with tics, tachycardia, etc, need to tread carefully with stimulants, even maybe sudafed.
Ultimately I couldn't use it this way more than a few days a week or I'd get lower back pain. I've also tried steeping ephedra tea but did not notice any effects on concentration.
Later on when I was formally diagnosed and prescribed proper meds I was placed on Adderall first and had similar unwanted side effects after a time. Ultimately, I settled on Dexedrine and no more side effects (other than insomnia if I take it too late) and haven't felt a need to up the dose for years now. It does still have decongestant effects like the other two.
Considering I'm caffeine dependent and can't cycle off daily intake without crippling headaches, where I cycle Dexedrine off on the weekends/holidays without any withdrawal effects, I'd have to agree: So long as it's a therapeutic dose it's on-par or safer than coffee.
https://news.ycombinator.com/newsguidelines.html
My strategy is to take it full strength for a day or two and then taper it off gradually for the next few days after that.
On one hand, we're decriminalizing drugs. Pot is widely legal now. Other states are allowing mushrooms and LSD. Cocaine and heroin are not legal, but have all but been decriminalized on the West Coast.
Meanwhile it's harder than ever to get pain killers from your doctor, even when you have a demonstrated need for them. Same with ephedrine -- a very useful drug -- it's very difficult to get even when in need. And if you mention enjoying tobacco products, you're treated as a leper.
I wish we had a self-consistent view of the issue.
There's talk that WA is going to introduce a bill in the next session to completely decriminalize.
https://www.harvard.com/book/the_urge/
Citation needed. Never heard this before now. Or is this just some California thing?
I live in Seattle where marijuana is legal. Alcohol and marijuana are widely consumed and I rarely see any large-scale problems from it. Obviously, there are many people who can't handle either of those, but their failure to handle it well seems to not impinge on others as much. And, compared to them, there are a huge number of people able to consume alcohol and marijuana in a safe, healthy, non-problematic way.
I also live next to a couple of homeless encampments. Many of the people living there are clearly addicted to opioids and/or meth. In just this month and within a mile of my house:
* I saw a woman, topless, brandishing an umbrella, wandering between the sidewalk and into the street screaming at no one.
* A man was shot in the stomach in front of a food bank.
* Another man was shot in the neck at an encampment.
* A drive-by shot up an RV and car. (The people inside fortunately weren't hit.)
There's more I'm sure but these are just the ones I know about in the last few weeks.
It's entirely consistent to say that we should treat drugs that lead to the latter behavior differently from drugs that don't. Opioids and meth are incredibly destructive. I'm not saying what specific policies I advocate for them, just that it is reasonable to have different policies for those drugs compared to others.
https://slatestarcodex.com/2019/09/16/against-against-pseudo...
Essentially by rules a patient asking for higher dosage of an addictive drug is automatically seen as a sign of addiction, even if sometime it might just be that the current dosage is too low.
And the way we should look at drug addition with opiates isn't by looking at the homeless users, but consider the fact that we're all potentially one bad car accident away from getting hooked on pain killers, and asking what kind of support we would need to avoid winding up homeless due to that.
Punishment via the criminal justice system is what is likely to wind up with you losing your job and winding up out there in that camp with them. So how should you be treated if it happens to you?
And the glib answer of "put a bullet in my head" or whatever isn't an acceptable response. Treat the problem seriously and propose how society helps you help yourself to get clean without at trip through a homeless camp. And the people who refuse to deal with the reality that it could happen to them or engage with the problem are likely those most at risk of lacking the self-awareness to recognize when it starts happening to them.
I also don't see anyone who is using alcohol and marijuana in the privacy of their own home.
My sampling is biased in that it doesn't accurately reflect the percentage all people using those various drugs. But it is (I believe) relatively unbiased in that it shows that of the people whose drug use concurrent with homelessness a much higher fraction of them are using opioids or meth compared to booze and pot.
I think there is a reasonable inference there that using opioids or method is much more likely to result in homelessness than using booze or pot.
Again, I'm not making any claims about what our policies should be for opioids and method. All I claim is that it's entirely reasonable to have different policies for them versus booze, pot—hell, caffeine—because while, sure, they are all technically drugs, they are radically different in how they affect individuals and society at large.
I'll also point out that I didn't suggest criminalizing hard drug use. Also, of the four epidodes I described, only one is about drug use itself. The other three were violent crimes whose victims were homeless people.
You've observed that the most highly criminalized drugs are used by the people who have probably been the most affected by trying to use the criminal justice system as our drug treatment program.
You need to disentangle the effects of the drug from the effects of how we treat the users of the drug. You can't look at the end product at attribute it entirely to the inherent properties of the substance. You're not observing it in a sociological vacuum.
This post could have easily been written about alcohol in the prohibition era. We've since learned that criminalizing alcohol makes its impact on society worse rather than better. We can't strip drug users of their autonomy and their ability to lead any sort of normal life and then act surprised when they turn to crime or turn back to drugs when they have nothing left.
It's worth remembering that Prohibition was, in fact, quite successful: https://www.vox.com/the-highlight/2019/6/5/18518005/prohibit...
To quote that article:
> Across the Hudson River, in Manhattan, the number of patients treated in Bellevue Hospital’s alcohol wards dropped from fifteen thousand a year before Prohibition to under six thousand in 1924. Nationally, cirrhosis deaths fell by more than a third between 1916 and 1929. In Detroit, arrests for drunkenness declined 90 percent during Prohibition’s first year. Domestic violence complaints fell by half.
Of course, one can still find Prohibition objectionable, or think that the costs outweighed the benefits. But there is strong evidence that Prohibition succeeded in reducing some of the negative impacts of alcohol use.
Didn't the massive opiod epidemic occur before they were criminalized?
[0] Careful, you can easily form an "addiction" to this med.
I make it a point buy a pack of actual pseudoephedrine from my pharmacist every 6 months or so, to ensure I have a stock when I need it. Fortunately, I don't need it too often, but there's no good substitute when I do.
> Why is oral phenylephrine so useless? It is extensively metabolized, starting in the gut wall. You can find a bioavailability figure of 38% in the literature, but that appears to be the most optimistic number possible, and you can also find studies that show 1% or less. Overall, the Cmax is highly variable patient-to-patient, and the lack of cardiovascular effects at low doses argues for very low systemic effects (and expected low efficacy as a decongestant). The bioavailability increases at higher doses as you apparently saturate out some of the metabolic pathways, but at the 10mg dose typically used for decongestants, you can forget it.
Phenylephrine has variable Bioavailability. The bioavailability doubles if you take it with Tylenol, which is actually common in the context of colds. (Source: https://pubmed.ncbi.nlm.nih.gov/25475358/ ) The maximum dose was probably chosen based on worst-case scenarios, whereas the average person who complains it doesn't work is probably absorbing much less.
Always consult with your doctor, but I've found that taking a second dose of phenylephrine if the first one hasn't worked within about 30 minutes usually does the trick. Or just take it with Tylenol. It's worth checking your blood pressure to make sure you haven't started entering the realm of side significant side effects, though.
Also I should point out that pseudoephedrine isn't available behind the counter everywhere. It's prescription-only in some places.
Note that Figure 3 also mentions the Tylenol combination effect and even shows how 10mg Phenylephrine + Tylenol performs somewhere between 10mg and 45mg of phenylephrine.
The article author just cherry-picked the one study where phenylephrine performed the worst. Cherry-picking a single study to support a conclusion and ignoring meta-analyses would normally get someone torn apart in the HN comments but apparently everyone loves pseudoephedrine so it gets a pass.
This is a huge red flag - I've read too many of Derek Lowe's blog posts to take that kind of study very seriously as medical advice. Much more promising leads than this have utterly bombed in clinical trials, it happens all the time.
You could just read those studies and ignore the meta-analyses if you want.
I honestly don't understand this current trend of assuming meta-analyses are inherently incorrect and cherry-picking the worst study as the source of the truth.