Pharma: December 2006 Archives

 

December 31, 2006

Mark Kleiman points to this article about the enormous drop in the street price of heroin. Largely due to the ready availability of high quality Afghan product, the price is down to $90/g. Ordinarily, when the price of a product drops, that's good news for consumers of the product, but Kleiman claims otherwise:
The price of having a heroin habit, by contrast, doesn't go down much. Opiate tolerance is virtually complete, so in the medium term an addict's consumption is limited only by his ability to find cash; the cheaper the stuff gets, the more he uses, without getting any more pleasure out of it once his receptors have adapted.

I didn't know that opiate tolerance was that extreme, but I'm willing to take Kleiman's word for it. That said, I'm not convinced that what he says about the cost to users is right. At any given time, the amount of heroin you can take is limited by your tolerance (lest you overdose). This represents the upper bound. The lower bound is what it takes for you to get high all. Between these two points, there's presumably some pleasure/dosage curve with decreasing marginal pleasure per dose. Thus, if heroin is a lot cheaper, you'll tend to be somewhat more aggressive in terms of how much heroin you use, but it's still limited by the overdose point.

So, if heroin is a lot cheaper, you'll tend to develop tolerance somewhat faster, but there's still a maximum rate at which you can develop it, even if you have unlimited access to the drugs. So, cheap drugs extend the time during which you can afford to maintain your habit (before it exceeds your resources). In the limiting case, if drugs were free then you would never exceed your resources. As I understand it, users develop techniques for managing tolerance—detoxing in order to let their receptors recover, for instance—cheaper drugs would seem to reduce the frequency at which you had to do this, which, if you're a user, sounds like a win.

 

December 19, 2006

As you may have noticed, it's become quite inconvenient to get pseudoephedrine. Luckily, Pfizer has rolled out a replacement, Sudafed PE, containing phenylephrine, a common topical nasal decongestant Not so luckily, there's no good evidence that it works as an oral decongestant, and substantial reason to think it doesn't, as indicated in this review by Ronald Eccles (þ Robert Cohen via Radley Balko) :
The aim of this review was to investigate the rationale for replacing the nasal decongestant pseudoephedrine (PDE) with phenylephrine (PE) as a means of controlling the illicit production of methamphetamine. A literature search was conducted in electronic databases and use of textbooks. Restrictions have been placed on the sale of PDE in the USA in an attempt to control the illicit production of methamphetamine. This has caused a switch from PDE to PE in many common cold and cough medicines. PE is a poor substitute for PDE as an orally administered decongestant as it is extensively metabolized in the gut and its efficacy as a decongestant is unproven.

Pseudoephedrine, by the way, does work. Outstanding!

 

December 14, 2006

The feds have cracked down on pseudoephedrine sales but it's still possible to order it from Amazon. Possible, but not convenient:
Due to recent DEA (U.S. Drug Enforcement Agency) restrictions on the sale of products containing Pseudoephedrine ("PSE"), the drugstore.com Web Store is now required to obtain additional information from customers who order PSE products.

The DEA now requires that we verify identification by seeing a copy of photo identification from all customers who purchase items that contain PSE. We are pleased to offer three methods by which you can satisfy this requirement:

1. You may scan or take a legible digital photo of your drivers license, or other photo ID issued by a State or Federal government, and email a copy to pse@drugstore.com. --Recommended--

2. You may fax a copy of your drivers license, or other photo ID issued by a State or Federal government, to the following number 1-866-764-4886 (poor quality or illegible copies will delay your order).

3. You may mail a copy of your drivers license, or other photo ID issued by a State or Federal government, to the following address:

I wonder what they do with that low quality scan of your driver's license, something that really isn't that hard to fake up, assuming you know someone's name and DL #, something which isn't exactly a secret. It seems like there are two possibilities. First, they could look it up in some central database to verify that really exist and live at the address that you're having stuff shipped to. Of course, if they do that, then there's no need to actuallly see your license, they just need the number to use it as a database locator and verify that it matches your address. The other alternative is that they just stuff it into some file folder somewhere. That doesn't seem very useful either.

What's more likely, actually, is that they're just complying with a generic requirement to show a driver's license that never really contemplated mail particularly well. Having to show a drivers license for in-person sales does make (some) sense (assuming that you think restricting pseudoephedrine sales is a good idea in the first place). It lets you identify who is buying the drug and therefore at least in theory prevent multiple sales. But it's not really clear it does anything very useful in this context.