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• Remote supervision
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Letters to the Editor
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Pseudoephedrine
P to POM status — a good move
From Mr R. I. Dunkley, MRPharmS
I wish to respond to the articles in the PJ about pseudoephedrine changing
from pharmacy to prescription-only status. Pharmacists have said that
the Medicines and Healthcare products Regulatory Agency’s stance
is a “slap in the face for pharmacy”. I disagree with every
pharmacist who has this point of view. June Raine, director of vigilance
and risk management at the MHRA, has got it exactly right in saying that “we
are acting early to avoid [methylamphetamine abuse] becoming a problem”.
I do not think pharmacists appreciate the ease with which pseudoephedrine
can be converted into methylamphetamine — it is easier than the “bathtub” amphetamine
that could be produced. It is on a par with producing crack cocaine from
cocaine hydrochloride and baking powder, ie, it is a kitchen sink manufacture
par excellence. The US Drug Enforcement Agency has found methylamphetamine
laboratories in the portable milieu of a suitcase.
Let me quote Steven Karch1:
“Both (-) ephedrine and (+) pseudoephedrine can be converted into
methylamphetamine by reductive dehalogenation, using red phosphorous as
a catalyst.” There
is another route to make it via phenyl-2-propanone (P2P). This one, according
to Karsch, is the method of choice, but as P2P is now restricted, the
red phosphorous is the way methylamphetamine is synthesised “in
the field”.
My reason for sending this letter is to alert pharmacists to any sales
of pseudoephedrine that occur. Criminal gangs can, and will, employ armies
of shoppers to visit pharmacies to buy just one pack of Sudafed or Galpseud — who
would remark on the sale of a single pack? But, multiply this by a hundred,
or a thousand times, and the volume of pseudoephedrine goes up and forms
the basis for the manufacture of methylamphetamine. I would say to all
those pharmacists who scorn the restriction of pseudoephedrine to POM
status to think again. This has all the hallmarks of a new threat to
public health, the like of which we have never seen.
Bob Dunkley
Leeds
Reference
1. Karsch, S. Karsch’s pathology of drug abuse. 3rd ed. Florida:
CRC Press, 2003.
Stock up on hankies
From Mr I. C. Strachan, MRPharmS
The 1939–45 war heralded the foundation of human rights based
on the ideals of dignity, privacy and choice. Even national service frameworks
embody the notion of treating others as you yourself would wish to be
treated. The announcement to reclassify pseudoephedrine from pharmacy
to prescription-only status is more notable for its uncompromising arrogance
than the pursuit of any credible policy to combat illicit drug manufacture.
The ability to transform pseudoephedrine to methylamphetamine is a conundrum
for scientists or those who may wish to abuse such technology; but so
what? The practicalities or consequences are superfluous because such
activity would be outside the scope of UK law. Any illegal activities
should not undermine the liberties of individuals, or challenge people’s
integrity by suppressing the right to choose.
A government’s remit does not include rolling back the principles
upon which these rights were established. Too much today endeavours to
correct antisocial behaviour through denying the rights of law-abiding
people. It creates fear, perpetuates the idea that nanny knows best and,
worst of all, denies people the right to exercise their freedom of choice.
As for pharmacy, the rug has been thoroughly pulled without deliberation,
without compensation and without effective alternatives. I suppose I
need to stock up with clothes pegs and hankies for that runny nose in
the future.
I. C. Strachan
Bury, Lancashire
Pharmacists are more than capable of controlling supply
From Miss D. V. Taylor, MRPharmS
The Medicines and Healthcare products Regulatory Agency, in its wisdom,
has decided that “reclassification is the only way to restrict the
availability” of pseudoephedrine and ephedrine products and that “rigourous
supervision of pharmacy sales of single packs would not impact on the known
practice of purchasing small quantities from multiple pharmacies”.
Is this the same MHRA which told us that reducing the pack size of paracetamol,
etc, has been successful in reducing the number of suicides? It still seems
remarkably easy to buy two packs of 16 tablets from the local supermarket
and one pack of 32 from each pharmacy in the village, and I have not yet
had to try the petrol station.
Pharmacists are responsible professionals. We have now had our attention
drawn to a potential abuse problem. For years, and with few exceptions,
we have controlled the sale of codeine linctus and cyclizine tablets without
reclassification. Once our awareness is raised we are more than capable
of controlling the supply of another medicine that is open to abuse. On
a regular basis, (numerous times each day), we refuse to sell pseudoephedrine
products to hypertensive patients, pregnant women and others, recommending
safer alternatives. We do a superb job in keeping healthy patients with
bad colds out of busy GP surgeries, minimising risk of infection of other
more seriously ill patients who really do need to see a doctor.
As a final thought, perhaps alcohol and tobacco, both potentially harmful
to far greater numbers of patients should also become POM?
Diana Taylor
CPPE Tutor for Doncaster, Wakefield and Barnsley
Community Pharmacy Clinical Governance Facilitator, Doncaster Primary Care
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Pharmaceutical Journal