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Comment by Zarathust | Hacker News Reader

In Canada you can still buy that over the counter. You get id-ed and they keep a record of your purchases, but since it's now generic pills it is now much cheaper than it was before

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I grew up in Germany in a household that never used nasal decongestants, probably out of some fear that they might be dangerous.

When in Canada a doctor told me to buy some pseudoephedrine pills to treat a clotted ear and I found the experience so nice, that when back in Germany I walked into a pharmacy to get some.

The looks...

Japan is similarly puritanical about stimulants. Might have something to do with the way those drugs were used in those countries during the war…

It is the same in the US, but the FDA calls it "behind the counter". OTC means you grab it off a shelf yourself, BTC means the pharmacy checks your ID, and gives it to you, but still no prescription required.

https://www.fda.gov/drugs/information-drug-class/legal-requi...

OTC normally means that it doesn't require a prescription.

OTC just means "Over the counter" or "without a prescription". A good way to test this is to see if your health insurance in the US will pay for it - most won't pay for OTC drugs.

Behind the counter just means there is less chance of folks stealing it and more control over who buys it and the amounts they buy.

There is generally a good amount of things you can get at the pharmacy that are like this: Most of the time, they are simply ordered if someone wants them because there isn't enough demand to keep it on the shelf. Most require no ID either: Sweet almond oil (for ears) is the example I can think of.

Related: In some states, they require a prescription for it because their laws are stricter than the federal guidelines.

It's the same in the US; you can buy it without a prescription, but you have to have your ID logged.

A few pharmacies weren't set up to take either a foreign ID or a US passport when the program started.

I ended up just buying it on Postmates, delivered, no ID check.

Is shake and bake easy? Seems pretty trivial

I'm guessing your courier got ID checked.

We'll be there soon. You still need a prescription in Oregon until Jan 1, 2022.

And there's a limit on how much you can buy at a time, you can only get 15 24-hour pills every 15 days, which means you need a regular pharmacy trip

FDA pressured loperamide manufacturers to stop selling large quantity bottles because people thought eating a whole bottle was a good idea.

Problem: taking massive amounts of loperamide to get an opiate effect is a myth

Of course, the manufacturers were all happy to fall in line anyway and dramatically raise per-tablet prices (and packaging!)

Except one manufacturer.

Several years ago, I bought a 200-ct bottle for US$9 shipped to Canada. Now it's US$36.

Tell me who needs 200-ct bottles of imodium. People who observe proper hygiene have food poisoning maybe once in 10 years (and whether a motility agent is a good idea in such cases is another question).

People that ignore expiry dates. And at least in our household's case, a clinically ignored case of endometriosis.

a clinically ignored case of endometriosis

That's exactly what I mean (and the sibling posting is more of the same). If you need more than six doses in a row then you should see a physician for a thorough workup because loperamide is just for the symptoms. The package will say as much. It's really hard to find fault with the FDA coming down on the extended-family size packaging.

I meant the clinician's ignorance about endometriosis.

The package will say to take 2 tabs stat and 1 after each loose bowel movement. Not hard to go through a dozen+ each menstrual cycle.

I'm sorry you had to put up with a hippocratic oaf. This should never have happened.

I have chronic gastrointestinal issues and the best "treatment" for them has been taking one every morning (on the recommendation of my GI doctor). This change has made it a lot more expensive and inconvenient to deal with.

In a just world, you'd get a 3 month supply covered like your normal prescription. It is an injustice that it isn't.

It’s not a myth so much as it’s not particularly effective: large doses of it (dangerously so, I might add, people should not do this) are quite effective in getting rid of opioid withdrawals — and not just the peripheral effects.

In extremely large doses it has a distinctly weird feeling. I wouldn’t call it getting high, so I’d suppose that is indeed a myth, but gosh it feels hard on your heart at those doses.

Typically it’s addicts trying to avoid withdrawals (and who felt they did not have access to other opioid replacement therapies for various reasons) that tried that. Some died.

Problem: taking massive amounts of loperamide to get an opiate effect is a myth.

A decade or so ago I was reading a drug forum where an addict-chemist reported that acylating loperamide extracted from OTC pills allowed it to pass the blood brain barrier and deliver a true opiate high. His only reported test subject was himself, so I don't know if it was a genuine effect or not. And I haven't kept up with drug forums in recent years to see if this idea/technique spread. If so, it could explain the pill quantity restrictions; pseudoephedrine went through many years of changes in packaging/formulation as manufacturers tried to keep their products OTC while placating governments that didn't want those pills used as illicit drug precursors.

There's also an age minimum. My freshman year of college I had the sniffles and a bad cough. I went to the pharmacy to get some Sudafed but couldn't purchase since I was still 17. Went to the school's health center where the doctor happily prescribed me opioids (the infamous purple drank).

That really surprised me once. I was traveling in the states and wanted to buy pseudoephedrine, and the guy asked me for my id, asked me to sign a log book, and then proceeded to unlock a giant safe behind him.

New Zealand banned it some years ago and I'm still pissed off. The supposed replacement is clinically useless, and I resent suffering through massive head pain from clogged sinuses every winter, while professional gangs still make money hand over fist from meth.

I was in Vegas some years back and got some under the laxer US rules, and have enjoyed a few years of having it available, but alas my supply has run dry.

Can you order it from an online Australian pharmacy?

Or know someone here who can ship some over to you?

They ID you in Oz, but it's fairly easy to get. Pharmacists know the PE stuff is junk!

I've also found Ritalin works as a decongestant too! (for which I have an ADHD prescription)

I didn’t get IDed either of the times I’ve bought a box.

First time was in 2019: I went to Walmart for something for my ears on flights, after some back and forth the pharmacist recommended me pseudoephedrine.

Second time was in Sobeys last month (can fly again, yaaay) and I asked for it directly. The pharmacist had some trouble finding it, but sold it to me with no further issue.

A bit of a change was that it became pharmacy-only in many (most?all?) provinces. But pharmacies are everywhere, so not a huge deal.

Sad thing is many products were reformulated with phenylephrine, an uncontrolled similarly structured molecule that's completely junk as a decongestant.

Keep an eye out if you purchased Sudafed PE or Sudafed original. PE is a new product that has old fashion Acetaminophen and is sold just like any other painkiller since that's all it is. It doesn't work well at all compared to the pseudoephedrine found in the behind the counter product.

This isn't true.

Sudafed PE is phenylephrine. It is not a pain killer, and it does not have the same safety profile as acetaminophen (Paracetamol for some of you). Not saying either is actually unsafe, but the drug interactions will most definitely differ and you might find yourself suffering.

I totally agree that it doesn't work very well.

Chances are that you bought the useless Sudafed PE. The (original) Sudafed is pseudoephedrine. Sudafed PE is phenylephrine. The molecules are similar, but the latter cannot be easily converted to methamphetamine so it is not regulated like the former. Sudafed is an effective nasal decongestant, while Sudafed PE is equivalent to a placebo. [1]

[1] https://pubmed.ncbi.nlm.nih.gov/19230461/

Can still buy it over the counter in the UK too.

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