Pseudoephedrine is a substance that naturally occurs in the plant Ephedra sinica, which is referred to as ma huang in traditional Chinese medicine. The substance is chemically related to amphetamine and often used in the illicit production of the central nervous system stimulant methamphetamine (crystal meth).
Pseudoephedrine is a common decongestant medication used in the treatment of colds, hay fever, and the flu. It is found in many over-the-counter medications, such as Sudafed, Sinutab, Allegra-D, and Claritin-D. The drug has also been used to enhance athletic performance and may be banned by many professional athletic associations.
Because it has been recognized as an ingredient that is used in the illegal production of methamphetamine and methcathinone (a chemical often used in the production of bath salts), pseudoephedrine is subject to controls and monitoring by the United States Drug Enforcement Administration. Despite this, it is not listed as a controlled substance.
The major concern regarding abuse of pseudoephedrine is the ease with which it can be manufactured into more powerful stimulants such as methamphetamine. Federal law limits the amount of pseudoephedrine any person can buy at one time. It also requires that purchasers produce a photo ID and that retailers keep records of sales of this drug for a minimum of two years.
Mechanism of Action
Pseudoephedrine and its sister drug ephedrine are classified as sympathomimetic amines, meaning that they have stimulant-like effects that increase the activity of the cells in the sympathetic nervous system, part of the peripheral nervous system that is associated with controlling the fight-or-flight mechanism.
These drugs also reduce the effects of nasal congestion and can be used as appetite suppressants. Both pseudoephedrine and ephedrine were at one time the main ingredients in many over-the-counter dietary supplements.
These cold medicines are so closely related to amphetamine that only mild alterations to their structure can produce very powerful central nervous stimulants like methamphetamine.
Abuse of Pseudoephedrine
Unaltered pseudoephedrine is a drug that has been abused by individuals, mostly younger individuals, due to its over-the-counter availability. When individuals can get their hands on a sufficient amount of the drug, they can use it to experience its stimulant-like effects.
Abusers of pseudoephedrine report that they experience:
- Increased feelings of energy and alertness
- Extreme euphoria and wellbeing
- A pleasant tingling sensation over their bodies
These effects do not occur at the recommended medicinal levels of the drug, but can only occur when individuals use significant amounts of the drug and snort it or even mix it in liquid and inject it. There are no solid and reliable statistics regarding the prevalence of pseudoephedrine abuse or current statistics on other drugs that are produced from pseudoephedrine, like methamphetamine. It appears that pseudoephedrine abuse is relatively rare due to the controls placed on its purchase.
Signs of cold medicine abuse include:
- Red eyes
- Dilated pupils
- Increased energy
- Loss of appetite
- Difficulty sleeping
- Weight loss
At high doses, it would be expected that individuals may develop signs associated with amphetamine abuse, such as high blood pressure, sweating, increased heart rate, and psychiatric symptoms like paranoia and hallucinations.
Side effects associated with pseudoephedrine abuse include:
- Increased thirst
- Dry mouth
- Muscle weakness
- Tightness in the chest
- Increased blood pressure
- Irregular heartbeat
- Tremors, in extreme cases
- Potential seizures
- Nausea, vomiting, and/or diarrhea
There is no evidence that abuse of pseudoephedrine results in physical dependence (withdrawal symptoms). As with most stimulant substances, tolerance most likely develops rapidly. Based on the diagnostic criteria for stimulant withdrawal put forth by the American Psychiatric Association, some individuals who chronically abuse the drug and then suddenly discontinue its use could likely experience issues with:
- Negative mood states like depression, anxiety, apathy, and irritability
- Extreme lethargy and sleepiness
- Increased appetite
- Vivid dreams that are unpleasant
- Problems with nasal congestion
- Cravings for the drug
Combining alcohol and cold medicines is most likely a very common practice among younger individuals. When an individual mixes a stimulant like pseudoephedrine with alcohol, the effects of both drugs are dampened. Because most individuals are limited in the amount of pseudoephedrine they can obtain and abuse, the result of combining these two substances would most likely be that the individual would unknowingly consume more alcohol than normal, because the effects of the stimulant would dampen the intoxicating effects of the alcohol. The situation could lead to issues with alcohol toxicity or extreme intoxication. Over the long run, the continued practice of abusing alcohol and pseudoephedrine could lead to a significant acceleration of the detrimental effects associated with use of both drugs.
There is no formal withdrawal management protocol associated with recovery from the abuse of pseudoephedrine or cold medicines. Physicians could give medications that are specifically designed to treat the symptoms the person is experiencing, such as lethargy or depression.
The treatment protocol should address the specific needs of the individual with the substance abuse issue and at the same time follow the overall general principles associated with the effective treatment of substance use disorders. These principles have been outlined by the National Institute on Drug Abuse (NIDA) and would include:
- Making sure that the person gets treatment immediately
- Using medications and psychotherapy in conjunction
- Treating any co-occurring mental health issues along with the person’s substance use disorder
- Making the person accountable for their behavior
- Getting family members involved in the individual’s recovery process
- Ensuring that the individual remains in treatment for a sufficient length of time
Younger individuals often respond to groups that are filled with their peers, such as group therapy with others of similar ages. Since younger individuals are more at risk to develop pseudoephedrine abuse issues, this should be taken into consideration.