When it comes to medication, we usually think of two types: prescription and over-the-counter. But as you probably noticed, a few years ago, some of the cold and flu medications available without a prescription moved from the publicly accessible shelves to behind the counter — only available if you specifically ask a pharmacist for them.
So what’s behind the move? And why did some cold medications wind up guarded by the pharmacist while others remain on display next to the antifungal cream? Let’s find out.
The USA Patriot Act — signed into law in 2006 — typically conjures up images of post-9/11 policies intended to keep terrorism at bay. While that’s partially true, it also contained a provision that required all cold and allergy medications containing the ingredients pseudoephedrine, ephedrine and phenylpropanolamine be moved to behind the counter. According to Dr. Edmond Sarraf, Genexa medical expert and attending physician at Cedar Sinai Medical Center, this was because of the influx of methamphetamine, aka crystal meth, production.
“People were buying large quantities and breaking it down to be used in the production of illegal drugs, including speed/methamphetamines,” Dr. Ehsan Ali, a concierge doctor practicing in Beverly Hills, tells SheKnows. “Sudafed or any medicine that has pseudoephedrine in it, are some of the ones found behind the counter because they’re a decongestant that also acts as a stimulant meant to treat a runny nose and/or common cold.”
Eventually, law enforcement officials became increasingly aware more children and young adults were buying these OTC meds in large quantities to make meth, which was heavily contributing to the opioid epidemic we are still combating today in the United States, Sarraf says.
“Fast-forward to January 2018, when the FDA recently banned opioid ingredients in children's cough medications to prevent unwarranted deaths,” he adds. “Year over year, the FDA has banned more ingredients in medicines that have been found to be unsafe or deadly.”
In addition to concerns over crystal meth production, the move to behind-the-counter medications also affected those that contain codeine — like certain cough syrups, Dr. Susan Besser, a primary care provider at Mercy Personal Physicians at Overlea, explains. She says these medications were relocated because of the possibility of abuse.
“Codeine is an opioid, and we have all heard about the current epidemic relating to that,” Besser adds.
Instead of having products containing pseudoephedrine on the shelves, many pharmacies put cards with a photo and description of the medication on the display. This allows you to select what you want and bring it up to the pharmacist at the counter.
Also know that the pharmacy is supposed to be keeping track of your purchases of the behind-the-counter medications. Amy Lanctot, CVS spokesperson, tells SheKnows all their pharmacies are connected to the MethCheck database, and their electronic log system prevents sales of drugs that contain pseudoephedrine to an individual beyond the permissible limits set by federal and state laws.
It’s a pretty long list, but some of the major ones are: Advil Allergy Sinus, Advil Cold and Sinus, Aleve-D Sinus and Cold, Children's Advil Cold, Children's Motrin Cold, Claritin-D, Mucinex D, Sudafed 12 Hour Pressure/Pain, Sudafed Triple Action, Theraflu Max-D Severe Cold and Flu, Tylenol Sinus Severe Congestion Daytime and Zyrtec-D.
This is a tricky one. While the opioid epidemic isn’t exactly getting better, Ali says moving some cold medications behind the counter is working because now it’s considerably harder to buy drugs with these potentially dangerous ingredients — not to mention that each customer is only allotted a limited quantity.
If nothing else, this move has made consumers more aware of the ingredients in their medications and reinforced the notion that it’s important to look at drug labels, Sarraf says. Given the opioid crisis is at an all-time high, he notes the FDA is becoming more cooperative with ingredient transparency — which he thinks is a step in the right direction.
“Not only should these medications stay behind the counter, the ingredients used to make them should be used to a minimum, which has already happened in most European countries,” Sarraf says. “Just like there is a movement for organic fruits and vegetables, there should be a movement for organic ingredients to make healthier medicines.”
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