My drug of choice for colds is NyQuil. It's always been great for opening up my nasal passages enough to let me breathe easily and then knocking me the fuck out so I could sleep off most of the cold.
I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo.
Only a couple years later did I make the connection that this was right when they passed the law restricting pseudoephedrine. I got my hands on some NyQuil D and everything was back to normal and I had a functioning cold remedy again.
NyQuil is a combination medicine. The cough, cold and flu formula contains Tylenol (fever/pain reliever), DXM (stops cough) and an antihistamine (dries out your runny nose/postnasal drip).
NyQuil can be a great all-in-one product when it's what you need. It's useful to know what it is composed of and why. All of the medicines in it treat symptoms, not the underlying cause, which will be fought off by your immune system. If you have only one or two symptoms, you can always buy each drug separately - doing so allows you to more precisely control dosage and timing as well.
FYI, two other common symptoms not covered above are sinus congestion - which can be treated with Sudafed - and chest congestion (e.g. a phlegmy cough) - which can be treated with Mucinex.
Antihistamines do not directly dry up your runny nose/post nasal drip. Rather, they reduce the histamine response, which is helpful when something is caused by allergies. It's usually not that helpful with an actual cold (but allergic rhinitis is often mistaken for a cold).
Sudafed is what the parent was referring to with Pseudophedrine; a decongestant. This works by shrinking blood vessels, causing swollen passageways to open back up. It doesn't actually do anything to reduce the runny nose or post nasal drip, but by opening the passages more can help them drain more efficiently, preventing that feeling of congestion (hence the name).
Guaifenesin (Mucinex being the name brand) is an expectorant; it causes you to generate more mucus, and reduces the viscosity, allowing you to cough/sneeze/etc your mucus/phlegm based congestion out more easily.
Otherwise I totally agree; it is worth understanding what each of these do so you can pick and choose what you need. Nyquil includes DXM (dextromethorphan) to reduce cough severity, but the acetaminophen is not helpful unless you have a fever or headache, and the Doxylamine Succinate and Phenylephrine (both antihistamines; the Doxyl is added to Nyquil because it's also a sleep aid) aren't particularly helpful unless your cold symptoms are actually allergy related.
Better to buy DXM separately usually; fewer side effects, cheaper, and you can pair it with what else will help you (if you need something to help you sleep, you can add Doxyl or Diphenhydramine if you want; YMMV as to how effective they are)
Don't take Guaifenesin before bed (the increased mucus/phlegm production will make it harder to sleep), but it's good during daytime.
A common side effect of Sudafed is trouble sleeping; if you don't have this side effect it can be helpful in reducing congestion while you try and sleep, but if you do have this side effect, obviously, don't take it before bed.
Do any of these compounds actually do what they say? I have always found all cold medicines to be entirely worthless. Supposedly a study found guaifenesin to be no better than a placebo:
So the treatment of symptoms, in general, leads to some really inconsistent results, as it's really hard to measure them. Some studies have definitely found guaifenesin to not be helpful (others have), but the way all of them measure it is...questionable. Ultimately, what a user wants is a subjective experience of "I feel better", but what is being tested for is stuff like "what concentration of inhailed capsaicin leads to them coughing".
So generally my take is "hey, this is what it's been found effective for, and it's generally regarded as safe to take. Is it going to help here, for you, in this situation? Who knows! Give it a whirl if you got the money and want to try".
Guaifenesin is mostly useless and only approved so that they can stick it next to your dextromethorphan as an emetic to stop you from abusing it. I was vomiting from COVID and I was incredibly pissed off when I found out it was actually just because they poisoned my cough syrup on purpose.
Prior to the regulation of pseudoephedrine, NyQuil also contained pseudoephedrine and since the nasal congestion from a a virus can often be the most disruptive factor for sleep (at least, in my personal experience, that's the case) it's considered by some to the be most important component.
NyQuil with pseudoephedrine included is now marketed as "NyQuil D" and is available behind many pharmacy counters with the same restrictions as other pseudoephedrine products. However, it could also rightly be called "NyQuil Classic" (to borrow branding from Coca-Cola).
While true, the cocaine is processed out of the leaves themselves and sold to pharmaceutical companies. The remaining leaf product is used in the flavoring.
I’m not sure if it is still legal, but importing “coca tea” - that is, tea bags filled with shredded coca leaves - was legal at some point and a few enterprising folks imported a few kilos of it and processed it into the drug.
It's still legal to buy decocanized coca leaves but I think the odds of getting anything worthwhile out of it would be slim and probably more expensive than a plane ticket to Peru.
NyQuil also contains alcohol and pseudo (in some formulations).
My pet theory is that NyQuil's biggest effect is simply to make you mildly "faded" so all your symptoms are more tolerable. DXM, the antihistamine, the pseudo, and the alcohol are all drugs that would definitely do that if taken in larger doses. While NyQuil doesn't have those larger doses, the combination of all of them may amplify the otherwise weaker effects into a general buzz/haze that helps you go about your day/night.
Sort of! There isn't consistent evidence that -any- antitussive is more effective than placebo. A majority of studies show a statistically significant result for DXM, but not all, and they aren't fully replicable which definitely calls it into question. But that's true of every purported cough suppressant, and there's understandable reasons for that; coughing is a voluntary response to irritation, so there's definitely a lot going to determine whether you cough or not on beyond a purely autonomous system response. Plus there's not really much clarity in how to measure improvement (reduction in frequency may not actually be a reduction in irritation; reduction in severity is hard to measure. Etc).
So, really, for a given incident, try it, see if it helps. If it does, great, if it doesn't, stop taking it.
On one hand, we're decriminalizing drugs. Pot is widely legal now. Other states are allowing mushrooms and LSD. Cocaine and heroin are not legal, but have all but been decriminalized on the West Coast.
Meanwhile it's harder than ever to get pain killers from your doctor, even when you have a demonstrated need for them. Same with ephedrine -- a very useful drug -- it's very difficult to get even when in need. And if you mention enjoying tobacco products, you're treated as a leper.
I wish we had a self-consistent view of the issue.
It's not inconsistent to treat different things differently and different drugs are radically different in their individual health and societal effects.
I live in Seattle where marijuana is legal. Alcohol and marijuana are widely consumed and I rarely see any large-scale problems from it. Obviously, there are many people who can't handle either of those, but their failure to handle it well seems to not impinge on others as much. And, compared to them, there are a huge number of people able to consume alcohol and marijuana in a safe, healthy, non-problematic way.
I also live next to a couple of homeless encampments. Many of the people living there are clearly addicted to opioids and/or meth. In just this month and within a mile of my house:
* I saw a woman, topless, brandishing an umbrella, wandering between the sidewalk and into the street screaming at no one.
* A man was shot in the stomach in front of a food bank.
* Another man was shot in the neck at an encampment.
* A drive-by shot up an RV and car. (The people inside fortunately weren't hit.)
There's more I'm sure but these are just the ones I know about in the last few weeks.
It's entirely consistent to say that we should treat drugs that lead to the latter behavior differently from drugs that don't. Opioids and meth are incredibly destructive. I'm not saying what specific policies I advocate for them, just that it is reasonable to have different policies for those drugs compared to others.
You don't see anyone who is using opioids in the privacy of their own home who aren't out on the streets, so your sampling is massively biased.
And the way we should look at drug addition with opiates isn't by looking at the homeless users, but consider the fact that we're all potentially one bad car accident away from getting hooked on pain killers, and asking what kind of support we would need to avoid winding up homeless due to that.
Punishment via the criminal justice system is what is likely to wind up with you losing your job and winding up out there in that camp with them. So how should you be treated if it happens to you?
And the glib answer of "put a bullet in my head" or whatever isn't an acceptable response. Treat the problem seriously and propose how society helps you help yourself to get clean without at trip through a homeless camp. And the people who refuse to deal with the reality that it could happen to them or engage with the problem are likely those most at risk of lacking the self-awareness to recognize when it starts happening to them.
> You don't see anyone who is using opioids in the privacy of their own home who aren't out on the streets
I also don't see anyone who is using alcohol and marijuana in the privacy of their own home.
My sampling is biased in that it doesn't accurately reflect the percentage all people using those various drugs. But it is (I believe) relatively unbiased in that it shows that of the people whose drug use concurrent with homelessness a much higher fraction of them are using opioids or meth compared to booze and pot.
I think there is a reasonable inference there that using opioids or method is much more likely to result in homelessness than using booze or pot.
Again, I'm not making any claims about what our policies should be for opioids and method. All I claim is that it's entirely reasonable to have different policies for them versus booze, pot—hell, caffeine—because while, sure, they are all technically drugs, they are radically different in how they affect individuals and society at large.
I'll also point out that I didn't suggest criminalizing hard drug use. Also, of the four epidodes I described, only one is about drug use itself. The other three were violent crimes whose victims were homeless people.
Alcohol, marijuana and caffeine aren't anywhere near as likely to lead to someone losing their job.
You've observed that the most highly criminalized drugs are used by the people who have probably been the most affected by trying to use the criminal justice system as our drug treatment program.
You need to disentangle the effects of the drug from the effects of how we treat the users of the drug. You can't look at the end product at attribute it entirely to the inherent properties of the substance. You're not observing it in a sociological vacuum.
The fallout from the over-criminalization of opioids, meth, etc is a big reason that you're observing these behaviors. Stigmatizing drug use perpetuates the punitive approach to this problem. If the law treated addiction and the abuse of hard drugs with compassion rather than the draconian approach that we have in place currently you'd be seeing a lot less of this stuff.
This post could have easily been written about alcohol in the prohibition era. We've since learned that criminalizing alcohol makes its impact on society worse rather than better. We can't strip drug users of their autonomy and their ability to lead any sort of normal life and then act surprised when they turn to crime or turn back to drugs when they have nothing left.
> This post could have easily been written about alcohol in the prohibition era. We've since learned that criminalizing alcohol makes its impact on society worse rather than better.
> Across the Hudson River, in Manhattan, the number of patients treated in Bellevue Hospital’s alcohol wards dropped from fifteen thousand a year before Prohibition to under six thousand in 1924. Nationally, cirrhosis deaths fell by more than a third between 1916 and 1929. In Detroit, arrests for drunkenness declined 90 percent during Prohibition’s first year. Domestic violence complaints fell by half.
Of course, one can still find Prohibition objectionable, or think that the costs outweighed the benefits. But there is strong evidence that Prohibition succeeded in reducing some of the negative impacts of alcohol use.
Interesting, thanks! I think I mostly took issue with the idea that throwing drug users in jail is the best course of action, and the condescending/judgemental tone of the original comment. I think we can dissuade substance use and abuse through other means (better drug education and rehabilitation, taxation, non-felony level criminalization) that will be a good middle ground between no drug laws and the draconian life-ruining ones that we have in place right now.
Essentially by rules a patient asking for higher dosage of an addictive drug is automatically seen as a sign of addiction, even if sometime it might just be that the current dosage is too low.
I just finished reading The Urge: Our history of Addiction. If you're interested in some background on how we got here, the author does a great job of laying out the historical, legal, and social constructs that have resulted in the inconsistent mess.
There is probably some truth to this but it is worth noting the opiod epidemic is largely why it's hard to get pain killers now. A few of the pharma companies have settled that they sort of knew people were taking them from pharmacies and selling them on the black market.
In several cities they are now citations. You may get a fine for possession but you will not be arrested. In Portland for example the ticket is around $150, which is about the same as the fee for an expired vehicle registration. This change in policies has basically stopped enforcement. As you can imagine it is not a profitable practice to ticket the unhoused.
In Canada you can find cough & cold medications in both the Phenylephrine and Pseudoephedrine formulation, often under near-identical labels (IIRC one can buy "Tylenol Cough and Cold" with either active ingredient, for example - carefully checking the label is the only way to tell). I didn't realize there was a difference until one day after running out of Phenylephrine-based medication I bought the Pseudoephedrine-based one - it was a night and day difference! Now I tell everybody with a cold to check the labels and buy the good stuff.
Interesting case study in being able to sell a low-quality product (one of the most important active ingredients doesn't work!) side-by-side with a much better product and most people won't ever notice that one is better.
In US, same deal, but you have to show your ID at the counter to obtain the pseudophedrine version. Phenylephrine is so useless. Nothing worse than getting to a store after pharmacy hours and being forced to only get the useless garbage.
From what I've read, d-amphetamine[0] was the decongestant of choice for much of the 20th century. It's just that the counterculture weirdos were abusing it and that led to its restriction. Compared to pseudoephedrine its way more useful with minimal side effects like drinking a cup of coffee.
I mentioned in my last comment that Sudafed had effects in treating my ADHD.
Ultimately I couldn't use it this way more than a few days a week or I'd get lower back pain. I've also tried steeping ephedra tea but did not notice any effects on concentration.
Later on when I was formally diagnosed and prescribed proper meds I was placed on Adderall first and had similar unwanted side effects after a time. Ultimately, I settled on Dexedrine and no more side effects (other than insomnia if I take it too late) and haven't felt a need to up the dose for years now. It does still have decongestant effects like the other two.
Considering I'm caffeine dependent and can't cycle off daily intake without crippling headaches, where I cycle Dexedrine off on the weekends/holidays without any withdrawal effects, I'd have to agree: So long as it's a therapeutic dose it's on-par or safer than coffee.
That's dangerous to think it's the same as coffee. You can have a daily coffee when pregnant but we don't know about a daily dl-amphetamine. Not even close to the same side-effect profile. Coffee doesn't dilate your eyes, for starters. It's just not the same as a dopaminergic
Well, it's not the only study, it's just an example. I think it was already generally considered safe but doctors were worried it might be passed on through breastfeeding.
Sure but I would not equate with coffee which empirically we know can be well-tolerated by most of the population basically from birth to death.
Adderall (dl mixture) is just not the same. We know Adderall tends to exacerbate acne and some forms of dermatitis but we don't know how much. We don't know if the pupil effects contribute to driving incidents. We don't know if dry mouth from Adderall is worse for dental health than the dry mouth that some people get after heavy espresso or other stimulating substances, like pseudoephedrine. We don't think the risk of paranoid behavior is high but it is higher than coffee, of course.
And of course some not insignificant portion of the population can tolerate coffee or pseudoephedrine, but we're not too sure about Adderall. Schizophrenic, bipolar, OCD individuals, those with tics, tachycardia, etc, need to tread carefully with stimulants, even maybe sudafed.
I believe you're just not supposed to drink alcohol on Pseudoephedrine because you'd be combining an upper with a downer, and it's very easy to go overboard with the downers when you're on an upper (tolerance to alcohol increases dramatically and increases overdose risk along with all the other side effects and risks.)
So a small amount of alcohol won't really have much of an effect, I'd claim.
I don't know about this medication in particular (since I don't live in the US), but I see it contains DXM (dextromethorphan), which is a dissociative (such as ex. ketamine), which probably causes the effects you described. I'm seeing it also contains acetaminophen, which probably makes it hard on your kidneys, if you take too much, so that is probably why people don't abuse it more (I guess or hope).
in the US Robitussin DM is the one you get if you aim for disassociation(?) - NyQuil is explicitly a sleep aid with some other stuff mixed in, I'd have to go dig a bottle out but i think the active ingredient is an anti-histamine (diphenylhydramine i think) - as a sleep aid, mind you. It is true that NyQuil used to have alcohol, and didn't have DXM or acetaminophen. If the liquid you are looking at is Orange, that's the "daytime" stuff, and that's overpriced garbage.
One could buy generic "tussin DM" (or pill form of dextro), mucinex (for guafenasin), and benadryl (or generic diphenylhydramine) to get the same usefulness that a bottle of liquid NyQuil has.
Didn’t they also drop the alcohol percentage? It’s 10% now (I know this because post Covid I seem to be catching EVERYTHING), I could have sworn it was 14% or higher growing up.
This may be regional, but it's been 10% here for as long as I can recall - although the alcohol free version is much more prevalent than it used to be.
This works for one or two nights with me, and then it feels like I've built up a tolerance to it and I think that it actually keeps me awake. I'll use it if I have a cough which keeps me awake, and, if I time it right, I'm pretty good at recovering within a day or two.
I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo.
Only a couple years later did I make the connection that this was right when they passed the law restricting pseudoephedrine. I got my hands on some NyQuil D and everything was back to normal and I had a functioning cold remedy again.
Phenylephrine is completely useless.