Published on

Published in: Health & Medicine, Technology
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide


  1. 1. Pseudoephedrine Misuse and Regulation Vince Buttrick, Jinender Kumar, Sami Musleh, Angela Nikolakis, Ahmad Sayed, Shawn Smith
  2. 5. <ul><li>These people are addicted to </li></ul><ul><li>Methamphetamine- also known as </li></ul><ul><li>Crank, speed, crystal meth, ice </li></ul><ul><li>Methamphetamine is illicitly manufactured from pseudoephedrine, the active ingredient in many over-the-counter cold medications </li></ul>
  3. 6. Chemistry <ul><li>Pseudoephedrine </li></ul><ul><li>-a phenethylamine </li></ul>
  4. 7. Chemistry <ul><ul><li>Pseudoephedrine is a diastereomer of ephedrine </li></ul></ul><ul><ul><li>Diastereomers: stereoisomers that are not enantiomers; not mirror images </li></ul></ul><ul><ul><li>Ephedrine: Pseudoephedrine: </li></ul></ul>
  5. 8. Chemistry <ul><li>As a sympathomimetic amine, pseudoephedrine relies on its indirect stimulation of the adrenergic receptor system to produce its effects </li></ul><ul><li>The principal mechanism by which pseudoephedrine achieves its effects is by displacing noradrenaline (norepinephrine) from storage vesicles in presynaptic neurons </li></ul>
  6. 9. Chemistry <ul><li>Once the norepinephrine is displaced from storage vesicles, it is released into the neuronal synapse </li></ul><ul><li>At the neuronal synapse, the norepninephrine becomes available to activate the alpha and beta postsynaptic adrenergic receptors </li></ul>
  7. 10. Chemistry <ul><li>The alpha and beta receptors are located on the muscles lining the walls of blood vessels </li></ul><ul><li>Activation of the receptors by pseudoephedrine causes muscle contraction, resulting in vasoconstriction of the blood vessels </li></ul>
  8. 11. Chemistry <ul><li>By constricting the blood vessels, less fluid is capable of leaving the blood vessels and entering the nose, throat, and sinus linings </li></ul>
  9. 12. Chemistry <ul><li>The end result of pseudoephedrine results in decreased inflammation of nasal membranes, as well as decreased mucous production </li></ul>
  10. 13. Chemistry <ul><li>Methamphetamine </li></ul><ul><li>Pseudoephedrine </li></ul>
  11. 14. Chemistry <ul><li>Methamphetamine is a central nervous system stimulant </li></ul><ul><ul><li>Meth Mechanism of Action </li></ul></ul>
  12. 15. Indications: <ul><li>For treatment of Nasal, Sinus and eustachian tube congestion. </li></ul><ul><li>For treatment of vasomotor Rhinitis. </li></ul><ul><li>As an adjunct to other agents in optimum treatment of allergic rhinitis, sinusitis,otitis media and tracheobronchitis. </li></ul><ul><li>Could also be used as first line therapy for priapism. </li></ul><ul><li>Used as off label indication for urinary incontinence. </li></ul>
  13. 16. Adverse effect <ul><li>Common adverse effects include CNS stimulation, sleeplessness, nervousness, excitability, dizziness, anxiety. </li></ul><ul><li>Infrequent adverse effect include tachycardia and/or palpitation. </li></ul><ul><li>Rare adverse effect could be hallucination, arrhythmia, seizure, ischemic colitis, recurrent pseudo scar Latina, systemic contract dermatitis, stroke. </li></ul>
  14. 17. Precautions <ul><li>Should be used with caution in patients with diabetes mellitus, cardiovascular disease, hypertension, Prostatic hypertrophy, hyperthyroidism, closed angle glaucoma and/or pregnancy. </li></ul><ul><li>When used for nasal congestion, try appropriate alternative like topical decongestant, saline spray/instillations depending on patient condition. </li></ul>
  15. 18. Contraindication <ul><li>Concomitant or recent (previous 14 days) use of monoamine oxidase inhibitor. </li></ul><ul><li>Severe/uncontrolled hypertension, and /or severe coronary artery disease. </li></ul><ul><li>People with bipolar disorder as it can cause insomnia and thus can trigger a manic episode. </li></ul>
  16. 19. Manufacture <ul><li>pseudoephedrine occurs naturally as an alkaloid in certain plant species for example, as a constituent of extracts from the ephedra species, also known as Ma Huang in which it occurs together with other isomers of ephedrine </li></ul><ul><li>Ma Huang has been used in traditional Chinese medicine for 5,000 years for the treatment of asthma and hay fever, as well as for the common cold. </li></ul>
  17. 20. Manufacture <ul><li>The majority of pseudoephedrine produced for commercial use is derived from yeast fermentation of dextrose in the presence of benzaldehyde. </li></ul><ul><li>In this process, specialized strains of yeast typically a variety of Candida utilis or Saccharomyces cerevisiae are added to large vats containing water, dextose, and the enzyme pyruvate decarboxylase </li></ul>
  18. 21. Manufacture <ul><li>After the yeast has begun fermenting the dextrose, the benzaldehyde is added to the vats. </li></ul><ul><li>In this environment, the yeast converts the chemical precursor ingredients to 1-phenylacetylcarbinol (L-PAC) </li></ul><ul><li>In the final step of the synthesis, the L-PAC undergoes reductive amination to produce pseudoephedrine </li></ul>
  19. 22. Manufacture <ul><li>The countries which contribute to the bulk production of PSE include India and China, due to their optimum economic and industrial conditions </li></ul>
  20. 23. Why Pseudoephedrine is Misused <ul><li>Very similar to chemical structure of amphetamines which is used to make methamphetamines </li></ul><ul><li>Previously easy to obtain; over the counter </li></ul>
  21. 24. Ways of Obtaining PSE <ul><li>Smurfing: multiple purchases at one location </li></ul><ul><li>Shelf-Sweeping: theft of all medications containing pseudoephedrine from a shelf stock </li></ul><ul><li>Shoplifting </li></ul><ul><li>Theft from wholesalers </li></ul>
  22. 25. Ingredients to Make Methamphetamies
  23. 26. Ingredients to Make Methamphetamines <ul><li>Cold Medicines/Decongestants that contain PSE </li></ul><ul><li>Iodine </li></ul><ul><li>Distilled Water </li></ul><ul><li>Red Phosphorus (matches and road flares) </li></ul><ul><li>Ether (camping fuel, brake cleaner, starting fluid, paint thinner, toluene, or acetone) </li></ul><ul><li>Coffee Filters </li></ul><ul><li>Rock Salts </li></ul><ul><li>Lithium (batteries) </li></ul><ul><li>Denatured Alcohol (gasoline additives) </li></ul><ul><li>Muratic Acid </li></ul><ul><li>Kitty Litter </li></ul><ul><li>Anhydrous Ammonia </li></ul><ul><li>Foil, Funnels, and Tubing </li></ul>
  24. 27. Ways PSE is Misused in The Manufacture of Methamphetamines <ul><li>Made by reduction of PSE </li></ul><ul><li>Involves hydrogenation of the hydroxyl group on the PSE molecule </li></ul><ul><li>Most common way is called “Red, White, and Blue Process” because it involves red phosphorus, PSE (white), and blue iodine </li></ul><ul><li>Increasingly common method is Birch reduction which uses anhydrous ammonia and lithium to reduce PSE </li></ul>
  25. 28. Ways to Misuse <ul><li>Smoking: not really smoking because it is actually vaporizing to produce fumes. Also called “Clucking”; fastest and most potent effect. </li></ul><ul><li>Injection: a.k.a. “Slamming”. Biggest Risk- easier to overdose (anywhere from 125 mg to 1 gram can fit through a small needle), infection, skin rashes, and HIV. </li></ul><ul><li>Less Common Ways: Snorting, Swallowing, and Anal Insertion </li></ul>
  26. 29. Effects of Misusing <ul><li>Immediate Effects: Inc. energy, euphoria, excessive swelling, loss of appetite, insomnia, agitation, tremor, panic attacks, inc. libido, dilated pupils, nausea, diarrhea. </li></ul><ul><li>Chronic Use Effects: addiction, weight loss, withdrawal-related depression, tooth decay (“meth mouth”), high blood pressure, seizures, skin ulcers, and amphetamine psychosis (mild craziness) </li></ul><ul><li>Tolerance occurs rapidly. Repeated over stimulation of dopamine receptors cause down regulation of the receptors. </li></ul>
  27. 30. Dangers of Misusing <ul><li>Overdose can cause: brain damage, Meningitis (lead poisoning), meth bugs ( sensation of bugs crawling under the skin), paranoia, delusions, hallucinations, Rhabdomyolysis (muscle breakdown), and death. </li></ul><ul><li>Meth labs cause 194 fires, 117 explosions, and 22 deaths in 2002. </li></ul><ul><li>Dump sites cause death in livestock, contaminated streams, and dead vegetation </li></ul>
  28. 31. Dangers of Misusing <ul><li>Meth labs cause 194 fires, 117 explosions, and 22 deaths in 2002. </li></ul>
  29. 32. Ways to Stop PSE From Being Misused <ul><li>Many stores and pharmacies have policies where the drug must be kept behind a counter, limiting purchase sales, a minimum age requirement with identification, and some require a signature. </li></ul>
  30. 33. Pseudoephedrine Laws <ul><li>In 2005, the Committee on Education & Workforce heard testimony regarding rising methamphetamine production </li></ul><ul><li>Combat Methamphetimine Epidemic Act (CMEA) passed by Congress as an amendment to the Patriot Act </li></ul><ul><li>Signed into law March 6 th , 2006 by President Bush </li></ul><ul><li>Regulate over-the-counter sales of ephedrine and pseudoephedrine </li></ul>
  31. 34. Pseudoephedrine Laws <ul><li>Each pharmacy must keep a copy or electronic logbook which contains: </li></ul><ul><ul><li>Name of person purchasing, receiving or acquiring the ephedrine, pseudoephedrine, or PPA. </li></ul></ul><ul><ul><li>Address of the person purchasing, receiving or otherwise acquiring the ephedrine, pseudoephedrine, or PPA be properly recorded by the seller in the log. </li></ul></ul><ul><ul><li>Date and time of sale </li></ul></ul><ul><ul><li>Name and quantity of the controlled substance sold </li></ul></ul><ul><ul><li>5) Purchaser must sign the logbook </li></ul></ul>
  32. 35. Pseudoephedrine Laws
  33. 36. Pseudoephedrine Laws
  34. 37. Pseudoephedrine Laws
  35. 38. Pseudoephedrine Laws <ul><li>The pharmacy may not sell the product unless the customer provides an ID even if you know the person </li></ul><ul><li>Must be 18 years or older to purchase </li></ul><ul><li>Regulated products are to be sold behind the counter or in a locked cabinet in such a way as to restrict public access </li></ul><ul><li>A retrievable record of all purchases identifying the name and address of each party to be kept for two years </li></ul><ul><li>Daily sales of regulated products not to exceed 3.6 grams or 9 grams per month </li></ul><ul><li>Non-liquid dose form of regulated product may only be sold in unit dose blister packs </li></ul><ul><li>Anyone who makes a materially false, fictitious, or fraudulent statement to the U.S. Government is subject to criminal penalties. Penalties may include a fine of up to $250,000 and or imprisonment for up to five years </li></ul>
  36. 39. Effect of Laws Since the Combat Methamphetamine Epidemic Act of 2005, methamphetamine lab seizures have decline by nearly 50%. *2006 study by the Drug Enforcement Agency Methamphetamine Lab Seizures in the US Year Seizures 1999 7,438 2000 9,902 2001 13,357 2002 16,212 2003 17,356 2004 17,710 2005 12,484 2006 6,435
  37. 40. Now What?
  38. 41. Additional Measures of Prevention <ul><li>Stricter Regulations </li></ul><ul><ul><li>Hong Kong and Canada </li></ul></ul><ul><ul><li>Life imprisonment </li></ul></ul><ul><li>Schedule III drug </li></ul><ul><ul><li>Oregon & Kansas by prescription only </li></ul></ul><ul><li>Montana Meth Project </li></ul><ul><ul><li>Ads to horrify addicts or anyone considering use </li></ul></ul>
  39. 42. Drug Reformulation <ul><li>Phenylephrine is a recent reformulated compound that has been marketed as a substitute for Pseudoephedrine. </li></ul><ul><li>It is used as decongestant orally or as a nasal spray. </li></ul><ul><li>Phenylephrine uses the same pathway as PSE but does not release noradrenaline. Therefore it is less likely to cause CNS stimulation like PSE. </li></ul>
  40. 43. Optical Isomer <ul><li>Optical isomer used in PSE products are </li></ul><ul><ul><li>D-pseudoephedrine (L-PSE) </li></ul></ul><ul><ul><li>L-pseudoephedrine (D-PSE) </li></ul></ul><ul><ul><li>L-PSE has fewer side effects and fewer CNS stimulations yet remains a good decongestant. </li></ul></ul><ul><ul><li>L-PSE isomer does not reduce to D-PSE which is the isomer used to produce methamphetamine. </li></ul></ul><ul><ul><li>Currently, Pfizer/Warner-Lambert holds this patent but it is not yet approved for public sale. </li></ul></ul>
  41. 44. Conclusion <ul><li>What is Pseudoephedrine? </li></ul><ul><li>common decongestant used to relieve symptoms associated with colds or respiratory allergies, such as nasal, sinus, and Eustachian tube congestion. </li></ul><ul><li>Effects are achieved by indirect stimulation of the adrenergic receptor system in the SNS. </li></ul><ul><li>Adverse effects include: CNS stimulation, sleeplessness, nervousness, excitability and anxiety </li></ul>
  42. 45. Conclusion <ul><li>Critical ingredient in the manufacturing of methamphetamine. </li></ul><ul><li>The Combat Methamphetamine Epidemic Act of 2005 regulates and restricts the sale and distribution of PSE. </li></ul><ul><li>This act was passed to help control the production of methamphetamine </li></ul>
  43. 46. Questions?