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Though banned as a supplement, ephedrine can be sold as an over-the-counter drug when formulated with an asthma medication. |
Wayne King II and Bunny Maxey celebrated when the U.S. Food and Drug Administration banned ephedrine supplements.
King and Maxey hoped that the ban would help Alicia King, Wayne's wife and Bunny's daughter. They thought the change would make it easier for Alicia to shake her ephedrine habit.
Their hopes didn't pan out. The ban took effect last month, but Alicia King continued to buy and use ephedrine. The type she favored was not included in the FDA action.
King purchased her ephedrine daily at convenience stores near her Stafford County home. Eight days after the ban took effect, she died from an apparent overdose.
The Office of the Chief Medical Examiner in Richmond performed an autopsy. The cause of death is still pending, though the King family said it would be surprised if it was anything other than an overdose of ephedrine.
The family agreed to talk about her death to illustrate the potential dangers of ephedrine and to show how it is still available on retail shelves, despite the national ban.
Ephedrine can be purchased legally at dozens of Fredericksburg-area convenience stores. And despite the FDA's action, prohibited ephedrine products also could be purchased at several locations last week.
Ephedrine is a stimulant that occurs naturally in some plants. The FDA estimates that 12 million people were using it in dietary supplements prior to the ban. Users said that it aided weight loss and improved athletic performance, though clinical studies disputed that.
The agency said that ephedrine posed an unacceptable risk of heart attack, stroke and death. One of its most celebrated users was Steve Bechler, a 23-year-old pitching prospect for the Baltimore Orioles. Bechler died during spring training last year. An autopsy concluded that his use of ephedrine was a contributing factor.
The FDA ban included all dietary supplements containing ephedrine alkaloids, such as ephedra, ma huang, Sida cordifolia and pinellia. It took effect April 12.
One of the banned products, Ultra Energy Now, was still on Fredericksburg store shelves last week. The 99-cent foil packets could be found at the 7-Eleven on Lafayette Boulevard and at Snellings Markets.
The principal ingredient in Ultra Energy Now is ma huang, according to its label. Because of that, the product should not be sold, said a FDA spokeswoman last week.
Ted Snellings, owner of Snellings Markets, said he was not aware that he was selling a prohibited product. Snellings said he relies on his distributor to maintain his counter display and stock it only with legal products.
Snellings removed Ultra Energy Now from his William Street store and his Harrison Road store in Spotsylvania County on Thursday after learning that it was banned.
Nauman Peerwani, franchisee of the 7-Eleven on Lafayette Boulevard, also removed Ultra Energy Now from his store on Thursday after learning that it was banned. Peerwani said he, too, relied on a distributor.
"She told me she would send me only those products that I am able to sell," he said.
Margaret Chabris, spokeswoman for the 7-Eleven chain, said Friday that the Dallas company notified its franchisees late last year that the federal ban was imminent. It recommended that they remove dietary supplements containing ephedra from their shelves, she said.
After learning that Peerwani's store was still selling a banned product, the company checked with all of its Fredericksburg-area stores late last week to make sure that they had removed the supplement, Chabris said.
"He certainly wants to be in compliance," Chabris said.
The FDA ban does not include another form of ephedrine, marketed under names such as "Double Action Ephedrine" and "Ephedrine Plus." This form is sold as an over-the-counter drug for relief for asthma and is available in dozens of local convenience stores.
At local Fas Marts, signs tell customers that they may purchase no more than two bottles a day. At one 7-Eleven, a sign says that minors may not buy it.
The asthma-relief ephedrine is usually not displayed with other over-the-counter drugs, such as headache or cold remedies. Instead, customers must ask for it at the register. Two store clerks said last week that this was because people were stealing it.
The product is not covered by the ban because it is considered an over-the-counter drug, said the FDA spokeswoman.
As an over-the-counter drug, it is subject to FDA regulations on dosing, manufacturing, packaging and labeling.
"Ephedrine Multi-Action," for example, can be purchased in a 40-tablet bottle for $5 to $7. Each tablet contains 25 milligrams of ephedrine and 200 milligrams of guaifensin, an asthma drug.
The label on the back of the bottle lists a recommended dosage of one tablet every four hours, and no more than six tablets per day. Users also are told that the product is recommended for temporary relief of symptoms, and they are warned not to use the product unless they have been diagnosed with asthma by a doctor.
The FDA says that this over-the-counter form of ephedrine, with its drug label and mandatory warnings, "has not been associated with the same magnitude of reported adverse events" as the dietary supplements.
The relatives of Alicia King would disagree with that.
King was 28 and a stay-at-home mother for her three small children. She had been using ephedrine as a stimulant for more than three years, they said.
She was addicted to the drug and required ever-larger doses to reach the same level of satisfaction, family members said. She would take a handful of pills at a time, followed by another handful a few minutes later.
"Within 15 minutes, she'd take the whole bottle," said Wayne King, who works as an electrician for the Metro system in Washington.
King said that it was not unusual for his wife to take between 240 and 300 tablets a day, or more than 40 times the recommended dosage.
Her addiction created a dilemma for the family. Without the drug, she was irritable and difficult to live with, Wayne King said.
Yet, the pills were expensive--up to $30 a day--and took an obvious toll. She lost weight and damaged her kidneys, liver and teeth.
At 5 feet, 6 inches and 100 pounds, "she looked like a bag of bones. Her clothes fell off her," Maxey, her mother, said.
At various times, King tried hiding his wife's car keys and asking the clerks at the convenience stores near their home on Hope Road not to sell to her. Nothing seemed to work.
Her mother confronted her daughter several times, calling her habit "the snake," and telling her, "You're stepping on the snake."
Alicia King was treated for her habit at Mary Washington Hospital and Snowden of Fredericksburg, a psychiatric hospital, according to the family.
She was released from Snowden in February and had been drug-free for nine weeks. However, on April 19, Wayne King woke to find that his wife had already gone to the Fas Mart near their home and bought more ephedrine. She was crying and apologized to him.
That evening he found her unconscious on the couch. The rescue squad took her to Mary Washington Hospital, where she died the next day.
King said he would support extending the ban to the type of ephedrine that his wife used.
"It's legalized speed," he said.
An FDA spokesman said in an e-mail response to a query, "We are unable to predict if there will be any changes regarding the status of ephedrine as an [over-the-counter] broncodilator."
To reach JIM HALL: 540/374-5433 jhall@freelancestar.com
