Ephedrine legal despite ephedra ban

Ephedra, the herbal supplement blamed for the deaths and injuries of numerous athletes, was banned in Illinois last month.

But ephedrine, a drug experts say has similar physiological effects, still is being sold. And a check of pharmacies shows stores also are stocking pills marketed to aid in weight loss and give users more energy — the same qualities for which ephedra was promoted.
Even so, lawmakers, drug experts and the man most responsible for the ban, Gov. Rod Blagojevich, said there is less to fear from these substances than from ephedra.

The law forbidding the sale of ephedra, signed May 28 by Blagojevich, allows continued over-the-counter sale of ephedrine-containing remedies regulated by the Food and Drug Administration. Ephedrine, the synthetic drug, is available in over-the-counter products such as Primatene Tablets and Bronkaid. But ephedra, the herb often mixed with caffeine in products such as Yellow Jackets, has been banned.

Sean Riggins, a 16-year-old Lincoln High School football player, died last year of heart failure after using Yellow Jackets. Ephedra also has been blamed in the death of 23-year-old Baltimore Orioles pitcher Steve Bechler during Major League Baseball’s spring training this year.

Ephedra speeds the heart rate, increases blood pressure and constricts blood vessels.

“There is a known toxicity from ephedrine, the chemical, in both humans and in animals,” said Paul Coates, the director of the Office of Dietary Supplements at the National Institutes of Health, or NIH. “The kinds of adverse events with ephedra exposure, like Riggins and Bechler, are similar to ephedrine.”

But Coates noted that fewer injuries have been linked to the FDA-approved drug. He said that is because ephedrine is marketed as medicine, it is not combined with other compounds such as caffeine, and it is sold in small doses.

Still, Anne Thurn, the director of the Evidence-Based Review Program in NIH’s Office of Dietary Supplements, said some states are considering requiring that products containing ephedrine be kept behind the counter to make it more difficult to buy large quantities of the drug.

Illinois is not one of those states. Sen. Barack Obama, D-Chicago, who sponsored the legislation banning ephedra, said lawmakers will revisit the issue if necessary.

Kevin Riggins, Sean Riggins’ father, spearheaded the drive to ban ephedra in Illinois. He said the continued presence of ephedrine on the shelves does not worry him.

His son and many of Sean’s peers used Yellow Jackets, which come in three-pill packages. The FDA has banned their import.

“I think someone comes in looking for a sports enhancement-type product, they’re not going to go toward an asthma medication,” Riggins said.

He is scheduled to appear June 24 before a California legislative committee to testify in favor of a ban. He said Blagojevich has agreed to write a letter to California Gov. Gray Davis urging a ban.

Riggins, who testified before a U.S. Senate committee in favor of a national ban, said outlawing ephedra in California is important because that state is the home to major dietary-supplement manufacturers. Ephedra remains available to Illinoisans who purchase it on the Internet or cross state lines.

In Lincoln, where the city council banned ephedra even before the state did, pharmacies have replaced ephedra-containing diet and energy pills with herbs from a similar family that are not banned under the new law.

Citrus aurantium, also known as bitter orange, contains the stimulant synephrine. Products such as Xtreme Lean and Stacker 2 have bitter orange and promote themselves as pep pills that are “ephedra free.”

Coates said synephrine is from the same chemical family as ephedrine and little is known of the dangers of its use, though he said it appears to place less stress on the body than ephedra.

But Coates offered a note of caution. As with ephedra, deaths or serious injuries are what typically alert the public and the scientific establishment to the risks of lightly regulated dietary supplements.

“There is no mandatory reporting for adverse events associated with any dietary supplement,” he said. “We don’t know until something happens.”