How ephedrine escaped regulation in the United States: A historical review of misuse and associated policy

Objective Ephedrine is not only efficacious in the treatment of numerous ailments, but also has a long history of misuse. Research was needed to examine ephedrine policy over time in order to determine potential regulatory flaws that allowed misuse to continue.Methods This review is based on primary literature derived from systematic searches of historical and scientific archives, as well as grey literature.Results Ephedrine managed to pass through numerous regulatory loopholes within seventy years. Despite warnings of misuse over the latter half of the century, ephedrine, and its herbal source, ephedra, were regulated in a piecemeal fashion and remained easily available to the public. Health authorities have struggled to control ephedrine, as an amphetamine "look-alike," as a methamphetamine precursor, as a dietary supplement, and as a medication. Despite being a potentially dangerous stimulant, under-regulation was perhaps more problematic than the substance itself.Conclusions Tighter control of all ephedrine products, drugs and dietary supplements alike, might have prevented adverse outcomes and allowed this substance to remain available in a safer manner. Stringent regulation of all ephedrine products is necessary to prevent misuse and to protect the public's health.