8 ms·

I live in a country where this scheme is already the norm (Saudi Arabia) and I can say that while it's not necessarily ideal, I much prefer it to the alternativ

I live in a country where this scheme is already the norm (Saudi Arabia) and I can say that while it's not necessarily ideal, I much prefer it to the alternative. It plugs some seriously annoying holes in the healthcare experience and frees up doctors' time for more patients. As it is, the only medications that require a prescription to buy in Saudi are psychotropic ones, narcotics, and most recently, antibiotics. Things like insulin, birth control medications, hypertension medications, even antidepressants and anti-psychotics- they are all OTC. And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor. The reason that this is the norm here is twofold; one, health insurance wasn't much of a thing here until a few years ago. The second reason (and the reason health insurance didn't factor in until recently) is that the socialized healthcare system here was (and still is) stretched thin; seeing a doctor to get prescriptions for every little thing becomes prohibitively difficult, with appointments taking months. It's asinine to expect someone suffering from, say, an acute athsma attack to try to navigate ERs or try to see a doctor on short notice during a crisis, when a pharmacist would be able to dispense the exact medication needed, leaving the others free for more complex cases that need closer attention. Edit: this actually created a bit of culture shock for an older friend of mine. He was traveling to an EU country for the first time and didn't do his homework- he thought he he could simply walk into any pharmacy and ask for a pack of his cholesterol medication, as he usually does back home. I don't envy the poor pharmacist that had to keep trying to explain the dispensing system to him and to emphasize that yes, they are aware that it's Lipitor, not morphine, it's just how the regulation is.

bumholio 8y ago
I find it doubtful that Atorvastatin was not available for health/risk reasons. I can buy it cash in 5 minutes, no questions asked. What tends to happen in some EU countries is that the retail drugs are heavily subsidized by the government, and then all kinds of kludges are put in place to prevent people buying bulk quantities and reselling them in some other EU country where the price is much higher - the export itself being 100% legal on the single market.
- Lanthanide 8y ago
  The subsidy/export explanation does make a lot more sense, since it's not exactly in a high-risk drug class. I suppose those regulations could have been misinterpreted by him to mean he needed a prescription. (unless Austria, where this happened, really does have very strict OTC drug laws on medical grounds)
Engineering-MD 8y ago
I’m not I agree. The first reason is that many medications carry significant risks. For instance you mention insulin. For someone already prescribed insulin, yes it should be easy to access in case they should be able to get more (and that is the purpose of a repeat prescription). However, to provide insulin over the counter to someone never previously prescribed it could be incredibly dangerous, and indeed fatal. This is Similarly true for some cardiac medication. Second, i think such a system makes pharmacists de facto community doctors, but without the time, training, or patient medical data to function correctly. Community doctors can make better decisions when they see the same patient multiple times, and have access to blood pressure readings, a list of other medical conditions etc. Buying over the counter makes a lot of this difficult and inefficient. Third, I think it leads to a risk of encouraging patients to manage conditions without valid medical advice. For instance, depression is often treated best with psychotherapy. By buying antidepressives OTC, it prevents patients getting the holistic care needed. Similarly, patients may follow quack medical advice and do themselves significant injury by taking medications not needed (in the short term or long term). Ultimately doctors offer a lot of value more than just prescribing medication, and often medicines need oversight to ensure the benefits outweigh the risk.
- mirimir 8y ago
  I can't imagine safely prescribing anti-hyperlipidemia and anti-hypertension drugs without medical advice. Sure, we can all measure our own blood pressure. But choosing which anti-hypertension drug to use, or which combination, is nontrivial.
  - microcolonel 8y ago
    > But choosing which anti-hypertension drug to use, or which combination, is nontrivial. Then why not consult a doctor? It is already an immense legal risk to recommend starting a course of drugs like this without seeking medical advice, I don't see why it would be any different if you could technically self-administer an anti-hypertension drug.
    - tptacek 8y ago
jessaustin 8y ago
Things like... hypertension medications, ...are all OTC. This would be so nice. Every time I switch providers, I have to hear the same tired "Lisinopril is the modern blood pressure medication and it's certainly all that you need!" "No asshole, it doesn't work for me and it makes me cough 17 times a minute, 1440 minutes a day. Just give a water pill, which does work and has worked for years."
- StillBored 8y ago
  This is actually what irritates me and keeps me away from doctors. Its seems to be 99% seat of the pants guess work, and in my case the doctors seem to have a pretty poor batting average. I get that antibiotics are over-prescribed, but do I really need to have the same test run again for the 3rd time to see if I'm lying about the antibiotic not doing a darn thing? I get that treatment is frequently trial and error when it comes to medications, but the doctor/patient/pharmacist loop is BS, particularly for minor/frequent issues. Take for example that I seem to run myself into poison ivy a couple times a year while mountain biking. Do I really need to fight to see a doctor/nurse/whatever just to have the same prescription I've gotten the last couple years straight? Or for that matter, maybe I should experiment more with stronger allergy medications to avoid the nasty withdraw I seem to get from prednisone. Worse, what irritates me, is like the GP, it seems a lot of the common "safe" prescriptions in the US are over the counter in the rest of the world.. I know this, but got myself quite a surprise last time I was in mexico, because the hotel gift shop had viagra next to the advil!
api 8y ago
Off topic but: birth control is OTC in Saudi Arabia? That busts a stereotype.
- Lanthanide 8y ago
  Aisle 5, right next to the condoms and lube bottles =) and Victoria Secret makes money hand over fist here. This would be off-topic here, but I think most people outside of the region would be stunned about the state of sex-change operations over here. They happen VERY frequently, albeit with a heavy veil of privacy.
  - avar 8y ago
    Male -> female or female -> male? I have no desire to have a sex-change, but if I had to choose between living as a woman in Saudi Arabia and having invasive surgery and hormone therapy, I might choose the latter.
    - Lanthanide 8y ago
      Both. Anecdotally I’d actually say that the ratio of MTF surgeries to FTM ones is higher than usual over here.
- fjsolwmv 8y ago
  Assuming that Christian laws apply to an Islamic country is a strange stereotype.
flyGuyOnTheSly 8y ago
I have always thought that it was completely asinine and unnecessary that my female friends were having to visit a doctor to renew a prescription that rarely changed for years at a time.
talltimtom 8y ago
“ And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor.” When people start self prescribing antibiotics even for minor stuff, it’s not a problem because of the minor risks to them, but because of the major risk to the entire society. We are seeing more and more antibiotic resistance germs and if we don’t collectively work to reduce antibiotic usage we end up exasperating the issue.
- saiya-jin 8y ago
  you didn't catch the part where he mentions antibiotics are still for prescription and went on a tirade about overuse of antibiotics (which is a topic on its own but unrelated to parent)
AngryData 8y ago
Do you guys also allow drug advertisements? The only problem I see is our drug producers here using advertising to push people into buying and using drugs that they really shouldn't be using and inadvertently causing themselves a myriad of additional health problems. Im 100% for people being able to use whatever drug they wish, provided that they actually know what they are taking and what it does. Any half decent advertiser though would leave that as an open-ended as legally possibly interpretation in order to drive sales though.
- Lanthanide 8y ago
  Not in the US style of drug ads, but not completely banned either; things like Tylenol and the various cold and flu drugs can be advertised. I’ve never seen ads for something that would be prescription-only in other countries except for Viagra and a coupe of other ED drugs, and that’s an edge case. As far as I can see all drug advertisements (including things such as social media promotions) have to be approved by the Saudi FDA, and they don’t seem lenient at all in allowing ads for anything beyond the aforementioned meds.

bumholio 8y ago

I find it doubtful that Atorvastatin was not available for health/risk reasons. I can buy it cash in 5 minutes, no questions asked. What tends to happen in some EU countries is that the retail drugs are heavily subsidized by the government, and then all kinds of kludges are put in place to prevent people buying bulk quantities and reselling them in some other EU country where the price is much higher - the export itself being 100% legal on the single market.

Lanthanide 8y ago
The subsidy/export explanation does make a lot more sense, since it's not exactly in a high-risk drug class. I suppose those regulations could have been misinterpreted by him to mean he needed a prescription. (unless Austria, where this happened, really does have very strict OTC drug laws on medical grounds)

Engineering-MD 8y ago

I’m not I agree. The first reason is that many medications carry significant risks. For instance you mention insulin. For someone already prescribed insulin, yes it should be easy to access in case they should be able to get more (and that is the purpose of a repeat prescription). However, to provide insulin over the counter to someone never previously prescribed it could be incredibly dangerous, and indeed fatal. This is Similarly true for some cardiac medication. Second, i think such a system makes pharmacists de facto community doctors, but without the time, training, or patient medical data to function correctly. Community doctors can make better decisions when they see the same patient multiple times, and have access to blood pressure readings, a list of other medical conditions etc. Buying over the counter makes a lot of this difficult and inefficient. Third, I think it leads to a risk of encouraging patients to manage conditions without valid medical advice. For instance, depression is often treated best with psychotherapy. By buying antidepressives OTC, it prevents patients getting the holistic care needed. Similarly, patients may follow quack medical advice and do themselves significant injury by taking medications not needed (in the short term or long term). Ultimately doctors offer a lot of value more than just prescribing medication, and often medicines need oversight to ensure the benefits outweigh the risk.

mirimir 8y ago
I can't imagine safely prescribing anti-hyperlipidemia and anti-hypertension drugs without medical advice. Sure, we can all measure our own blood pressure. But choosing which anti-hypertension drug to use, or which combination, is nontrivial.
- microcolonel 8y ago
  > But choosing which anti-hypertension drug to use, or which combination, is nontrivial. Then why not consult a doctor? It is already an immense legal risk to recommend starting a course of drugs like this without seeking medical advice, I don't see why it would be any different if you could technically self-administer an anti-hypertension drug.
  - tptacek 8y ago

jessaustin 8y ago

Things like... hypertension medications, ...are all OTC. This would be so nice. Every time I switch providers, I have to hear the same tired "Lisinopril is the modern blood pressure medication and it's certainly all that you need!" "No asshole, it doesn't work for me and it makes me cough 17 times a minute, 1440 minutes a day. Just give a water pill, which does work and has worked for years."

StillBored 8y ago
This is actually what irritates me and keeps me away from doctors. Its seems to be 99% seat of the pants guess work, and in my case the doctors seem to have a pretty poor batting average. I get that antibiotics are over-prescribed, but do I really need to have the same test run again for the 3rd time to see if I'm lying about the antibiotic not doing a darn thing? I get that treatment is frequently trial and error when it comes to medications, but the doctor/patient/pharmacist loop is BS, particularly for minor/frequent issues. Take for example that I seem to run myself into poison ivy a couple times a year while mountain biking. Do I really need to fight to see a doctor/nurse/whatever just to have the same prescription I've gotten the last couple years straight? Or for that matter, maybe I should experiment more with stronger allergy medications to avoid the nasty withdraw I seem to get from prednisone. Worse, what irritates me, is like the GP, it seems a lot of the common "safe" prescriptions in the US are over the counter in the rest of the world.. I know this, but got myself quite a surprise last time I was in mexico, because the hotel gift shop had viagra next to the advil!

api 8y ago

Off topic but: birth control is OTC in Saudi Arabia? That busts a stereotype.

Lanthanide 8y ago
Aisle 5, right next to the condoms and lube bottles =) and Victoria Secret makes money hand over fist here. This would be off-topic here, but I think most people outside of the region would be stunned about the state of sex-change operations over here. They happen VERY frequently, albeit with a heavy veil of privacy.
- avar 8y ago
  Male -> female or female -> male? I have no desire to have a sex-change, but if I had to choose between living as a woman in Saudi Arabia and having invasive surgery and hormone therapy, I might choose the latter.
  - Lanthanide 8y ago
    Both. Anecdotally I’d actually say that the ratio of MTF surgeries to FTM ones is higher than usual over here.
fjsolwmv 8y ago
Assuming that Christian laws apply to an Islamic country is a strange stereotype.

flyGuyOnTheSly 8y ago

I have always thought that it was completely asinine and unnecessary that my female friends were having to visit a doctor to renew a prescription that rarely changed for years at a time.

talltimtom 8y ago

“ And I think they should remain so, because from what I've seen the damage from misusing those drugs against pharmacists' advice is far less than the damage from going without them due to the difficulties encountered in seeing a doctor.” When people start self prescribing antibiotics even for minor stuff, it’s not a problem because of the minor risks to them, but because of the major risk to the entire society. We are seeing more and more antibiotic resistance germs and if we don’t collectively work to reduce antibiotic usage we end up exasperating the issue.

saiya-jin 8y ago
you didn't catch the part where he mentions antibiotics are still for prescription and went on a tirade about overuse of antibiotics (which is a topic on its own but unrelated to parent)

AngryData 8y ago

Do you guys also allow drug advertisements? The only problem I see is our drug producers here using advertising to push people into buying and using drugs that they really shouldn't be using and inadvertently causing themselves a myriad of additional health problems. Im 100% for people being able to use whatever drug they wish, provided that they actually know what they are taking and what it does. Any half decent advertiser though would leave that as an open-ended as legally possibly interpretation in order to drive sales though.

Lanthanide 8y ago
Not in the US style of drug ads, but not completely banned either; things like Tylenol and the various cold and flu drugs can be advertised. I’ve never seen ads for something that would be prescription-only in other countries except for Viagra and a coupe of other ED drugs, and that’s an edge case. As far as I can see all drug advertisements (including things such as social media promotions) have to be approved by the Saudi FDA, and they don’t seem lenient at all in allowing ads for anything beyond the aforementioned meds.