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I've actually run into issues with drug laws from a side I never even thought about: prescription medication. I have asthma, but I don't have health insurance.

I've actually run into issues with drug laws from a side I never even thought about: prescription medication. I have asthma, but I don't have health insurance. Asthma inhalers in my country require a prescription. I know what inhaler I need and I know how to use it, but I cannot legally purchase it. I have to go make a doctor's appointment, pay them a bunch of money so they can write a note that permits me to buy that inhaler. It's a lot of hassle and some cost. The end result is that I just don't have an inhaler. If I get difficulty with breathing I'll just drink coffee and wait until it goes away. Without prescriptions being required for something like this (eg more relaxed drug laws), I wouldn't have this issue.

x86_64Ubuntu 6y ago
I ran into the same issue. And Dr.s offices have pretty much become churn factories for insurance billing, so I hate the fact that I have to go through them. To get around them, I found that Mexican and Indian pharmacies would send me inhalers. The only issue is that it took so long to get to the US, but it seemed to be as good as the US stuff.
agency 6y ago
The comedian Hannibal Buress (who has asthma) has a funny bit about this in his most recent special [1]. He talks about how asthma gets a raw deal compared to other illnesses and isn't taken seriously at all (nerdy stereotypes etc) and how insane it is that you need to keep renewing a prescription for such a necessary and life-saving substance. As if there are people out there getting messed up on albuterol. [1] http://www.youtube.com/watch?v=kVc4-05Agf0&t=18m33s http://www.youtube.com/watch?v=kVc4-05Agf0&t=18m33s
- derefr 6y ago
  You know what's bizarre for requiring a prescription? Peridex — chlorhexidine mouthwash. You can buy chlorhexidine gluconate concentrate (which is still not all that "concentrated" — something like 2% w/v) in the form of a medical or veterinary scrub — or even a floor cleaner — over the counter. But dilute it to 0.15% (at which concentration it would now become not-painful to put it in your mouth; but also would cause it to expire after a couple of days) — and then add the stabilizers and preservatives to it necessary to have it last a few months at STP? Well, now it's a prescription product. As far as I'm aware, there are no risks from "chronic" use of Peridex as one's every-day mouthwash. Chlorhexidine does the same thing the alcohol in regular mouthwash does — it kills bacteria in your mouth. The only difference is that chlorhexidine sticks around keeping your mucus membranes aseptic for around eight hours (if you don't eat anything), compared to an alcoholic mouthwash's couple-of-minutes. So it actually protects you on a long-enough timescale for your body to get in there and clear out any biofilms causing you gingivitis, canker sores, enamel erosion, etc. — rather than just treading water in the fight against those. I almost wonder whether the mouthwash companies are in some sort of mutually-assured destruction arrangement, where they all would like chlorhexidine mouthwash to be something they could sell OTC, but they don't want their competitor to be the first to sell it OTC (and win the market by advertising increased effectiveness), and they're willing to lobby to keep it prescription-only so that that doesn't happen.
  - gamblor956 6y ago
    The only difference is that chlorhexidine sticks around keeping your mucus membranes aseptic for around eight hours (if you don't eat anything), compared to an alcoholic mouthwash's couple-of-minutes. So it actually protects you on a long-enough timescale for your body to get in there and clear out any biofilms causing you gingivitis, canker sores, enamel erosion, etc. — rather than just treading water in the fight against those. It also kills off the good bacteria in your mouth, and if ingested the bacteria in your digestive system, which is why the formulation designed for ingestion is subject to prescription. The floor cleaner version is similar to the ingested version but it is not the same thing and the differences matter.
    - derefr 6y ago
      Yes, but... alcoholic mouthwashes also kill the good bacteria in your mouth, and your digestive system if ingested. So does regular drinking alcohol, for that matter. (In fact, both OTC mouthwashes and high-ABV beverages tend to kill good gut and mucosal flora in preference to the bad ones, because the good flora are highly adapted to the ecological niche that only pertains in the "normal" ecological environment of the body.) But neither alcoholic mouthwashes, nor alcoholic beverages, are prescription-only. > and if ingested ... which is why the formulation designed for ingestion There are all sorts of things sold OTC for putting in your mouth or other mucus membranes, that would harm you if you swallowed the active dose. Eye drops, for example. Governments generally trust people to just... not do that. They require that the manufacturer put instructions to not ingest the thing on the label, and that's usually the end of it. Also, there is a reason that mouthwashes have child-proof caps! They are, in fact, dangerous in general if you don't know what you're doing with them! But chlorhexidine is no more dangerous than your average mouthwash. And far less dangerous than other things you can get ahold of without a prescription. (And, given the implication of gingivitis gingipains in Alzheimer's, it might turn out to be a lot more dangerous to not sterilize your gums. Especially if you're old, immunoincompetent, and/or have lost many of your teeth, exposing more of the gum surface to regular microabrasion. Enabling OTC access to chlorhexidine mouthwashes could very well be highly-positive in global QALYs.) > The floor cleaner version is similar to the ingested version but it is not the same thing Yes, my point wasn't that you should put floor cleaner in your mouth; my point was that someone can buy things that contain a large amount of chlorhexidine gluconate OTC very easily — sometimes even pure! — and anyone who cares could then just distill the active ingredient out to ensure purity. It's not like these are intentionally denatured; none of the other ingredients have the same molecular weight.
- CaptainZapp 6y ago
  Can't your doctor just write a long term prescription? I need an asthma inhaler, which is prescription only. My doc writes out a prescription, which allows me to pick it up at any pharmacy for the duration of a year (can also be a shorter period). After that he writes a new one year prescription. This is quite common here if you need a regular supply of specific prescription medication. This is not allowed for controlled substances, which have specific prescriptions (multiple copies), which a doctor must obtain officially and is not allowed to copy. But for any other prescription medication, which is required over a longer period the prescription usually reflects that. Is that illegal in other countries?
  - consp 6y ago
    I don't know for asthma medication but for insulin it used to be 1 year max and has been unlimited since about 15 years here in the Netherlands as it is chronic. If you change types/dosage (concentration) you need a new prescription.
    - Scoundreller 6y ago
      Oddly in Canada, insulin doesn’t require a prescription. No idea how we decided on that one. Really dangerous to mess up, used in homicides, etc. Life-preserving, but so is pretty much everything else in a pharmacy, mostly over a longer-time period, but not always.
  - srtjstjsj 6y ago
    1 year is less long then most people need to breath. Bonus, in the US you can miss refills due to insurance squabbles leaving you with 0 medication unless you pay huge out of pocket.
- bserge 6y ago
  As a matter of fact, yes, albuterol is used by bodybuilders and "adrenaline junkies" I guess. It's an adrenergic agonist, works somewhat like coffee, but with different/stronger effects. Oral intake is the best, although inhalation works OK. Clenbuterol is overall better for that purpose, though. Still doesn't change the fact that it should be OTC.
- Broken_Hippo 6y ago
  People are most definitely getting messed up on albuterol. Pretty much any inhaler, actually. Same with those vapor nose sticks that - folks take the pellet out and get high. Nyquil and other cough syrups? Yup, folks are getting high off of it. That cold medicine for folks with high blood pressure? Yup. Mucinex? Check. Pretty much anything for asthma? Yup. And slews of other medications. This is why you have pharmacies that keep some medications behind the counter, even though there is a spot on the shelves and they are OTC: These are high theft items. But then again, I've seen someone get high in the pharmacy from a can of canned air. (I used to work at a pharmacy in the states).
SllX 6y ago
I have the exact same problem and the exact same condition. The justification is kids “might use them to get high” but as far as I’m concerned it’s a handout to Doctors. An inhaler is only $25 without insurance. Recently I have been able to setup a video call with an urgent care clinic to just write me the damn prescription and add about a year’s worth of refills, $50 for the call, but it’s still stupid I can’t just walk in and buy an inhaler off the shelf. You didn’t specify a country, but if you can setup a call with a doctor, I would encourage you to go that route. It’s still more money than you should have to pay, but it’s better than going in person and in my experience, a lot cheaper.
- luckylion 6y ago
  > The justification is kids “might use them to get high” but as far as I’m concerned it’s a handout to Doctors. That's also such a weird concept in 2020. Kids can just buy literally any drug they want on the dark net and have it shipped to their homes, they don't need to drink a gallon of cough syrup or use inhalers to get high. It's interesting that you can get refills on a single prescription. I'm in Germany, and all doctors I've ever been to go the Let's Encrypt route, aka you'll get a prescription for 1-3 months worth (whatever the size sold at the pharmacy is), but you need to call them up and get a new prescription afterwards.
- sneak 6y ago
  They’re $4 or so. I order mine 2 dozen at a time from https://www.alldaychemist.com/ https://www.alldaychemist.com/. Ships to the US, no prescription needed. Takes a month or two to arrive. $600 Advair is like $60 on there, too.
  - SllX 6y ago
    Good to know. Thank you!
tsco77 6y ago
Can a physician not just call it in?
- Ccecil 6y ago
  That still implies you can afford to see a doctor long term. I assume if someone isn't seeing you regularly they might have issues with calling in a prescription and require a visit. Not saying all do...but without insurance and/or research it may be hard to find one which you know the answer for sure. I personally have never had a major issue getting referrals and at times call in medication for known long term illnesses but in those cases they were medical professionals who I had been using for long periods of time before having a lapse in regular visits.
- therockspush 6y ago
  a buddy of mine got asthma when the smoke was bad a few years in the bay area. The doctor requires a chest xray every year to renew the subscription.
  - michaelmrose 6y ago
    This is quite insane because there is a cumulative risk of cancer from successful xrays. Not huge but non zero.
    - therockspush 6y ago
      ya, its almost like the doctor doesn't have his patients best interest in mind.
      - mipmap04 6y ago
        This seems like a way for the doctor generate RVUs and show greater productivity. RVUs as a concept for anyone interested: https://www.texmed.org/Template.aspx?id=32053#:~:text=An%20effective%20way%20to%20measure,a%20way%20to%20quantify%20production https://www.texmed.org/Template.aspx?id=32053#:~:text=An%20e....
travisoneill1 6y ago
And since asthma is not curable, you should get a lifetime pass to buy inhalers, but instead you have to keep paying a doctor more money to renew your prescription.
- jnsie 6y ago
  Same for insulin for type 1 diabetes. Drives me crazy that there is no long-term prescription (US). I once dropped my 2nd last vial of insulin while waiting for supplies to be delivered. There was a delay due to weather or wild fires or something and I had to call so that my insurance company would allow a one time emergency supply to be sent. It was a scary experience.
skissane 6y ago
Here in Australia, melatonin is prescription only. A lot of people in my family buy it over-the-counter when on trips to the US (I often go there for work, plus my brother lives in Oregon). However, this year with COVID nobody has been able to get to/from the US. So I went to the doctor to ask for a prescription. He told me just to order it online instead from a grey-market supplier. Being the intense rule-follower that I am, I was stressed out about doing that, but he reassured me that there was nothing to worry about, the police aren't going to smash down my door over melatonin. Since it is over-the-counter in the US, you can buy so many different brands and formulations, and we've found one we all quite like (cherry-flavoured sublingual tablets), and all you can get on prescription here is expensive slow-release tablets that the kids can't swallow. (Compounding pharmacists also offer immediate release in capsule or liquid form, but sublingual tablets are still easier.) 2-3 years ago, Australia's equivalent to the FDA, the TGA, asked for public submissions on rescheduling melatonin to over-the-counter. The sleep specialists put in an objection, arguing that insomnia is a serious medical condition and requires professional care not over-the-counter treatment, and in response to their objection the TGA kept it prescription-only. The real world reality is that people's insomnia often has complex causes (including psychosocial factors) and a sleep specialist isn't necessarily the answer. Our son's paediatrician told us to give him grey market melatonin, he didn't refer him to a sleep specialist. EDIT: Actually, I learn today they are going to make it available from pharmacists without prescription, but only for people aged over 55 – not going to help us this decade – https://www.tga.gov.au/book-page/13-melatonin https://www.tga.gov.au/book-page/13-melatonin
- neckardt 6y ago
  As someone in the US who has DSPD [0] and uses melatonin daily, I personally wish it was a prescription medication. There are a few reasons for this: 1) The proper dose of melatonin for me is somewhere between 150ug and 400ug, but most melatonin sold comes in 3mg to 10mg pills. That's around 10x too much, taking that dosage of melatonin destroys my sleep schedule. It takes a lot of hunting to find the right dose. I tried once to crush up some melatonin and make my own pills with a precise dosage, but that ended up being a bit of a disaster. 2) Melatonin is regulated as a supplement in the US. Basically that means there is no regulation and even the active ingredient can vary wildly in a pill. When I visited a sleep specialist they mentioned to always buy the same brand, because "Each supplier has a different incorrect dosage, your best bet for dialing in on the correct dosage and timing is hoping that they're at least consistent among themselves". But I do agree with you, regulating it as a prescription medication would do more harm than good for most people. I wish there were some middle ground that would both solve the above issues but still keep it easily available for people who rely on it. [0]: https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder
vimax 6y ago
Reading Don Quixote I was amazed to find people 400 years ago complaining about needing a prescription from a guild barber for a potion from a guild apothecary.
throwawayLex 6y ago
I take Escitalopram (Lexapro) for anxiety. At home you can get 6 months of repeats, and it's all pretty simple, however I am now an expat in Europe which makes it that much more painful to get Lexapro. It's available here, but I hate having to find a doctor to get a prescription. The doctors consultation usually costs about 70-80€ (and they will usually only give you a prescription for 2 months worth). I have found that it's available from a variety of sources without prescription. Thailand has many pharmacies that will sell you whatever you want, and when I stop there, I always stock up (Pre COVID-19). Spain as well, the pharmacies are incredibly lax on prescriptions for certain things (they won't sell you anything addictive, but other things are easy). I haven't been back to Spain recently either for COVID-19 reasons. There are also definitely grey market websites that one can use, much like there are for things like Modafinil, though it's less in demand. All this for something that I need to keep taking (it's quite dangerous to stop).
- cameronh90 6y ago
  My experience with Escitalopram in the UK: After the (free) doctor prescribed it to me, they put it on the system as a "repeat prescription". This means the online pharmacy app would automatically order more to be delivered well in advance of running out, 3 months worth of pills at a time (9 GBP each). Once a year, the doctor would send me an appointment for a medication review. Aside from that the only time I saw a doctor was when I wanted to adjust the dosage.
aneutron 6y ago
I don't know what country you are, but in both the countries I lived in, pharmacies are more reasonable, especially for adult buyers. They would usually ask if you have an old prescription (maybe dating back a year or two), or perhaps your old inhaler, and would generally agree to give you a new one. Of course you'll pay the full price, no insurance, unless you have a valid prescription (generally a year old at most), but otherwise, the price isn't too steep (about 6€).
DreamSpinner 6y ago
This is interesting, particularly in light of skissane comments about melatonin being prescription only. Here in Australia, you can buy Asthma Inhalers "over the counter" (no prespcription) from pharmacies (Salbutamol). They sometimes do ask if you're seeing a doctor for your asthma, but that's about it. (I take a regular treatment for it)
C1sc0cat 6y ago
Why do you need to see a doctor for a repeat prescription is the question here, why cannot you logon to the doctors website and just request a repeat.
- tpxl 6y ago
  I live in a third world European country and I just did that for the first time a couple of months ago. Couldn't get them on the phone to request an appointment (that would have been free anyways), so I just filled out a form and got an email a day later. What a time to be alive!
- cameronh90 6y ago
  In the UK you can do just that: https://www.nhs.uk/using-the-nhs/nhs-services/pharmacies/how-to-order-repeat-prescriptions-online/ https://www.nhs.uk/using-the-nhs/nhs-services/pharmacies/how... - so there is no fundamental reason why not.
cultofmetatron 6y ago
yea I know thats the case in the USA. I was without health insurance for a bit while fun-employeed and didn't want to pay for the $500/month plan. After an unfortunate running with a friend's pet rabbit, I was left unable to do anything strenuous due to acute bronchial inflammation. After suffering for a few days, I was willing to pay anything to be able to breathe properly again I ended up paying a doctor out of pocket $200 for a consultation. I literally told her what I had and that I needed albuterol. she agreed and wrote me the damn prescription so I could pay $75 for the inhaler. All in all, 4 days of sufferring + $270 in expenses LONG STORY SHORT, I ran into a similar situation in Thailand. I walked the pharmacy within an hour of having the reaction, bought the inhaler for $3 and was fine within minutes. again: $3 vs $270 The whole system is a racket and a big part of why I prefer to not live in the united states anymore.
coldtea 6y ago
>I know what inhaler I need and I know how to use it, but I cannot legally purchase it. What about the thousands of idiots who would mis-use it and die, or self-prescribe whatever BS and have harmful effects? Even if you're some hardened Ayn-Rand style "each to themselves" person, their bad decisions would then also negatively impact others who had nothing to do with their decision, not to mention wasting societal resources.
- srtjstjsj 6y ago
  What about the millions of idiots and non idiots who die due to lack of medication? Give counseling at the pharmacy counter, limit to reasonable doses, check ID.
  - coldtea 6y ago
    >What about the millions of idiots and non idiots who die due to lack of medication? Is that because of lack of money (to see doctor, get prescription, buy drugs) or because of mandatory prescription alone? Because in civilized countries nobody dies "due to lack of medication" just because a prescription is required. Except if you mean people can't self-expirement with their own arbitrary self-prescriptions, and die from that because their doctors wouldn't prescribe them the same stuff. Which is an argument I don't really understand -- is the premise that people informed by the self-study/internet/drug ads/friends/fake news/whatever, know better than a qualified doctor what to prescribe themselves? And that these competent self-prescribers abound so much, that are more in number than the people who would just fuck themselves with BS self-prescriptions?
- bserge 6y ago
  Guess he should die because there might be some idiots out there inhaling Salbutamol?
  - coldtea 6y ago
    Or, you know, he should just get a prescription?
artificialLimbs 6y ago
A person I know gets infections every couple/few years and has done so for many years. Instead of paying for a doctor script they go to a pet store and buy fish biotics. It's literally amoxicillin and works.
- explorigin 6y ago
  This is very risky. Some people are allergic and can become allergic to penicillin-based drugs. Also...how do you get the dosing right? How do you know when to quit taking it in order to be responsible not adding to the creation of antibiotic-resistant "super-bugs"? I'm asking these rhetorically. Of course the answer is make the regulation more accessible. But in the meantime, this solution should not be taken lightly.
  - artificialLimbs 6y ago
    I believe there is listing of the dosage in mg of the active ingredient on the bottle, and so they just matched up the dosage with what they had been previously prescribed. They're aware of the 'super-bug' problem, but when you're the one in pain you're a lot more willing to undertake some risky behavior to make it stop. They only take a single dose, I believe. With you on the regulation. I'll advise them of developing allergy, I'm not sure if they're aware, and I was not. Thank you.
kortex 6y ago
Have you tried nebulized albuterol? It's dirt cheap, even off-insurance, you can get the steroid solution, also cheaper than Pulmacort, to boot and get long-acting protection. The nebulizer pumps and the inhaler cups can be found used or online with some searching. I use rescue inhalers ($30/ea after good insurance) but also keep nebs around for attacks.
catsdanxe 6y ago
Buy many inhalers on one prescription. It's like contacts. They give you a prescription for a year. Then you buy a few years worth
Melting_Harps 6y ago
> I've actually run into issues with drug laws from a side I never even thought about: prescription medication. I have asthma, but I don't have health insurance. Asthma inhalers in my country require a prescription. I'm afraid this is one of the many pitfalls that occur to the most vulnerable in Society, one that is largely ignored or dismissed entirely by regulators with good intentions that ultimately keeps the status quo in place. Last year the poorly kept secret of DNMs [0] less known usecase(s) came to the light to the masses in MN regarding insulin due to shortages and rising costs--it got so bad/lucrative that they were using clearnet marketplaces. People need to realize that DNMs are more than just access to illicit drugs, they often serve as lifelines for people to get access to generic drugs or access to less expensive alternatives (drugs/devices) to people with limited means and no access to medical insurance and the Rx to otherwise insipid things as mentioned below (Melatonin). This is why, if nothing else, people should not be lauding these closures, which are done with tax money, and done under the guise of 'helping people' when in reality all they are doing is reducing the competition for large pharma and to an extent the drug trades of certain intelligence agencies. I see this becoming a bigger concern as so many in the US are losing their insurance tied to their FT jobs no longer existing or being reduced to PT status due to COVID. This news is just showing how inhospitable Nation-States are and to what length they are going to impair creating alternatives and maintain their perverse model(s). Having spent time in the Pharma-controlled Industry of Diagnostics (post Obama-care), I have come to worry more about what a Stanforite CEO like Joe Jimenez can wrought on the World more than a Pablo Escobar or El Chapo. [0]: https://www.govtech.com/health/Frustrated-Diabetics-Use-Internet-Black-Market-for-Insulin.html https://www.govtech.com/health/Frustrated-Diabetics-Use-Inte...
glerk 6y ago
Coming to the US, I was surprised I need a prescription from a US doctor ($100+ shakedown) to get glasses or contact lenses. This is what happens when you let special interest groups write the law.

x86_64Ubuntu 6y ago

I ran into the same issue. And Dr.s offices have pretty much become churn factories for insurance billing, so I hate the fact that I have to go through them. To get around them, I found that Mexican and Indian pharmacies would send me inhalers. The only issue is that it took so long to get to the US, but it seemed to be as good as the US stuff.

agency 6y ago

The comedian Hannibal Buress (who has asthma) has a funny bit about this in his most recent special [1]. He talks about how asthma gets a raw deal compared to other illnesses and isn't taken seriously at all (nerdy stereotypes etc) and how insane it is that you need to keep renewing a prescription for such a necessary and life-saving substance. As if there are people out there getting messed up on albuterol. [1] http://www.youtube.com/watch?v=kVc4-05Agf0&t=18m33s http://www.youtube.com/watch?v=kVc4-05Agf0&t=18m33s

derefr 6y ago
You know what's bizarre for requiring a prescription? Peridex — chlorhexidine mouthwash. You can buy chlorhexidine gluconate concentrate (which is still not all that "concentrated" — something like 2% w/v) in the form of a medical or veterinary scrub — or even a floor cleaner — over the counter. But dilute it to 0.15% (at which concentration it would now become not-painful to put it in your mouth; but also would cause it to expire after a couple of days) — and then add the stabilizers and preservatives to it necessary to have it last a few months at STP? Well, now it's a prescription product. As far as I'm aware, there are no risks from "chronic" use of Peridex as one's every-day mouthwash. Chlorhexidine does the same thing the alcohol in regular mouthwash does — it kills bacteria in your mouth. The only difference is that chlorhexidine sticks around keeping your mucus membranes aseptic for around eight hours (if you don't eat anything), compared to an alcoholic mouthwash's couple-of-minutes. So it actually protects you on a long-enough timescale for your body to get in there and clear out any biofilms causing you gingivitis, canker sores, enamel erosion, etc. — rather than just treading water in the fight against those. I almost wonder whether the mouthwash companies are in some sort of mutually-assured destruction arrangement, where they all would like chlorhexidine mouthwash to be something they could sell OTC, but they don't want their competitor to be the first to sell it OTC (and win the market by advertising increased effectiveness), and they're willing to lobby to keep it prescription-only so that that doesn't happen.
- gamblor956 6y ago
  The only difference is that chlorhexidine sticks around keeping your mucus membranes aseptic for around eight hours (if you don't eat anything), compared to an alcoholic mouthwash's couple-of-minutes. So it actually protects you on a long-enough timescale for your body to get in there and clear out any biofilms causing you gingivitis, canker sores, enamel erosion, etc. — rather than just treading water in the fight against those. It also kills off the good bacteria in your mouth, and if ingested the bacteria in your digestive system, which is why the formulation designed for ingestion is subject to prescription. The floor cleaner version is similar to the ingested version but it is not the same thing and the differences matter.
  - derefr 6y ago
    Yes, but... alcoholic mouthwashes also kill the good bacteria in your mouth, and your digestive system if ingested. So does regular drinking alcohol, for that matter. (In fact, both OTC mouthwashes and high-ABV beverages tend to kill good gut and mucosal flora in preference to the bad ones, because the good flora are highly adapted to the ecological niche that only pertains in the "normal" ecological environment of the body.) But neither alcoholic mouthwashes, nor alcoholic beverages, are prescription-only. > and if ingested ... which is why the formulation designed for ingestion There are all sorts of things sold OTC for putting in your mouth or other mucus membranes, that would harm you if you swallowed the active dose. Eye drops, for example. Governments generally trust people to just... not do that. They require that the manufacturer put instructions to not ingest the thing on the label, and that's usually the end of it. Also, there is a reason that mouthwashes have child-proof caps! They are, in fact, dangerous in general if you don't know what you're doing with them! But chlorhexidine is no more dangerous than your average mouthwash. And far less dangerous than other things you can get ahold of without a prescription. (And, given the implication of gingivitis gingipains in Alzheimer's, it might turn out to be a lot more dangerous to not sterilize your gums. Especially if you're old, immunoincompetent, and/or have lost many of your teeth, exposing more of the gum surface to regular microabrasion. Enabling OTC access to chlorhexidine mouthwashes could very well be highly-positive in global QALYs.) > The floor cleaner version is similar to the ingested version but it is not the same thing Yes, my point wasn't that you should put floor cleaner in your mouth; my point was that someone can buy things that contain a large amount of chlorhexidine gluconate OTC very easily — sometimes even pure! — and anyone who cares could then just distill the active ingredient out to ensure purity. It's not like these are intentionally denatured; none of the other ingredients have the same molecular weight.
CaptainZapp 6y ago
Can't your doctor just write a long term prescription? I need an asthma inhaler, which is prescription only. My doc writes out a prescription, which allows me to pick it up at any pharmacy for the duration of a year (can also be a shorter period). After that he writes a new one year prescription. This is quite common here if you need a regular supply of specific prescription medication. This is not allowed for controlled substances, which have specific prescriptions (multiple copies), which a doctor must obtain officially and is not allowed to copy. But for any other prescription medication, which is required over a longer period the prescription usually reflects that. Is that illegal in other countries?
- consp 6y ago
  I don't know for asthma medication but for insulin it used to be 1 year max and has been unlimited since about 15 years here in the Netherlands as it is chronic. If you change types/dosage (concentration) you need a new prescription.
  - Scoundreller 6y ago
    Oddly in Canada, insulin doesn’t require a prescription. No idea how we decided on that one. Really dangerous to mess up, used in homicides, etc. Life-preserving, but so is pretty much everything else in a pharmacy, mostly over a longer-time period, but not always.
- srtjstjsj 6y ago
  1 year is less long then most people need to breath. Bonus, in the US you can miss refills due to insurance squabbles leaving you with 0 medication unless you pay huge out of pocket.
bserge 6y ago
As a matter of fact, yes, albuterol is used by bodybuilders and "adrenaline junkies" I guess. It's an adrenergic agonist, works somewhat like coffee, but with different/stronger effects. Oral intake is the best, although inhalation works OK. Clenbuterol is overall better for that purpose, though. Still doesn't change the fact that it should be OTC.
Broken_Hippo 6y ago
People are most definitely getting messed up on albuterol. Pretty much any inhaler, actually. Same with those vapor nose sticks that - folks take the pellet out and get high. Nyquil and other cough syrups? Yup, folks are getting high off of it. That cold medicine for folks with high blood pressure? Yup. Mucinex? Check. Pretty much anything for asthma? Yup. And slews of other medications. This is why you have pharmacies that keep some medications behind the counter, even though there is a spot on the shelves and they are OTC: These are high theft items. But then again, I've seen someone get high in the pharmacy from a can of canned air. (I used to work at a pharmacy in the states).

SllX 6y ago

I have the exact same problem and the exact same condition. The justification is kids “might use them to get high” but as far as I’m concerned it’s a handout to Doctors. An inhaler is only $25 without insurance. Recently I have been able to setup a video call with an urgent care clinic to just write me the damn prescription and add about a year’s worth of refills, $50 for the call, but it’s still stupid I can’t just walk in and buy an inhaler off the shelf. You didn’t specify a country, but if you can setup a call with a doctor, I would encourage you to go that route. It’s still more money than you should have to pay, but it’s better than going in person and in my experience, a lot cheaper.

luckylion 6y ago
> The justification is kids “might use them to get high” but as far as I’m concerned it’s a handout to Doctors. That's also such a weird concept in 2020. Kids can just buy literally any drug they want on the dark net and have it shipped to their homes, they don't need to drink a gallon of cough syrup or use inhalers to get high. It's interesting that you can get refills on a single prescription. I'm in Germany, and all doctors I've ever been to go the Let's Encrypt route, aka you'll get a prescription for 1-3 months worth (whatever the size sold at the pharmacy is), but you need to call them up and get a new prescription afterwards.
sneak 6y ago
They’re $4 or so. I order mine 2 dozen at a time from https://www.alldaychemist.com/ https://www.alldaychemist.com/. Ships to the US, no prescription needed. Takes a month or two to arrive. $600 Advair is like $60 on there, too.
- SllX 6y ago
  Good to know. Thank you!

tsco77 6y ago

Can a physician not just call it in?

Ccecil 6y ago
That still implies you can afford to see a doctor long term. I assume if someone isn't seeing you regularly they might have issues with calling in a prescription and require a visit. Not saying all do...but without insurance and/or research it may be hard to find one which you know the answer for sure. I personally have never had a major issue getting referrals and at times call in medication for known long term illnesses but in those cases they were medical professionals who I had been using for long periods of time before having a lapse in regular visits.
therockspush 6y ago
a buddy of mine got asthma when the smoke was bad a few years in the bay area. The doctor requires a chest xray every year to renew the subscription.
- michaelmrose 6y ago
  This is quite insane because there is a cumulative risk of cancer from successful xrays. Not huge but non zero.
  - therockspush 6y ago
    ya, its almost like the doctor doesn't have his patients best interest in mind.
    - mipmap04 6y ago
      This seems like a way for the doctor generate RVUs and show greater productivity. RVUs as a concept for anyone interested: https://www.texmed.org/Template.aspx?id=32053#:~:text=An%20effective%20way%20to%20measure,a%20way%20to%20quantify%20production https://www.texmed.org/Template.aspx?id=32053#:~:text=An%20e....

travisoneill1 6y ago

And since asthma is not curable, you should get a lifetime pass to buy inhalers, but instead you have to keep paying a doctor more money to renew your prescription.

jnsie 6y ago
Same for insulin for type 1 diabetes. Drives me crazy that there is no long-term prescription (US). I once dropped my 2nd last vial of insulin while waiting for supplies to be delivered. There was a delay due to weather or wild fires or something and I had to call so that my insurance company would allow a one time emergency supply to be sent. It was a scary experience.

skissane 6y ago

Here in Australia, melatonin is prescription only. A lot of people in my family buy it over-the-counter when on trips to the US (I often go there for work, plus my brother lives in Oregon). However, this year with COVID nobody has been able to get to/from the US. So I went to the doctor to ask for a prescription. He told me just to order it online instead from a grey-market supplier. Being the intense rule-follower that I am, I was stressed out about doing that, but he reassured me that there was nothing to worry about, the police aren't going to smash down my door over melatonin. Since it is over-the-counter in the US, you can buy so many different brands and formulations, and we've found one we all quite like (cherry-flavoured sublingual tablets), and all you can get on prescription here is expensive slow-release tablets that the kids can't swallow. (Compounding pharmacists also offer immediate release in capsule or liquid form, but sublingual tablets are still easier.) 2-3 years ago, Australia's equivalent to the FDA, the TGA, asked for public submissions on rescheduling melatonin to over-the-counter. The sleep specialists put in an objection, arguing that insomnia is a serious medical condition and requires professional care not over-the-counter treatment, and in response to their objection the TGA kept it prescription-only. The real world reality is that people's insomnia often has complex causes (including psychosocial factors) and a sleep specialist isn't necessarily the answer. Our son's paediatrician told us to give him grey market melatonin, he didn't refer him to a sleep specialist. EDIT: Actually, I learn today they are going to make it available from pharmacists without prescription, but only for people aged over 55 – not going to help us this decade – https://www.tga.gov.au/book-page/13-melatonin https://www.tga.gov.au/book-page/13-melatonin

neckardt 6y ago
As someone in the US who has DSPD [0] and uses melatonin daily, I personally wish it was a prescription medication. There are a few reasons for this: 1) The proper dose of melatonin for me is somewhere between 150ug and 400ug, but most melatonin sold comes in 3mg to 10mg pills. That's around 10x too much, taking that dosage of melatonin destroys my sleep schedule. It takes a lot of hunting to find the right dose. I tried once to crush up some melatonin and make my own pills with a precise dosage, but that ended up being a bit of a disaster. 2) Melatonin is regulated as a supplement in the US. Basically that means there is no regulation and even the active ingredient can vary wildly in a pill. When I visited a sleep specialist they mentioned to always buy the same brand, because "Each supplier has a different incorrect dosage, your best bet for dialing in on the correct dosage and timing is hoping that they're at least consistent among themselves". But I do agree with you, regulating it as a prescription medication would do more harm than good for most people. I wish there were some middle ground that would both solve the above issues but still keep it easily available for people who rely on it. [0]: https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder

vimax 6y ago

Reading Don Quixote I was amazed to find people 400 years ago complaining about needing a prescription from a guild barber for a potion from a guild apothecary.

throwawayLex 6y ago

I take Escitalopram (Lexapro) for anxiety. At home you can get 6 months of repeats, and it's all pretty simple, however I am now an expat in Europe which makes it that much more painful to get Lexapro. It's available here, but I hate having to find a doctor to get a prescription. The doctors consultation usually costs about 70-80€ (and they will usually only give you a prescription for 2 months worth). I have found that it's available from a variety of sources without prescription. Thailand has many pharmacies that will sell you whatever you want, and when I stop there, I always stock up (Pre COVID-19). Spain as well, the pharmacies are incredibly lax on prescriptions for certain things (they won't sell you anything addictive, but other things are easy). I haven't been back to Spain recently either for COVID-19 reasons. There are also definitely grey market websites that one can use, much like there are for things like Modafinil, though it's less in demand. All this for something that I need to keep taking (it's quite dangerous to stop).

cameronh90 6y ago
My experience with Escitalopram in the UK: After the (free) doctor prescribed it to me, they put it on the system as a "repeat prescription". This means the online pharmacy app would automatically order more to be delivered well in advance of running out, 3 months worth of pills at a time (9 GBP each). Once a year, the doctor would send me an appointment for a medication review. Aside from that the only time I saw a doctor was when I wanted to adjust the dosage.

aneutron 6y ago

I don't know what country you are, but in both the countries I lived in, pharmacies are more reasonable, especially for adult buyers. They would usually ask if you have an old prescription (maybe dating back a year or two), or perhaps your old inhaler, and would generally agree to give you a new one. Of course you'll pay the full price, no insurance, unless you have a valid prescription (generally a year old at most), but otherwise, the price isn't too steep (about 6€).

DreamSpinner 6y ago

This is interesting, particularly in light of skissane comments about melatonin being prescription only. Here in Australia, you can buy Asthma Inhalers "over the counter" (no prespcription) from pharmacies (Salbutamol). They sometimes do ask if you're seeing a doctor for your asthma, but that's about it. (I take a regular treatment for it)

C1sc0cat 6y ago

Why do you need to see a doctor for a repeat prescription is the question here, why cannot you logon to the doctors website and just request a repeat.

tpxl 6y ago
I live in a third world European country and I just did that for the first time a couple of months ago. Couldn't get them on the phone to request an appointment (that would have been free anyways), so I just filled out a form and got an email a day later. What a time to be alive!
cameronh90 6y ago
In the UK you can do just that: https://www.nhs.uk/using-the-nhs/nhs-services/pharmacies/how-to-order-repeat-prescriptions-online/ https://www.nhs.uk/using-the-nhs/nhs-services/pharmacies/how... - so there is no fundamental reason why not.

cultofmetatron 6y ago

yea I know thats the case in the USA. I was without health insurance for a bit while fun-employeed and didn't want to pay for the $500/month plan. After an unfortunate running with a friend's pet rabbit, I was left unable to do anything strenuous due to acute bronchial inflammation. After suffering for a few days, I was willing to pay anything to be able to breathe properly again I ended up paying a doctor out of pocket $200 for a consultation. I literally told her what I had and that I needed albuterol. she agreed and wrote me the damn prescription so I could pay $75 for the inhaler. All in all, 4 days of sufferring + $270 in expenses LONG STORY SHORT, I ran into a similar situation in Thailand. I walked the pharmacy within an hour of having the reaction, bought the inhaler for $3 and was fine within minutes. again: $3 vs $270 The whole system is a racket and a big part of why I prefer to not live in the united states anymore.

coldtea 6y ago

>I know what inhaler I need and I know how to use it, but I cannot legally purchase it. What about the thousands of idiots who would mis-use it and die, or self-prescribe whatever BS and have harmful effects? Even if you're some hardened Ayn-Rand style "each to themselves" person, their bad decisions would then also negatively impact others who had nothing to do with their decision, not to mention wasting societal resources.

srtjstjsj 6y ago
What about the millions of idiots and non idiots who die due to lack of medication? Give counseling at the pharmacy counter, limit to reasonable doses, check ID.
- coldtea 6y ago
  >What about the millions of idiots and non idiots who die due to lack of medication? Is that because of lack of money (to see doctor, get prescription, buy drugs) or because of mandatory prescription alone? Because in civilized countries nobody dies "due to lack of medication" just because a prescription is required. Except if you mean people can't self-expirement with their own arbitrary self-prescriptions, and die from that because their doctors wouldn't prescribe them the same stuff. Which is an argument I don't really understand -- is the premise that people informed by the self-study/internet/drug ads/friends/fake news/whatever, know better than a qualified doctor what to prescribe themselves? And that these competent self-prescribers abound so much, that are more in number than the people who would just fuck themselves with BS self-prescriptions?
bserge 6y ago
Guess he should die because there might be some idiots out there inhaling Salbutamol?
- coldtea 6y ago
  Or, you know, he should just get a prescription?

artificialLimbs 6y ago

A person I know gets infections every couple/few years and has done so for many years. Instead of paying for a doctor script they go to a pet store and buy fish biotics. It's literally amoxicillin and works.

explorigin 6y ago
This is very risky. Some people are allergic and can become allergic to penicillin-based drugs. Also...how do you get the dosing right? How do you know when to quit taking it in order to be responsible not adding to the creation of antibiotic-resistant "super-bugs"? I'm asking these rhetorically. Of course the answer is make the regulation more accessible. But in the meantime, this solution should not be taken lightly.
- artificialLimbs 6y ago
  I believe there is listing of the dosage in mg of the active ingredient on the bottle, and so they just matched up the dosage with what they had been previously prescribed. They're aware of the 'super-bug' problem, but when you're the one in pain you're a lot more willing to undertake some risky behavior to make it stop. They only take a single dose, I believe. With you on the regulation. I'll advise them of developing allergy, I'm not sure if they're aware, and I was not. Thank you.

kortex 6y ago

Have you tried nebulized albuterol? It's dirt cheap, even off-insurance, you can get the steroid solution, also cheaper than Pulmacort, to boot and get long-acting protection. The nebulizer pumps and the inhaler cups can be found used or online with some searching. I use rescue inhalers ($30/ea after good insurance) but also keep nebs around for attacks.

catsdanxe 6y ago

Buy many inhalers on one prescription. It's like contacts. They give you a prescription for a year. Then you buy a few years worth

Melting_Harps 6y ago

> I've actually run into issues with drug laws from a side I never even thought about: prescription medication. I have asthma, but I don't have health insurance. Asthma inhalers in my country require a prescription. I'm afraid this is one of the many pitfalls that occur to the most vulnerable in Society, one that is largely ignored or dismissed entirely by regulators with good intentions that ultimately keeps the status quo in place. Last year the poorly kept secret of DNMs [0] less known usecase(s) came to the light to the masses in MN regarding insulin due to shortages and rising costs--it got so bad/lucrative that they were using clearnet marketplaces. People need to realize that DNMs are more than just access to illicit drugs, they often serve as lifelines for people to get access to generic drugs or access to less expensive alternatives (drugs/devices) to people with limited means and no access to medical insurance and the Rx to otherwise insipid things as mentioned below (Melatonin). This is why, if nothing else, people should not be lauding these closures, which are done with tax money, and done under the guise of 'helping people' when in reality all they are doing is reducing the competition for large pharma and to an extent the drug trades of certain intelligence agencies. I see this becoming a bigger concern as so many in the US are losing their insurance tied to their FT jobs no longer existing or being reduced to PT status due to COVID. This news is just showing how inhospitable Nation-States are and to what length they are going to impair creating alternatives and maintain their perverse model(s). Having spent time in the Pharma-controlled Industry of Diagnostics (post Obama-care), I have come to worry more about what a Stanforite CEO like Joe Jimenez can wrought on the World more than a Pablo Escobar or El Chapo. [0]: https://www.govtech.com/health/Frustrated-Diabetics-Use-Internet-Black-Market-for-Insulin.html https://www.govtech.com/health/Frustrated-Diabetics-Use-Inte...

glerk 6y ago

Coming to the US, I was surprised I need a prescription from a US doctor ($100+ shakedown) to get glasses or contact lenses. This is what happens when you let special interest groups write the law.