5 ms·

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 o

by 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.
- vidarh 6y ago
  Chlorhexidine mouthwash is sold OTC in the UK (under the brand name Corsodyl), and marketed for daily use.
  - philjohn 6y ago
    I was warned by my dentist against using it regularly as, according to her, it has a propensity to stain your teeth.
- MockObject 6y ago
  Interestingly enough, there are downsides to chlorhexidine gluconate. "It is well known that CHG causes considerable side effects, such as extrinsic staining, an alteration in taste perception, and an increase in calculus formation. The calculus surface itself may not induce inflammation in the adjacent periodontal tissue. However, calculus formation is known to be a factor in plaque retention as well as a reservoir for toxic bacterial products and antigens. In addition, a recent investigation has reported that treatment of Porphyromonas gingivalis biofilms with CHG for 5 min did not degrade their external structure or reduce the volume of protein and carbohydrate constituents. The residual structure following CHG exposure may accelerate calculus formation and may serve as an ideal substrate to promote new microbial adhesion." https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0517-3 https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12...
  - derefr 6y ago
    No argument about the staining or taste perception. And the calculus formation isn’t too relevant on its own, if you get your teeth cleaned regularly. It chips off. But re: this part — > In addition, a recent investigation has reported that treatment of Porphyromonas gingivalis biofilms with CHG for 5 min did not degrade their external structure or reduce the volume of protein and carbohydrate constituents. IIRC this isn’t a surprising finding; CHG is supposed to do its work in combination with brushing and flossing, not on its own. Picture a biofilm like a tree. A tree is a lot more brittle when it’s dead and dried out, than when it’s living and actively keeping itself hydrated. You wouldn’t try to uproot a live tree; that’d be hell, since all the roots would be stretchy. It’d be like trying to snap a live green branch off a tree, times a thousand. Instead, you cut the tree down; let the stump decay and dry; and then pull it out. Same with biofilms: live colonies are elastic and emit protective mucilage around themselves, rendering them resistant to physical onslaught from brushing. Kill them, though, and they become brittle and able to be abraded away. But, of course, just as with antibiotics, an intervention that kills 99% of a biofilm colony won’t do much if you just do it once and then immediately stop, because that last 1% can use the dead bacteria and the biofilm itself as a growth medium to come right back. With antibiotics, you need to keep the bacteriostatic effect going for long enough for your immune system to pick off the stragglers. With oral rinses, you need the effect to last long enough for the combination of brushing/flossing, saliva, rubbing from the tongue, and abrasion of fibrous food, to fully clean the biofilm away.
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).

by agency 6y ago

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.
vidarh 6y ago
Chlorhexidine mouthwash is sold OTC in the UK (under the brand name Corsodyl), and marketed for daily use.
- philjohn 6y ago
  I was warned by my dentist against using it regularly as, according to her, it has a propensity to stain your teeth.
MockObject 6y ago
Interestingly enough, there are downsides to chlorhexidine gluconate. "It is well known that CHG causes considerable side effects, such as extrinsic staining, an alteration in taste perception, and an increase in calculus formation. The calculus surface itself may not induce inflammation in the adjacent periodontal tissue. However, calculus formation is known to be a factor in plaque retention as well as a reservoir for toxic bacterial products and antigens. In addition, a recent investigation has reported that treatment of Porphyromonas gingivalis biofilms with CHG for 5 min did not degrade their external structure or reduce the volume of protein and carbohydrate constituents. The residual structure following CHG exposure may accelerate calculus formation and may serve as an ideal substrate to promote new microbial adhesion." https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0517-3 https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12...
- derefr 6y ago
  No argument about the staining or taste perception. And the calculus formation isn’t too relevant on its own, if you get your teeth cleaned regularly. It chips off. But re: this part — > In addition, a recent investigation has reported that treatment of Porphyromonas gingivalis biofilms with CHG for 5 min did not degrade their external structure or reduce the volume of protein and carbohydrate constituents. IIRC this isn’t a surprising finding; CHG is supposed to do its work in combination with brushing and flossing, not on its own. Picture a biofilm like a tree. A tree is a lot more brittle when it’s dead and dried out, than when it’s living and actively keeping itself hydrated. You wouldn’t try to uproot a live tree; that’d be hell, since all the roots would be stretchy. It’d be like trying to snap a live green branch off a tree, times a thousand. Instead, you cut the tree down; let the stump decay and dry; and then pull it out. Same with biofilms: live colonies are elastic and emit protective mucilage around themselves, rendering them resistant to physical onslaught from brushing. Kill them, though, and they become brittle and able to be abraded away. But, of course, just as with antibiotics, an intervention that kills 99% of a biofilm colony won’t do much if you just do it once and then immediately stop, because that last 1% can use the dead bacteria and the biofilm itself as a growth medium to come right back. With antibiotics, you need to keep the bacteriostatic effect going for long enough for your immune system to pick off the stragglers. With oral rinses, you need the effect to last long enough for the combination of brushing/flossing, saliva, rubbing from the tongue, and abrasion of fibrous food, to fully clean the biofilm away.

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).