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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by chad_3 on October 16, 2002, at 0:01:39
My experience over the past year has me wondering now moreso ...
Why aren't many of the psychotropics "OTC?" - at least available "at user liability" - especially with SSRI's, SNRI's, Serzone, etc.
It is easy to go into certain areas of towns or certain bars and get hard illegal drugs, ie; cocaine, heroin, you name it.
But get some Prozac through the mail. No way!!!
I had couple p-docs tell me they usually prescribe the SSRI for most disorders. Consistent with top 200 drugs, which Zoloft, Paxil, Prozac and soon probably Celexa all in top 20 drugs sold in USA.
I wonder if finding a "good p-doc" might be easier?
Chad
Posted by utopizen on October 16, 2002, at 11:17:05
In reply to Why not make most psychotropics OTC?, posted by chad_3 on October 16, 2002, at 0:01:39
More people die from legal drugs than illegal drugs.
Drugs can kill you, whether it's Prozac or Smack. Dosing must be followed, which isn't as universal as dosing is for cough syrup.
So we have this very complex infrastructure of pharmacies, drug makers and doctors and still end up with high fatalities. Imagine that rate ten fold as Prozac hits CVS.
"Clever" ones will think, "hey, maybe if I take a whole lot today I don't have to wait 2 months to kick in."
Posted by Mystia on October 16, 2002, at 21:08:44
In reply to Re: Why not make most psychotropics OTC?, posted by utopizen on October 16, 2002, at 11:17:05
Ok...hypothetical situation here: Let's say that all psychotropics (or at least MOST) are OTC. Let's say we have a woman named Mary. Mary is a hypochondriac. She thinks she has every disease known to mankind and goes to the doctor at least once a week. Now, let's say she starts getting mad at her doctor because he's telling her nothing is wrong with her. She decides to get these OTC psychotropic drugs because she really believes she has all these illnesses (when she really doesn't). If she takes all these meds trying to *cure* herself, and becomes suicidal, then who would be to blame??? And what if she is SUCCESSFUL in her suicide attempt?!? Many drugs do cause suicidal thoughts in some people, AND there are SO many meds that shouldn't be taken together, or shouldn't be taken by certain people. That is why we have doctors, to tell us what WE don't know. The docs did NOT go through years of med school just for people to log on to the internet and buy scripts!!! That is exactly why I think buying meds online should be illegal and not practiced. People tend to have "gambler's fallacy" and think they are right all the time. I'm sorry, but any time people can buy drugs online, that is asking for trouble. I mean, just think if some drug dealer got ahold of something like valium, oxycontin, even xanax and started selling to kids in the streets or WORSE in the schools?!? As sad as it seems, you have to think about the consequences OTC psychotropics (or ANY Rx med) being OTC would be. There are some sick people in the world, just waiting to take advantage of children or naive people.
I am sorry that's so long....AND I am not trying to put anyone down. I just had to get that off my chest....which brings me to something topic-related....I think Lexapro is turning me into a B**** (female dog in other words)
Posted by utopizen on October 16, 2002, at 21:24:15
In reply to Re: Why not make most psychotropics OTC?, posted by Mystia on October 16, 2002, at 21:08:44
>>
mean, just think if some drug dealer got ahold of something like valium, oxycontin, even xanax and started selling to kids in the streets or WORSE in the schools?!?
>>Oh the horrors! Kids might not be tensed up all day in an over-anxious school anxiety. Heck, with an opioid, they may even feel the dreadful euphoria side effect.
Good thing responsible students like myself would *never* dare to supplement their poor income by giving off their spares when they need some extra spending money...
Posted by chad_3 on October 17, 2002, at 0:35:01
In reply to Re: Why not make most psychotropics OTC?, posted by Mystia on October 16, 2002, at 21:08:44
Mystia -
I agree mostly with your points.
It's true that most of the psychotropics can be really bad news in overdose. And I think most OTC stuff is fairly hard to OD on.
Tricyclics, MAOI's, benzo's, most everything I think they could leave "by prescrip". But I guess I wonder about the top 4 - which I would guess accounts for over half of revenue of the psychotropics - Prozac, Zoloft, Paxil, Celexa.
5ht is sold OTC - and liquor is addictive, and also leads to half of all auto fatalities. SSRI's are, (I think) - supposedly fairly begign even in large overdose, unlike tricyclics and MAOIS etc....
So if 5ht-c it OTC, and liquor, why not the "top 4 ssri's"?
Maybe it is a bad idea. I just wonder what impact that would have on the pschiatric community - which will usually try to prescribe the SSRI if it is accepted by the patient. MY GP did that for me 7 years ago - why do I need a psychiatrist for Prozac?
I am probably a bit sour grapes because I have been shunned by p-docs not wanting to touch my trickier case - but still - I think we might be headed that way to some legalized SSRIs.
I found out today - I had trouble getting Nardil because manufacturer has stopped making it awhile and is out - so stocks are dwindling. Any more coming? I don't know.
Much OTC stuff (cold,cough) and most psychotropics are contraindicated with Nardil and Parnate. Might be easier to just get rid of the MAOI's which aren't making much money for anyone anyway ...
Just some misc. rambling ... ok - well I'm out - and for the record, honestly you do not sound like a b**** to me. I appreciate the candid opinions.
Chad
> Ok...hypothetical situation here: Let's say that all psychotropics (or at least MOST) are OTC. Let's say we have a woman named Mary. Mary is a hypochondriac. She thinks she has every disease known to mankind and goes to the doctor at least once a week. Now, let's say she starts getting mad at her doctor because he's telling her nothing is wrong with her. She decides to get these OTC psychotropic drugs because she really believes she has all these illnesses (when she really doesn't). If she takes all these meds trying to *cure* herself, and becomes suicidal, then who would be to blame??? And what if she is SUCCESSFUL in her suicide attempt?!? Many drugs do cause suicidal thoughts in some people, AND there are SO many meds that shouldn't be taken together, or shouldn't be taken by certain people. That is why we have doctors, to tell us what WE don't know. The docs did NOT go through years of med school just for people to log on to the internet and buy scripts!!! That is exactly why I think buying meds online should be illegal and not practiced. People tend to have "gambler's fallacy" and think they are right all the time. I'm sorry, but any time people can buy drugs online, that is asking for trouble. I mean, just think if some drug dealer got ahold of something like valium, oxycontin, even xanax and started selling to kids in the streets or WORSE in the schools?!? As sad as it seems, you have to think about the consequences OTC psychotropics (or ANY Rx med) being OTC would be. There are some sick people in the world, just waiting to take advantage of children or naive people.
> I am sorry that's so long....AND I am not trying to put anyone down. I just had to get that off my chest....which brings me to something topic-related....I think Lexapro is turning me into a B**** (female dog in other words)
Posted by Dinah on October 17, 2002, at 2:56:02
In reply to I like some of your points ..., posted by chad_3 on October 17, 2002, at 0:35:01
Well, I would add that SSRI's are not necessarily safe. Nor are the other antidepressants. I would quite possibly be dead by suicide had I been taking Wellbutrin or Effexor without a doctor's supervision, since both triggered nasty hypomanias in me.
Wait - in both cases I was the one who put the brakes on the drug experiments. However, I still think, in theory, that SSRI's should be given under medical supervision because of the adverse effects that can occur with, say, people on the bipolar spectrum. And the trouble is that when you're manic due to the effects of a psychotropic drug, you probably aren't in the best situation to accurately assess your condition.
Just my opinion, but one I feel strongly about given my own reactions.
Posted by Phil on October 17, 2002, at 6:45:40
In reply to I like some of your points ..., posted by chad_3 on October 17, 2002, at 0:35:01
I used to manage a drug store and I know the average consumer. SSRI's will never be over the counter and believe me, that's a good thing.
Trust me on that one.
Posted by Bill L on October 17, 2002, at 11:25:30
In reply to Why not make most psychotropics OTC?, posted by chad_3 on October 16, 2002, at 0:01:39
I would like to see more drugs go OTC. Right now, insurance companies have a big push to make the antihistamines Allegra and Claritin OTC. They should be OTC because they are safer with less side efects than the other antihistamines which are curretnly in OTC medications. Recently, an athelete's foot cream went OTC (Lamisal).
For consumers it's a double edged sword. If a drug goes OTC, insurance in the US will no longer cover it. So the consumer will not need a prescription. But then he or she will have more out of pocket spending.
In the case of SSRI's, I would like to see them go OTC. I think that more people would get help. It's much easier to die from an overdose of aspirin than from an overdose of an SSRI.
Posted by oracle on October 17, 2002, at 12:28:30
In reply to psychotropics OTC? , posted by Bill L on October 17, 2002, at 11:25:30
It's much easier to die from an overdose of aspirin than from an overdose of an SSRI.
One is for a headache, the other mental illness.
A large difference in magnitude. I think one should not be conserned about the effects of the drugs as opposed to the seriousness of the condition treated.
Posted by Mystia on October 17, 2002, at 20:27:23
In reply to Re: psychotropics OTC? , posted by oracle on October 17, 2002, at 12:28:30
I agree with you oracle!
ummm...also...I don't *think* aspirin can cause things like suicidal thoughts, manic episodes, seizures, and the other s/e's psychotropics can cause! Sure, aspirin can cause someone to die, but don't you (Bill L) think that psychotropics taken incorrectly (or even the wrong ones taken by certain people) cause many more deaths and permanant effects than a common pain reliever such as aspirin?? Psychotropics are not OTC and never will be OTC for very, very good reasons.
Personal case: I could have suffered MAJOR damage to my heart and maybe even died had I continued taking Serzone! I am glad it wasn't OTC and something I "just picked up" for depression. Because my doc and I were experimenting with different SSRI's to find what worked best for me, I was going to the doctor like once a week for checkups and such. Had I not gone to the doc, I might have kept taking Serzone. That is definitely scary!
Posted by Mystia on October 17, 2002, at 20:37:38
In reply to Re: Why not make most psychotropics OTC?, posted by utopizen on October 16, 2002, at 21:24:15
Your business is *your* business but....how would you feel if you sold some high school kid your "spare" pills and they had an allergic reaction and DIED??? Like I said, that's *your* business, but I sure wouldn't feel good if it were me. Although, when my doc gives me a med it's because I need it and I don't ever have "spares." Also, I kinda don't feel like going to jail for trying to get a few bucks out of a kid. I know how the high school environment is. MANY people can stand the pressure (I did-and I had clinical depression *and* GAD!) and I don't think that kids should take potentially dangerous/fatal meds not prescribed for them. I saw TOO many of my friends in high school get majorly screwed up on Rx meds not prescribed for them, just buying someone's "spares." It's not fair to the kids-they're mostly uninformed (or MISinformed) kids, trying to be "cool" or maybe they really do need a med, but if they take the wrong one, then it can be terrible. I'm not putting you or anyone else down, I just know how high school is "nowadays" and I have some strong opinions on the subject.
Myst
Posted by utopizen on October 17, 2002, at 23:08:26
In reply to Re: Why not make most psychotropics OTC? » utopizen, posted by Mystia on October 17, 2002, at 20:37:38
I do need stims, and I use them. But I forget to take them often.
And if some kid is willing to give me $5 because he's stupid enough to abuse a prescription drug, then he's basically paying me for his stupidity.
Posted by viridis on October 18, 2002, at 0:39:00
In reply to Re: Why not make most psychotropics OTC?, posted by utopizen on October 17, 2002, at 23:08:26
And if that kid had a bad reaction, or did something bizarre and destructive, or died, could you justify it to youself because he or she was "stupid"? Would it be worth $5?
Drug diversion is one of the reasons that it's hard for those of us who really need these meds to get them from many doctors. Aside from the risks to your customers, this sort of behavior provides ammunition for the anti-med factions, and those who want to further tighten the restrictions on potentially abusable drugs.
This is the end of the thread.
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