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Discussion in 'Topics in Healthcare' started by DrMom, Dec 9, 2005.
What do you guys think?
It's a double-edged sword. Since pseudophedrine and most other decongestants has been placed behind the counter, people have complained. I was in the pharmacy picking up a prescription for my mom a couple of months ago, and an older lady came up and asked where the cold medicine was. She had to get in line with everyone else and wait until it was her turn to get her cold medicine. She was confused, and asked why it was behind the counter. The person working there feigned innocence, but someone else in line volunteered the information about people make methamphetamines from these drugs. Anyway, the prescription line is bad enough where I live, and I could feel the lady's frustration when she had a cold and had to wait in line to get an OTC med.
I realize this is for medical safety instead of to prevent crime, but the principal is the same. I don't think it will keep people from taking too much if they really want to, just like someone running a meth lab can pay different people to buy Sudafed for them. Education is probably the best prevention of liver disease caused by Tylenol, but there will still be people who take too much. Some do it out of misinformation, others do it because one or two pills don't work anymore so they feel like if they take more it will help the pain.
Pain is a big problem. There are lots of people who can't afford treatment for the underlying problem so they pop ibuprofen, acetaminophen, aspirin and others to keep the pain down to a bearable level. At the same time, we all hear stories about narcotic addicts coming to the ED and faking a symptom to get pain meds. It's a tough call, and until there's a way to measure the amount of pain a patient is perceiving, it's going to be a problem.
No one should have to suffer in pain that could be alleviated/reduced by easily accessible and affordable OTC pain relievers. But no one should suffer liver damage because of a few mistakes or oversights, either.
There is a huge amount of misinformation and, quite frankly, ignorance, out there about health and medicine. I had one person tell me she saw a patient who came in with a UTI who said she'd tried Monistat and it hadn't cleared up the problem. Patient education and prevention is key.
Such a measure would increase cost and perhaps keep people from buying acetaminophen. Plus, many of the elderly can't deal with blister packs. We may just end up with a bunch of people on chronic NSAIDS, which would do more harm in the end the with the increase in cardiotoxicity, bleeding ulcers, and kidney toxicity greatly surpassing the harm from APAP mishandling.
The big issues with acetaminophen are labeling of content and patient comprehension of safe dosing. We get combination products where patients do not appreciate that acetaminophen is included and branded products where patients do not realize the active ingredient. Then, some pharmacies use APAP as an abbreviation on bottles, so patients may have prescription medications containing acetaminophen and not realize it. It's trouble waiting to happen. The key to getting people to use things safely is adequate labeling and patient education. It hasn't been that long since we figured out there was a problem, so not all healthcare providers are fully informed. It's too common for patients to receive Vicodin and Percocet together and not be counseled to cap at 4g/day and to avoid OTC APAP use. Additionally, most healthcare providers don't realize that for chronic use the maximum should be 2.6 g/ day, not 4g.
There are so many OTC and Rx products that would never be approved if they were submitted to the FDA today. And, oodles of drug interactions looming amongst both groups. OTC does not equal safe, and we should never try to convince ourselves or consumers that it does.
While I agree with what you are saying, OTC drugs mean cheaper drugs, because the free market dictates what drug companies can charge. For those people educated and savvy enough to understand the labels, OTC is actually a very good thing. There are lots of things people can go to the store and buy that, if used improperly, can kill them (eg. alcohol, cutlery). There are even things on the market that cannot be used safely (eg. cigarettes). Given these social norms, I'm not sure the government should play parent to adults making adult decisions.
(And for what it's worth, taking Dr. Lee's quote out of context, I'm not sure eating 500 M&Ms would be any smarter than some OTC drugs -- obesity is a big killer too. Everything needs to be done smartly and in moderation).