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
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://www.sciencedirect.com/science/article/abs/pii/S01918...
TL;DR: Yeah, powernapping is a thing.
In the past I tried various different times ranging from 6:30pm to 9:00pm. Even taking it at a suboptimal time is better than not taking it at all.
There are also a few other things I do to keep my sleep schedule on track:
1) I heavily use bluelight filters on my computers and phone in the evening. Redshift/gammastep on Linux gives me full control.
2) I have low blue light lights which I use in the evening [0], then I switch to fully red bulbs in the hour before going to sleep.
3) I have a super bright daylight LED lamp which turns on automatically at 8:30am, a few minutes before I wake up. This is my solution to automate light therapy [1].
All of this combined lets me function mostly like a normal person. Hope some of that helps.
* Adjusting diurnal rhythm (e.g. adjust a skewed sleeping schedule, jet lag). This works in lower doses over longer periods of time. So if you want to be less of a night owl, you may take 0.1-0.3 mg in the afternoon.
* Hypnotic - immediately making you more prone to fall asleep. This one is less well understood and dosages vary per person but it seems like 0.3-3 mg shortly before bed time is optimal. It also won't work on it's own like stilnoct or whatnot, so limiting light exposure, and all the other usuals, still apply.
I also find it frustrating how much more expensive and less available lower dosages are. From someone who also does bits and nibbles of 3mg pills.
[1] https://www.lesswrong.com/posts/E4cKD9iTWHaE7f3AJ/melatonin-...
Also, unless you are really old or travel to different time zones all the time you shouldn't need long-term melatonin supplementation. It's supposed to adjust your inner rhythm so you will naturally fall asleep at the correct time after some days of taking it.
I mean, there are potential complications to melatonin…but I think it’s hard to argue that it’s less safe than paracetamol or aspirin.
Take a big paracetamol overdose, get acute liver failure, significant chance of either death or urgent need for liver transplant–even if you are getting the best possible medical care.
Take a massive melatonin overdose, nothing anywhere near as serious happens. You may become unconscious for 12 hours. There are reports of other negative side effects – tachycardia, hypotension, hypothermia, etc [1][2] – medically risky, but still your odds of survival without serious long-term consequences are pretty high, especially if you get proper medical care. Animal studies have failed to determine an LD50 for melatonin, even giving massive overdoses to animals they survive–it isn't clear if it is even possible for a healthy human to die by massive melatonin overdose, I think if it were to ever happen it would require a complete lack of medical attention combined with a very big dose of bad luck. By contrast, fatal paracetamol overdoses (mostly intentional, sometimes accidental) occur with some regularity.
[1] https://journals.sagepub.com/doi/pdf/10.1177/102490790100800...
It's setting the bar _really_ low to compare to acetaminophen. There's a good chance if it weren't basically the only safe painkiller for pregnant and breastfeeding women it would simply not exist anymore.
Huh, is that why they keep it around? I thought it was mostly cruft/momentum. But it looks like NSAIDs are risky in the 3rd trimester.
Why would we ever assume that another person, totally unrelated and unconnected, would ever prioritize our needs ahead of their benefit? This is the assumption of so many institutions where authority over ourselves is forcefully delegated to chosen others. This goes predictably wrong just about every time. We shouldn’t even be upset about it.
Two packs will end the average teen, formanent liver failure takes about 5 days though, quite uncomfortable I'm told.
The antidote is n-acytel-cysteine, available from most sport supplement type places, I always keep 100g or so around cos early / immediate oral treatment can make the difference until medical intervention arrives, where they give the n-acytel-cysteine intravenously.
Paracetamol is very safe if used correctly, and doesn't have many serious interactions or contraindications. If you have to have one OTC painkiller it's probably about the safest. There's maybe an argument that it should be prescription, but "poisonous things are available in supermarkets" probably isn't one.
I can't tell if you're joking or not.
Taking away people's pain medication is not a winning move I'm certain of.
At the same supermarket, AUD 3.10 (USD 2.19) buys 2 packets of 24 tablet 200mg ibuprofen. Swallow 48 tablets, take a 9.6 gram overdose. For a person who weighs 80kg, that's 120 mg/kg. [1] reports that level of ibuprofen overdose is likely to produce mild CNS and GI symptoms. Fatalities have occurred with >300 mg/kg, so an 80 kg person would need to take over 24 grams, which is 120 tablets, 5 packets worth (cost AUD 7.75, USD 5.48). So you can immediately see how ibuprofen is safer than paracetamol, in that you have to swallow a lot more tablets to take a potentially fatal overdose. Given that, I think a case could be made for withdrawing over-the-counter paracetamol while continuing to allow over-the-counter ibuprofen.
Cannabinoids such as THC and CBD also provide pain relief, and certainly if we are just looking at overdose acute toxicity are far safer than either ibuprofen and paracetamol – indeed, there is no record of any fatal overdose ever happening from either. And yet, where I live they are only legally available on prescription, and prescribers face regulatory hurdles which do not apply to other drugs. If we are only thinking about safety in overdose, we'd make both ibuprofen and paracetamol prescription only, and allow THC and CBD over-the-counter instead.
What makes ibuprofen dangerous is that people tend to believe it can be taken safely to address arbitrary aches and pains. However, the kind of people experiencing aches and pains (beyond a common headache) tend to already be on some other form of medication. More often than not, these medications are either NSAIDs or steroids. Both of which interact poorly with ibuprofen, given that it is itself an NSAID. Paracetamol does not suffer from this issue.
I know little of how THC and CBD interact with other drugs people are likely to be consuming. However, drug interaction would need to be taken into consideration. As would subtle effects on mental state; focus, lethargy etc.
Prescriptions are for things that are dangerous under casual misuse, not intentional suicide or ignorant children.
Paracetamol is not an NSAID (unlike ibuprofen) and has a lot less negative effect on my gastritis. There are not many painkillers available OTC which are not also NSAIDs and so don't destroy your stomach lining. I'd rather not develop stomach ulcers to prevent some random lunatic from gorging himself on paracetamol into the grave.
Also, it is written on the instruction manual, in quite big letters.
This is a good point and something I consider every time I bring it up.
I don't have a perfect response though sorry.
I try to put people of this particular method by noting it's painful and takes a long time.
Do you have someone(s) you can talk to? Support people?
Please don't end your life. Almost everyone who tries regrets it. Get help with your dark thoughts and keep on being a part to your communities.
On the other hand diclofenac is over-the-counter in Australia.
And why is there so much credulity in this thread? In fact why isn't paracetamol's toxicity more well known? My mom is a nurse and I have an undergrad in chemistry and it wasn't till college senior year in a pharmacochem elective that I learned how narrow the therapeutic range is, and how alcohol shrinks it further to the point where accidentally nerfing your liver with booze and dayquil is plausible.
To post this and compare it to water overdose seem to be the only reason I can think of.
Probably alcohol would be another item that's easily available, and not many consider as dangerously lethal when overdosed.
On the other hand, I think there's still a lot of common sense left with paracetamol and other medicine.
But it's not illegal to possess without a prescription, so you can just order it from abroad and essentially nobody cares, the same is true incidentally for steroids in the uk as well.
I don't think that's quite right; vitamin D is non-prescription in the UK AFAIK.
https://au.iherb.com/pr/natrol-melatonin-3-mg-60-tablets/246...
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.
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.
> 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.
Many (all?) in Canada have reformulated as alcohol-free. Unsure if it’s because water is cheaper than alcohol or to avoid a tobacco-style lawsuit because alcohol is linked to oral cancers.
Maybe because people drink the stuff, but I don’t think the manufacturers really had a problem with that.
Also it's OTC in europe
"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/s12...
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.
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.
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).
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?
Bonus, in the US you can miss refills due to insurance squabbles leaving you with 0 medication unless you pay huge out of pocket.
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.
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.
I order mine 2 dozen at a time from 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.
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-Inte...
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€).
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).
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.
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.
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.
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.
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)
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.
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.
https://www.health.harvard.edu/staying-healthy/should-i-worr...
There is only one arrest for every 27000 miles driven drunk too it doesn't mean you should drive even one mile down the road drunk to get tacos or get one unnecessary x-ray so doctor billsgood can make another payment on his boat.
You will statistically probably make it ok in either case but its a stupid pointless risk.
Incidentally the link looks very informative but I cannot read it due to a paywall.
RVUs as a concept for anyone interested: https://www.texmed.org/Template.aspx?id=32053#:~:text=An%20e....
Regular xrays... does he own stock in the xray business?
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.
Give counseling at the pharmacy counter, limit to reasonable doses, check ID.
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?
I've had it with terrible doctors, long waiting times and needing to get a prescription every damn month or so.
And God forbid you move countries, that's months of going through the whole process again. All for some non addictive medication.
Some countries have them OTC and it works fine. It just doesn't put money into the system's budget and the doctors' pockets.
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.