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ShalmaneserIII t1_ixzlzeg wrote

I practically guarantee you that more people are going to harm themselves with OTC acetaminophen/paracetamol than would do so with epi pens.


-paperbrain- t1_ixzmvfe wrote

Maybe, but from a practical standpoint, conditions treatable by epi pen are long term issues that people will bring up with a doctor.

Headaches don't involve doctor visits and it would be prohibitive to simple treatment to require one.

There's no perfect harm elimination, there is a balancing of factors.


ShalmaneserIII t1_ixzni54 wrote

The main issue is time- once someone is told they are allergic to something and should carry an epipen in case of anaphylaxis, why require a prescription for it?

If you forget to pack one for your kid on vacation, should you need to see a doctor to get one?


-paperbrain- t1_ixzuhw8 wrote

>If you forget to pack one for your kid on vacation, should you need to see a doctor to get one?

You don't need to. You can have your doctor's office send the prescription to a local pharmacy.


ShalmaneserIII t1_ixzulv7 wrote

Unless it's a weekend, holiday, etc.

Really, what harm are you trying to prevent by keeping the thing prescription?


deadpandiane t1_ixzvnv5 wrote

If you want to buy it over the counter you might be able to. I remember someone else that wanted to get one without a doctor for reasons. (I think they were on Vacation) It still had to be ordered and was expensive.

It is covered by prescription so people get them and get them replaced. Prescriptions get them to people and get replaced regularly. This system gets a life saving treatment to people that need it.


Clewin t1_iy0wcl0 wrote

The same thing happened for a while with asthma inhalers. HFA propellant requirements took the OTC Primatine Mist off the shelves and despite promises that cheap inhalers and OTC HFA inhalers would appear in a couple of years, big pharma reformulated the propellant every 10 years to keep it perpetually under patent. Primatine had to develop and patent their own HFA to return to the OTC market.

Incidentally, asthma inhalers are kind of a directed epi and do help with anaphylaxis in the lungs. For example, Fel-D-1 is a common protein in cat saliva that can trigger anaphylaxis in asthmatics. For me, I also get red eyes and congestion with sneezing along with gasping for breath. Dogs produce less allergens for me, but I definitely notice when they haven't been bathed in a while. Dogs may be more of a fur allergy than saliva, cats are definitely saliva.


86tuning t1_ixzt60o wrote

pretty sure it's high priority, and low chance of forgetting the epipen.

it's possible that there is medical coverage for prescription medications like epipen, whereas regular tylenol etc would normally not be covered.


pupae t1_iy0g61k wrote

I've definitely had friends with allergies mention they forgot their epipen. Kinda often, actually.


86tuning t1_iy0roju wrote

i guess i'm more paranoid than your friends are lol


FogletGilet t1_ixzn0xb wrote

But strangely we can get narcan everywhere.


The_RealKeyserSoze t1_ixzt1ls wrote

Narcan is not something you’d abuse, it either does nothing or makes you come down from a high, either way it’s does the opposite of motivating you to use it again. Also availability depends on the state. Many places have politicians who intentionally limit access to narcan, even ban first responders from using it, despite clear evidence that it saves lives.


maricute t1_iy0iqya wrote

Epinephrine is not really pleasant and people don’t really abuse it


The_RealKeyserSoze t1_iy0jstl wrote

I agree epinephrine is unlikely to be abused by most people, it would probably be fine as an OTC. My comment was mainly on narcan which should definitely be OTC and unfortunately that is more controversial.


zebrawithnostripes t1_iy0j7vr wrote

Not that I'm against this, not at all, but one could argue that having the antidote easily accessible would make some people take greater risks. Kindof like if there was a cure for hangover, alcohol abuse might rise.


The_RealKeyserSoze t1_iy0kzkv wrote

That is usually the argument made by those that oppose narcan use but it has been debunked. Opioid users dont try to OD, but they will use the drugs with or without narcan available to them and doses are not standardized so ODs are inevitable.

There are some correlations like increased ER visits when narcan is used that are often pointed to as an argument against it however that is expected when people are found alive rather than long dead thanks to narcan. Kinda like how helmets increase head injuries, because they are actually preventing deaths.


-paperbrain- t1_ixzr0gj wrote

What diagnoses would you expect someone to get to have narcan prescribed?


TyrconnellFL t1_ixzvi49 wrote

Opioid use. Not necessarily opioid use disorder (addiction), just opioid use for any reason.


-paperbrain- t1_ixzvyh6 wrote

Think this through.


TyrconnellFL t1_ixzxeap wrote

I don’t know what point you’re making. Narcan is routinely prescribed for people who are either abusing opioids or taking opioids for e.g. cancer pain. The Narcan is intended to be given by family members.

Narcan also has standing orders and anyone can get it to save someone else, but it’s not an individual prescription and, because America, not covered by insurance.


-paperbrain- t1_ixzy65m wrote

The user I was replying to was complaining that it was so freely available without prescription. There are very good reasons that people who are addicted, but because of the stigmatization and legal consequences are afraid to tell a medical provider, or don't have access to doctor visits, should still have access to narcan. There are very good reasons why people who are NOT addicted but for various reasons may encounter an overdosing person need access.

My point is that there are very good reasons to not require a prescription. And that more lives are saved by not requiring a prescription for narcan.


Clewin t1_iy0ueu4 wrote

There are several charities in the US that provide doses; I used to volunteer for one and packaged "overdose kits" that were given to first responders and homeless encampments. I am no longer involved, however - ex-wife's best friend ran the charity, a bit awkward now. The weird thing is it still requires a prescription but charities can give out for free due to the way a later law was written ..


police-ical t1_iy0c1az wrote

This is the result of a big push for reform, saying "the benefits of making this one very safe and easy to use antidote widely available greatly outweight the harms, because people are dropping like flies from opioid overdose and many are afraid to seek care or can't afford it." Moreover, if the average person squirts Narcan up their nose, nothing really happens. If these average person gives themselves a shot of epinephrine, they're going to get quick and clear side effects, some of which are dangerous in the wrong person. You could still make a case for over the counter but it's not as clear.


pupae t1_iy0fw7w wrote

Plus, even ppl who feel narcans effects wouldn't want to abuse it or risk having to take it. It blocks opioid receptors, which sends addicts straight into withdrawal. It's literally only attractive when the other option is death.


TyrconnellFL t1_ixzvdl2 wrote

If it were brought to market today, Tylenol wouldn’t be over the counter. I’m not sure it would get approval at all with its horrible overdose toxicity.

But the same is even more true for alcohol, and yet that ship has sailed. Actually it sailed thousands of years before the invention of ships.


DBDude t1_iy0luga wrote

Primatene Mist is OTC epinephrine. It was also out of OTC for years because the government banned CFCs so one company got the patent on alternatives, so all the OTC ones had to come off the shelves.


EspritFort t1_ixzx2mt wrote

>I practically guarantee you that more people are going to harm themselves with OTC acetaminophen/paracetamol than would do so with epi pens.

I agree, those should absolutely not be OTC ;P


shortyninja t1_iy0amr6 wrote

In the UK, you actually can’t buy more than two packets of Paracetamol in one transaction. AFAIK this did actually lower the number of suicides-by-OD.


pupae t1_iy0gkl4 wrote

That's interesting. Did it lower the number of suicides overall, or just push ppl to a different method? If ppl are taking too much Tylenol on purpose, this solution seems... incomplete.


shortyninja t1_iy0wamt wrote

I’m not sure tbh. But a lot of suicides are spur of the moment things, so if you do something that makes it take time and effort to acquire the means to do it, people are more likely to talk themselves out of it.


Jackcooper t1_iy2h0qb wrote

Yep. As a pharmacist many people think they're allergic to things that are just side effects manifesting.... You got stomach upset from codeine because it is codeine. I can imagine OTC epipens being used for all sorts of nonsense.


ShalmaneserIII t1_iy37ait wrote

> I can imagine OTC epipens being used for all sorts of nonsense.

One does wonder if the people who are so overly sensitive to those side effects are going to jab themselves with an epipen twice, though.

Nothing helps an anxious disposition like dumping some catecholamines into the mix.


shuvool t1_iy45uaj wrote

One of the things that determines whether a drug is available over the counter versus behind the counter or by prescription isn't just the potential for harm in case of overdose, but the potential for abuse and the potential for affecting public health. For example, if everyone could just grab amoxicillin whenever they want, we'd probably end up with a bunch of strains of medication resistant bacteria because a lot of people would take it every time they got symptoms that felt like being sick and wouldn't take enough for a long enough time to kill off all the bacteria exposed to the drug. Epinephrine has potential to be abused as a stimulant.


Folsomdsf t1_iy0vj8w wrote

>than would do so with epi pens.

If OTC it would be abused very heavily actually. Epinephrine would be manufactured on a scale you don't understand if allowed otc or into other sources. Caffeine specifically causes your adrenal glands to release epinephrine and cortisol. Imagine how quickly our most abused drug in the world would be supplanted by skipping that step and just taking actual doses of what we're trying to get.

People already abuse otc sources of epinephrine when the opportunity presents.


ShalmaneserIII t1_iy0w6u5 wrote

Dude...that's a case report.

And epinephrine has a half life in plasma of about two to three minutes. Do you think that someone's going to replace their morning pick-me-up by stabbing themselves with an expensive auto-injector every ten minutes?


Folsomdsf t1_iy0xexd wrote

>Dude...that's a case report.

And? It was the first obvious one, and also showing it's already available OTC and has been abused rofl.

>Do you think that someone's going to replace their morning pick-me-up by stabbing themselves with an expensive auto-injector every ten minutes?

.... Have you ever actually met another human being with a bad habit? Like seriously, how can you ask this question? Yes they absolutely fucking would rofl. People do stupid shit for way less.