Nursin' USA - Over the counter drugs: Who is getting it right?

11 May, 2010

Our resident American nurse Sara Morgan asks who is doing a better job at protecting the public when it comes to over the counter drugs?

In nursing, and healthcare in general, we are constantly trying to find the right balance between empowering patients to care for themselves and limiting access to products or services that might be used inappropriately. For example, the ideal patient makes healthy lifestyle choices to keep his blood pressure within the normal range, but if a proper diet and exercise aren’t enough, he is not able to self-treat his hypertension by purchasing ramipril over the counter (OTC).

As a new nurse, I naively thought that there were generally accepted guidelines about what can and cannot be safely made available to the public. Maalox is safe so anyone can buy it, but chemotherapy agents, being almost as toxic as they are curative, are kept guarded by pharmacists and doctors. But, like so many things that are seemingly similar between the US and the UK, once you start to closely examine what each country makes available to the public, then chasm-wide differences begin to appear.

If I wanted to, I could walk down the block to my local Boots right this minute and buy co-codamol or Nurofen Plus without a prescription. Both of these contain the opiate codeine. It’s a weak opiate, but an opiate nonetheless. Not in any of the 50 United States, liberal-leaning or otherwise, would you be able to get this without a prescription. You could however, buy the jumbo-sized, value-priced bottle of 500 tablets of 500 mg paracetamol ($7.82 at Walmart). By my calculation, that single bottle contains over 16 lethal doses of the drug.

So, the government on the western side of the Atlantic is worried that its citizens may get hooked on opiates and has banned them in OTC drugs. The government on the eastern side is concerned that people may overdose on paracetamol if it is available in bulk, so legislation means that it is sold only in small (expensive) quantities. In both countries, patients with broken bones, recent surgery, or anything else that needs mild to moderate pain relief may have difficulty in getting the supplies that they need to self-treat their pain. Which government is right? Which is doing a better job at protecting the public? Which is the bigger nanny state? I haven’t decided yet.

Moving on to other drug classes, the UK is terribly worried about the development of drug-resistant bacteria, so it is very difficult to get antibiotic creams without visiting your doctor first. Just to be clear, Savlon is an antiseptic, not an antibiotic — I know this because I had to check soon after moving here when I had an unfortunate incident with some potatoes and a paring knife. On the bright side, the last time I had a nasty cold and my sinuses were getting ready to pop, I was quickly able to get my hands on some pseudoephedrine, which is by far the best decongestant known to humankind, as far as I’m concerned.

Back home in the US, where I stock up on Neosporin—which contains not just one but three antibiotics in an ointment formulation—the government is very careful with pseudoephedrine, ruling that it must be kept behind the counter at pharmacies. It does not require a prescription, but it is only dispensed in limited quantities and the purchaser must show either a driver’s license or passport and the details recorded by the pharmacist who almost certainly has better things to do. Only then can you get your decongestant and begin treating your blocked sinuses.

Why all the hysteria about a simple cold remedy? Pseudoephedrine is the primary ingredient in methamphetamine, also known as crystal meth, ice, rock, crank or pick another street name of your choice. Until the authorities got wise to it, drug dealers were buying huge quantities of OTC Sudafed to cook into meth. Good old-fashioned American entrepreneurialism—buy something from the local pharmacy, add matchstick heads, lye and drain cleaner (no really, I’m not kidding, that’s the basic formula) cook for several hours and mark up the final product by 400%.

All of these differences illustrate the effect that culture has on how medicine is practiced. Even though both the US and the UK have access to the same research data on medication efficacy and the British and American public have (theoretically) the same general level of common sense, our two governments have variable ideas on what regulations will keep us safe. Which just goes to show, once again, that what works with one population will not always translate to another.

Readers' comments (17)

Anonymous | 12-May-2010 2:37 pm
we are quite happy with our own rules and regs. and don't need comparison with what happens in the usa so keep your nose out of it!
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halfanurse1987 | 12-May-2010 7:15 pm
Actually I find it rather interesting getting another perspective. Thanks.
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Anonymous | 13-May-2010 9:12 am
i think its very interesting to compare our culture to another - anonymous 2:37 you might learn to be a little more liberal minded - or does change worry you!
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Anonymous | 13-May-2010 12:45 pm
comment above - i do not need teaching thank you very much - if i wasn't liberal minded I would never have survived my career or private life having worked in several different healthcare systems and come across more cultures than most nurses who have only worked in GB can only dream of!
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Anonymous | 13-May-2010 1:07 pm
I find these blogs really interesting, and have always been fascinated in how different countries run their healthcare. I spent time in Mexico where you can buy antibiotics over the counter, which i found pretty alarming to say the least - the family i lived with ate them like smarties! Anonymous @ 2:37; obviously you have a whole world of experience under your belt and know everything, but don't be so quick to disparage someone else's writing. The author is not suggesting we change, just reflecting on the differences, which i think is an excellent thing to do.
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Anonymous | 13-May-2010 3:43 pm
Personally I thought this article was great. It's always interesting to see the differences between cultures in how we do things.

Anonymous @ 12-May-2010 2:37 pm So with all your worldly knowledge what differences have you noticed between our cultures? You're obviously very opinionated about this so I'd be interested to know what you think...
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Anonymous | 13-May-2010 4:44 pm
It's not a question of comparing what happens in different countries and who gets it right. Each country has its own rules, regulations and laws and neither the USA or the UK are WRONG!
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halfanurse1987 | 13-May-2010 5:23 pm
The article did not actually say that either was wrong. It was a comparison by someone who has had the fortune to experience both. One day I hope that I too can reflect on many different experiences. But for someone like me who is just starting out this blog is great.
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Anonymous | 15-May-2010 12:35 pm
Anonymous 2:37 pm has come across as rude and obnoxious. I found the article interesting and informative. I always enjoy reading Sara Morgans blogs.
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Anonymous | 16-May-2010 9:26 am
I have not enjoyed Sara's previous blogs, but this is the best one so far (especially coming up to holiday season). I was grateful to be able to buy OTC oral antibiotics in Spain when I got an ear infection, but couldn't help but wonder about their levels of resistance. I would comment, that common sense in itself does not actually exist and the differences in shared beliefs are part of what makes a culture.
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Anonymous | 16-May-2010 9:29 am
BTW Sara Lennox - although the article doesn't say who is right or wrong, the articles title is "who is getting it right?", which implies someone is wrong! But I agree with your comment and we can only think that anonymous 2.37 had a really bad shift, perhaps involving some Americans, prior to coming home and writing that comment!
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Anonymous | 16-May-2010 10:55 am
I always look out for Sara Morgan's comments in the Nursing Times, for me one of the most interesting articles.
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Linda Stewart | 16-May-2010 3:53 pm
Good on you, Sara Lennox - you go, girl! Sara's blogs are always interesting and enlightening and by no means was she saying that either system is conpletely right or wrong. Both countries can probably learn a lot from each other and we should be open to that. I think Anonymous @ 2.37 was extremely and unnecessarily rude. Keep on writing, Sara - I for one will always look forward to the different perspective you put on our nursing practices.
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Anonymous | 17-May-2010 1:12 pm
Pleasantly good reading Sara but I think it can be better if you can include Harvard Referencing in your articles.
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Alex Lorien | 17-May-2010 1:25 pm
A really interesting article about the priorities that health care systems in the world assign to different medications. I find it amazing that you can buy certain medications over the counter in some countries that are difficult to get hold of in another, even through a doctor. Human growth hormone or steroids in Mexico rings a bell.

And yes: Anonymous | 12-May-2010 2:37 pm, that was very petty and rude.
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Anonymous | 17-May-2010 7:28 pm
Greetings to all of you across the great waters.

In response to anonymous 9:29am, perhaps the poor guy just had a bad shift, and it didn't involve any Americans at all. :)

In any case, I enjoyed the article and am intrigued how the UK and different cultures differ in their medical care from the United States.

I also appreciate how the UK is more open in it's discussion of the "downside" of modern day medicine, thereby, allowing changes to be addressed more easily.

I hope you all are having a great day!

From a Nurse on the Western side of the Atlantic.
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Kirsty Armstrong | 18-May-2010 8:51 am
Truly fab that we are all so keen to share our views-I love all of her arguments (and yours) and that, in addition to all of your blogs has made me to reconsder my attitude to OTC meds-AGAIN. Kirsty Armstrong
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