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.