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>If allergies, and especially anaphylaxis, are so common, why do we still need prescriptions for epi pens and such?

Prescriptions are used to limit dangerous chemicals/medications to the use of folk who 1. need them and 2. have been instructed on how to use them by a physician.

Whether or not they are commonly used or required doesn't factor into it.

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

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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.

But strangely we can get narcan everywhere.

Things need prescriptions when they're potentially dangerous or abusable. Epipens (a bunch of adrenaline in rapid-injection device) are both.

How commonly people need a medicine isn't a factor in whether it's available over the counter or only with prescription.

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?

Societal inertia.

A lot of what happens in any society, happens just because 'that's the way we've always done it.'

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

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.

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.

I remember seeing a fight in a nightclub a few years ago. This guy was getting some rough handling by one of the door staff and his girlfriend stuck her epi-pen in the back of the bouncer's neck. Guy ended up in hospital.

>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.

Unless it's a weekend, holiday, etc.

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

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.

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

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.

Think this through.

Because adrenaline can be abused and obviously has side effects. Hypertension, arrythmias, haemorrhage, aneurysm bursts, cardiac arrests are just some of the side-effects of adrenaline.

Of course he would. Adrenaline should be administered intramuscularly not intravenously. The iv dose for adr is far less than what we use for Im. So a std im dose can easily be lethal

>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

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.

I just googled the average price at $691. I’m really glad it’s available by prescription. I get refills when it expires.

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.

Insulin can be dangerous but can be bought without prescription, same with tylenol 1's.

Very few allergies are severe enough to cause anaphylaxis which is caused by an antibody called immunoglobulin E overreacting to what it thinks are infections and causing excess histamine to be released which in turn can cause severe reactions possibly leading to anaphylaxis. Giving an EpiPen injection to someone not in anaphylaxis could kill them so they aren't just handed out like sweets.

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.

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.

The per-dose price of the actual medicine is a few cents. The reason it costs so much is... well... there are a lot of people with vested interest in keeping things the way they are.

Some cheap single use syringes and a 3d printed spring loaded housing and a lot of money could be saved.

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.

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

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Ah, here in the U.S. you can buy a bottle of 500 of them in the grocery store.

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.

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

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.

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.

The couldn't we get this control done by the pharmacist then? It sounds like the issue is about controlling the distribution and educating people about usage. A pharmacist can do that. I can see that a doctor's medical advice would be necessary in the case where I don't know what my condition is and don't know how to treat it.

I believe thisnis the best answer. Other answers only talk about preventing abuse, which is not really tied to the professional act of a doctor handing out the prescription. Understanding side effects is the true work of a doctor.

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.

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.

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

Epipens can be dangerous, even when administered correctly.

People need to know that even though the symptoms should improve when they take the epipen they still need to go to hospital because other treatment and often additional adrenalin may be required- epipen is kinda a first aid move.

Diagnosis of who needs an epipen can be complex - its not always clear to people if what they had was anaphylaxis or not (severe episodes are generally fairly identifiable, but milder episodes can be tricky - a combo of rash and vomiting might need someone to have access to an epipen even though thats not what most people think of when they think anaphylaxis).

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 ..

>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.

https://pubmed.ncbi.nlm.nih.gov/3814285/

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

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?

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.

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.

>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.

We don't. Bought one two weeks ago, just need to ask the pharmacist (OTC, not free service).

I'm not sure where you live, but not all countries require a prescription to buy EpiPen...

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Why would that be strange?

Can you abuse an epi pen?

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.

> 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.

If the main purpose of guns is self defense, why do we need regulations and rules regarding them?

Because not everyone is in desperate need of one or will use them responsibly.

If we gave out guns to anyone who wanted one society would crumble.

Epi-pens are of course not as lethal as guns but if you use one and don't need it you're going to damage yourself. Adrenaline is great if you need to outrun an assailant or wild animal or need your heart to start beating but too much of it will damage your heart and muscles.

When they talk about Mothers lifting cars off their children in an Adrenaline rush those mothers often also end up needing medical attention because they tore their muscles to shreds lifting that car, not noticing because Adrenaline can turn off your pain receptors.

People who are/were "Adrenaline junkies" doing high intensity sports or stunts tend to have a larger chance of heart issues because they're overworking their hearts everytime they get their high meaning they go bad earlier.

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.