Comment by maxxxxx | Hacker News Reader

Comment by maxxxxx | Hacker News Reader

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"I took two ibuprofens that first day. In hindsight, I didn’t need them, but I felt like I should take something"

I have noticed the need to "take something" with a lot of American friends when they have problem. It's almost like a reflex.

> I have noticed the need to "take something" with a lot of American friends when they have problem. It's almost like a reflex.

I have a friend who was in an accident and required emergency surgery. She happens to be a drug addict who is no longer involved in drugs (we do not say 'former' drug addict as there is no such thing). Even though she put in her intake form "DRUG ADDICT" in bold letters and told them, they still insisted on trying to give opiate-based pain killers to her. It is almost like they are telemarketers going off a script to sell something, which is in this case to push opiate drug painkillers.

It's such a strange bimodal distribution, among people I know - there are those who take preposterous numbers of painkillers on a semi-regular basis, and those who won't take an OTC painkiller except under duress when they're on the edge of blacking out from the pain.

I do think a great many people either overprescribe or are overly dependent on painkillers, opioid and otherwise, but there's also many different kinds of pain. I have a fairly high pain tolerance for most things, but certain kinds of acute pain, mouth pain or the warning pain of a migraine immediately disrupt my ability to concentrate usefully, which can be problematic when you need to concentrate to resolve the source of the pain.

There's also a weird thing where a good number of people I've known have regularly taken well in excess of the maximum safe dosage (even for Rx) of painkillers for days or weeks every month, and not think this is something they should bring up with their doctor. If this were "I talked to the doctor and made this choice based on X information," I wouldn't be as surprised, but it just never crossed their minds that it was abnormal to have crippling pain on a recurring basis.

In the US, I recently had two teeth removed that had horrendous infections (the swelling was tremendous); after the surgery, I asked them about painkillers, and they told me I wouldn't need them, just take ibuprofen if the pain gets bad and it'll go away in a day or so. I was skeptical but listened, and much to my surprise, the pain did almost magically vanish after I went to sleep that night.

AIUI the reason they still tried opiate painkillers is that there aren't really many non-opioid alternatives available other than the OTC stuff - and the effectiveness of both types varies wildly by person, but since the distribution is wider for the opioids, on average you're more likely to get pain relief from it. (My brother, for example, gets almost no benefit from any non-IV opioid painkiller, whereas if I take a single hydrocodone I'm both pain-free and borderline asleep.)

It'd be nice if we could find ways of relieving crippling pain without risk of physiological addiction, but so far, I don't think I've seen much compelling research toward that.

This study showed that a Tylenol ibuprofen combo was as effective as opioids (and with zero chance of addiction). If course it's likely to vary in effectiveness by patient and depend on the type of pain. I can't help but feel that pharmaceutical companies probably don't want a lot more studies like this coming out.

https://www.healio.com/family-medicine/pain-management/news/...

This study is so bad I don't know where to start. Apart from its small size, the other major things is there was no ibuprofen control or ibuprofen with codeine control. There is a vast difference in the effectiveness of ibuprofen over acetaminophen.

It is studies like this that have caused us Australians to lose access to OTC codeine this week.

Is there a compelling reason for codeine to be OTC in the first place? It's an addictive opiate.

Codeine at the dose available over the counter is not very addictive. On top of this the pharmacists record your details so that anyone addicted is picked up and helped. As far as I can determine there has not been a problem with OTC codeine in Australia.

As for why to not make it prescription only is we have universal healthcare in Australia. Shifting low dose codeine to prescription only will cause a massive increase in doctor visits at a huge increase in the cost to the Australian tax payer. I use OTC codeine to treat and catch my migraines before they become major. I maybe take codeine once a month and never visit the doctor. I will now have to visit at least once or twice a year for no reason other than to get a script for something I have been buying over the counter for the last 30 years.

If it's sufficiently low dose and it's tracked at a level that can detect and alert about potential abuse, that makes a lot of sense to me; thank you for the (much better) explanation.

Basically like lots of things in Australia we are getting caught up in the US hysteria about opioid addiction.

Yes opioids are powerful and potentially dangerous drugs, but used wisely they are very useful and effective. If there is a problem then the solution is to solve the problem, not just ban everything because there might be a problem.

On the topic of the US opioid addiction the way it has been handled is appalling. Getting millions hooked on powerful prescription opioids and then cutting them off cold turkey with effectively zero help so they end turning to really dangerous drugs like fentanyl is criminal.

When I was a kid you could purchase codeine cough medicine OTC in my U.S. state (it was same deal as you describe for Australia -- the patient would have to sign a register so the pharmacist could make sure you weren't buying five bottles a day or whatever).

Nothing works as well for a nagging cough as codeine and terpin hydrate. Nothing.

Unfortunately, you've got to go to a doctor to get it nowadays.

Instead, most people use OTC stuff with DXM (which doesn't work as well, is an abusable drug in its own right, and is quite likely more toxic than the codeine).

This is the wrong question.

The question should be is their a compelling reason to make it Rx Only, and people that support making it Prescription only have the requirement to provide evidence to support making it RX only.

The fact that is "addictive" is also not enough IMO

People are neither medically qualified to evaluate opioid use nor, when in a situation where they may be necessary, personally capable of evaluating their situation. This is why trained professionals exist. This is literally why.

Asking whether there is an argument for an addictive opiate with significant health impacts and the opiate-consistent tolerance growth that leads to self-medication and increased dosage to be available without medical consultation is the "wrong question"--to somebody whose posts throughout this thread are unempathic, pull-the-ladder-up-behind-us, so-brave stances that project personal (theoretical and probably wrong) resistance to addiction onto societal policy.

I will take that as a compliment.

>>This is why trained professionals exist. This is literally why.

Trained Professional exist to advise and recommend. Even in healthcare doctors are not dictators, they advise their patients on the best course of action it is then up to the individual to either follow that advice or not. I assume you oppose that, and believe doctors should have legal authority over their patients who should not be given any choices and should be compelled to do anything the doctor orders

So my question to you is why to you hate individualism and individual freedom? Following that how far does that extend, to you believe in a pure technocracy where decisions and public policy are selected on the basis of "trained professionals " in their areas of responsibility, particularly scientific knowledge with out considerations for personal liberty, rights or choices?

> I assume you oppose that, and believe doctors should have legal authority over their patients

This is a weakly constructed strawman. The gulf between doctors compelling behavior and society not enabling obviously self-destructive ones is wide.

Which you should know. And yet, the disingenuity is p. strong in here, so I'm gonna go with do know rather than should know.

> So my question to you is why to you hate individualism and individual freedom?

I "hate" individualism because I find selfishness to be base; in my experience the proportion of people who crow about "individualism" and who aren't in it to hurt those with fewer advantages than they have is a rounding error. And the freedom to ramp yourself into opioid dependence is not a meaningful freedom.

> with out considerations for personal liberty, rights or choices?

This degree of oh so you must believe silliness is some /r/iamverysmart stuff. C'mon.

>>And the freedom to ramp yourself into opioid dependence is not a meaningful freedom.

Nor is that a freedom I am speaking of, however the idea it should be a crime to "ramp yourself into opioid dependence" is unethical on its face as that is more of a medical and mental health problem not one that should be solved with criminality

I do however think it is a "meaningful freedom" for one to be allowed to judge for themselves what medication and/or pain management they should use in a given situation.

Further the War on Drugs as a directly result of prohibitionist policies have directly lead to more suffering and lose of "meaningful freedoms" for non-drug users than the abuse of the drug ever did.

I think it selfish is prohibitionist to not look at the big picture, to not see the Failure that the War on Drugs is, to not see the Extreme Harm the war on drugs in inflected not only on the US but the world, and double down on failed prohibitionist policies

>> in my experience the proportion of people who crow about "individualism" and who aren't in it to hurt those with fewer advantages than they have is a rounding error.

I must be in the rounding error then, I support many things that help people with fewer advantages, I believe these goals can be accomplished with liberty and respect of individual,

I also have a good understanding of history, and know that Authoritarian policies like the one you advocate for are often hardest on those not in the majority, on those that as "fewer advantages", Contrary to rose colored opinions authoritarians have, authoritarian polices are harmful to the less fortunate this has been proven countless time by countless authoritarian governments through out world history

Freedom and Liberty leads to prosperity, not Centralized Authoritarian Control

This is why you could only buy OTC codeine at pharmacies after you talked to the pharmacist about your condition and they checked and recorded your details in a database to see if you had been buying excessive amounts of OTC codeine.

We are moving from a system where we recorded who was buying codeine and making sure they were not needing help, to a system where there are no controls. The GPs in Australia lack any database on who has been prescribed codeine so it is now possible to doctor-shop around and abuse the system where previously it was regulated. About the only “winners” out of this change are the GP’s as they will now get more business from people like me.

Makes total sense. In the United States, despite their training pharmacists are mostly considered to be pill monkeys rather than meaningful medical professionals--what you get instead is an emoji shrug as the their-definition-of-freedom-lovers (the GP is a good example) froth out at the idea that their medical data should be available to medical professionals, leaving it an ongoing pain in the rear to try to get one pharmacy chain to talk to another (or to an independent pharmacist).

I sometimes forget that other countries have systems that actually work because the incidence of people trying to destroy societal systems is generally less; in that context what you describe certainly seems like an own goal to me.

Thanks!

On the contrary, since nobody in the US is willing to prescribe opioids any more, hospitals are doing Tylenol IV drips, and pharma is now charging 10x for acetaminophen.

They’re just fine with the hysteria and the studies, they still get paid.

> since nobody in the US is willing to prescribe opioids any more

Since when? I was given opioids when my wisdom teeth were pulled a year ago, far more than I needed.

From what I understand, opiate prescriptions are down, but only by 10-20% or so.

Opioids for wisdom teeth removal is insane to me (and 100% of the medical doctors that I know, and it's a lot of them). This is utterly disfunctional.

In fairness my wisdom teeth removal wasn’t exactly textbook. I had to go to an oral surgeon and he had to dig into the lower jawbone to remove one of them, breaking it into pieces to get it off the nerve. I had a lot of damage to the gums and quite a few bone fragments migrated out over the next few weeks.

I was however even offered opioids for a root canal once (different dentist). I didn’t fill that prescription.

I had this done two time (jawbone cut, tooth extracted in fragments, stitches thereafter) and while the healing process was annoying, it wasn't painful unless I tried eating solid foods with the wrong side of the mouth or something like that (which was a good indication of the fact that it was too early to do so, which helped healing faster, which is why - even discounting addiction issues - taking painkillers for avoidable pain is dangerous).

The "quite a few bone fragments migrated out" part sounds pretty bad, on the other hand; that's not really supposed to happen as far as I know.

I agree that the opiates probably weren't needed. I took the recommended dosage at first and just completely passed out for hours, so I have no idea how much pain I would have been in. After that, I cut the dose in half for the next day, until I got really sick of feeling foggy and just stopped entirely. (I found the whole "high" to be really annoying and not particularly pleasant, aside from the pain dulling properties. All I wanted to do was read and I couldn't do that.) I suspect ibuprofen would have been sufficient but I don't really know, either, since I took the surgeon's advice and took the opiates at first.

I do still have one wisdom tooth left. If I ever get that one out, I'll see how it goes without the opiates.

Bone fragments migrating out are apparently not that uncommon. Any bone piece that breaks off but doesn't get completely removed will eventually migrate out of the gums.

Having had a bunch of dental work done, sometimes it's not unreasonable - I had my wisdom teeth out and was given hydrocodone for afterward, but I was fortunate and didn't have any pain warranting it after.

Being given opiates for a root canal seems insane, though - if you have crippling pain _after_ a root canal, I think that means the dentist did something horribly wrong.

Could you elaborate on how there's no such thing as a former addict? I'm curious, as there are a couple substances I used to be addicted to but am not any longer.

It's a belief of some advocacy groups, like AA and such.

In real life, there are lots of drug addicts and alcoholics that managed to recover for the rest of their life just fine, including drinking in moderation for social reasons without relapsing (as opposed the teetotallism stance advocated by said groups).

Not to say it's a bad thing to drink after recovering from alcoholism, but wouldn't that just be managed addiction?

My uncle is an alcoholic, but has managed to drink at a reasonable level (not healthy, but doesn't socially harm him, e.g. drink driving, losing a job) for the past few decades. He'll crack his first beer at 10 AM, but manages to keep a good level of control.

>Not to say it's a bad thing to drink after recovering from alcoholism, but wouldn't that just be managed addiction?

Not any more so than drinking before alcoholism is "managed addiction".

If you can manage it and drink whenever you want after being an alcoholic (e.g. not drink for weeks, then drink at a party and then again not for weeks, and have no withdrawal effects when you don't drink) then you're not addicted anymore.

Addiction is not just a chemical dependency. The context in which you use the substance matters. Your personality and past behavior matters. This friend, in particular, took partying to an extreme. Not one drink but twelve drinks and blackout situations. Not just drinks but drinking and drugs. A lot of people who do not know her history will innocently say something like "We're going to happy hour" or "Just have a drink, it is the holidays." She knows though that, for her, the likelihood of that one drink turning into passing out at 5AM after an all-night rager are dangerously high. This is why I say there is no such thing as a former addict, as you can throw everything away with just "one".

That may be 100% true for her, but to say there is no such thing as a former addict, it would have to be true for everyone, which it isn't.

For migraine sufferers, not taking something as it starts to unfold will result in a very unpleasant experience that will take longer to resolve

I’ll second this statement. Migraines for me (and my mom as well) used to be crushing, and would take me out for potentially days at a time. Sumatriptan was a miracle drug for me, and now if I take it in time, I don’t suffer. If I catch it late, it will reduce the duration of the migraine to just a few hours (which feels like a miracle in the moment).

I had tried previous to sumatriptan many other remedies, and nothing compared. I’ve heard from my doctor many respond well to magnesium supplements as a way to head off the migraines altogether but I can’t say it worked for me (but I gave it a shot none the less).

All that being said, I’m generally averse now to opiates after seeing their long term effects on my father who was also an alcoholic. They did allow him to push through pain, which resulted in ever increasing damage to his joints (and ultimately internal organs as well). By the end, he couldn’t walk, was self medicating heavily with alcohol, and couldn’t keep himself in a physical rehab facility because his urge for alcohol and opiates couldn’t get satiated in that environment.

He died at 61.

So, I applaud the author and those who seek to responsibly limit access to medications which are highly addictive and potentially unnecessary for treatment. Pain management is very important, but it does need to be weighed against the potentially catastrophic dependency issues it can cause.

Migraine is slightly different than post-op pain though. Post op pain is good pain. The treatment was the surgery, and the pain is expected. Minimizing it may make the treatment less effective (e.g. by exertion, lack of rest ect). With migraine, the painkiller is effectively the treatment.

I had all four wisdom teeth removed at once and all I needed was one ibuprofen the first night, but a fucking migraine and I need at least one, sometimes two.

I had a wisdom teeth removed and was given basically nothing, besides the anesthetic injection needed for me not to feel pain during the procedure.

Please note that my wisdom tooth was about 80-90% developed and outside the gum, so no "surgery" was required, just some lever movement to pull it out. Also, no stitches were needed.

I was sent home with just an advice to eat non-solid, cold stuff "using the other side of the mouth".

Quite frankly, everything went okay. It was weird feeling that hole in my mouth, but it eventually filled itself.

I can second that experience. I'm still quite baffled by how little force is required to remove a tooth. The dentist barely wriggled his wrist and it popped out.

All I got sent home with was a wad of bandage to bite down on for the first 10 minutes. All in all probably the least painful experience I've ever had at the dentist. (Novacaine doesn't quite work properly on me it seems)

Well one of mine was tilted 90°, it had to be cut into pieces first and then cut from the bone. The others were quite OK though, not just a wiggle but no crazy stuff involved.

Not all migraine sufferers are the same. I have suffered from fairly regular migraine headaches for about twenty years (can't believe it's been that long!) and sometimes taking something like 200mg of ibuprofen when you first feel it can result in the progress of the headache being 'arrested' at that stage and though it still lasts as long as a normal headache before it passes, sometimes it manages to stop it from fully blooming.

However, even within my own experience, only ~1/4 of my headaches respond this way. I've taken other medications as well, and the majority of my migraines don't respond to anything other than trying to soothe the symptoms :/ In the majority of cases ~3/4 of the time, there's nothing you can do to stop it, you just have to dig yourself in and get to a quiet dark place for a few hours until it passes.

I assure you there are just as many of us with a complete aversion to taking anything at all.

Folks not reaching for a pill bottle are pretty rare, IME. I think the author of this article is touching on something pretty valuable with the willingness to be uncomfortable or even to endure pain. When I broke my leg in college, they gave me morphine while I was in the hospital (which just made me annoyed and mad) and I never touched the take-home codeine. Was walking in an air boot "early", too, as I was assured I couldn't hurt myself thanks to the metal rod through my shin and it just...didn't hurt that much.

I might take a naproxen if I have a bad headache or I tweak my neck and I can't stop working to take care of myself, but that's maybe two or three times a year (and I am being well-compensated for it). I know people, healthy people, who pop an ibuprofen in the morning just out of habit.

I don't think the average american uses that many pain pills.

OTC pain pills are a ~4 billion dollar industry. There are 320 million people so that's ~1$ / month in pain pill per person. And that's including both stuff that goes bad and is never used and daily Aspirin taken for cardiac health. https://www.chpa.org/OTCsCategory.aspx

5% of the population does take daily pain medication. At the same time it's common to go months without taking anything for pain.

Approximately 80 percent of the global opioid supply is consumed in the United States, which represents only 5 percent of the global population

"There was about 300 million pain prescriptions written in 2015,"

https://www.cnbc.com/2016/04/27/americans-consume-almost-all...

OTC = over the counter. There was a huge spike in prescription pain medications which has steadly declined over time.

While 2017 numbers are not in. 2016 Prescription pain medications are down 6% from 2015 and down 18% from 2012. https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

And again, we are talking less than one prescription per year per person on average. With many of these prescriptions for 2-3 days worth of pain management. Though again, a minority of people get a lot of pain medication.

> Approximately 80 percent of the global opioid supply is consumed in the United States, which represents only 5 percent of the global population

That article is borderline irresponsible with how it reports that metric.

80% of global prescription opiate medications are filled in the US, but that doesn't mean that 80% of those prescriptions are consumed in the US (or consumed at all). Nor does it include no-prescription opiates, which are generally much easier to obtain in most countries around the world (and also a lot cheaper) than their prescription counterparts.

I'm very reluctant to take drugs, even over the counter pain meds or allergy pills, but this is an American trend that a lot of people I've interacted with have noticed and I wouldn't discount it outright.

Indeed. Story time!

Last Monday evening, I had an accident with an angle grinder in my garage. The cutoff disc went through my leather glove and bit deep into the middle finger of my left hand. After deciding against gluing the cut back together, I drove myself to urgent care and received five stitches.

Did I need any painkillers, the doctor asked? I declined; my finger was pumped full of lidocaine at the time.

In the middle of the night, the lidocaine wore off, and while the finger hadn't hurt in the immediate aftermath of the injury, it certainly hurt then. After tossing and turning for about an hour, I decided to get up and try to find something to take.

The only analgesic I had in the house was an expired tiny bottle of ibuprofen. I needed about five minutes of digging before I found even that.

I simply don't use painkillers very often. I might take ibuprofen once or twice a year. I can't remember the last time I took anything other than ibuprofen, not even acetaminophen, not even when I twisted my knee.

I'm not sure if I have a higher tolerance of pain than other people or if other people like to self-medicate when the least bit of pain rears its head. Or, perhaps, I've simply been lucky enough not to have much pain.

Well it's a bit tough to do actual work when there's pain that keeps distracting you. In the article the author talks about just needing to rest... But many of us don't really have the luxury of taking multiple days to rest. At least when you're on painkillers you can still do white collar work, albeit at reduced capacity. Without painkillers though, all your mental capacity would be going towards managing the pain.

This may be another geographic difference - In Germany, unless you are self-employed, if you get a dr's note saying you should rest employers aren't allowed to ask you to come to work. And the amount of sick-leave is unlimited.

Side note: They can't even ask WHAT exactly you have that prevents you from working. Important detail in case you have something that could be stigmatising or somehow discriminated against.

It's cheating you out of needed rest. Without painkillers you are be forced to rest and prevented from making matters worse. The concept of pain has an important function. Here's a story of a family that doesn't feel it:

https://tonic.vice.com/en_us/article/mbpejy/the-family-that-...

No doubt. But I think you are in the minority.

I've notice this too. But it was a more general mindset: "If I have a health disturbance, I need a _dedicated_ solution.". The _dedicated_ word is important. It can't be a _generic_ solution (like walking, sleeping, change my eating for few days, etc.) so they too "the thing" and don't change anything like if the problem would be solved by this. As an European, it was so weird for me.

Interesting. I wonder if we have stats on painkiller usage per country? I found this ranking of countries by Opiate usage[0] which places the US at 27 (below Ireland, Switzerland, Italy, and the UK.

Maybe I only hang out with granola Americans, but the only people I know who think the way you describe-- looking for pills to solve minor problems-- are relatives of medical personnel.

I can't think of the last time I personally took a pain killer. I didn't even take one after a major surgery I had a couple of years ago.

[0] https://en.wikipedia.org/wiki/List_of_countries_by_prevalenc...

"The list does not include opioids, which is classified as a different drug under the World Drug Report 2011 list, which is considered "opiates and prescription opioids."

I think you got the wrong list.

My wife fusses at me when I mention I've had a headache for the past X hours and I haven't taken anything for it...

Same for me. When I take something during a headache it doesn't change anything, and most of the time I'll even throw up in the next 30min if I take something. So I just try to sleep.

Well, for me it definitely helps, I just don't like taking pills unless a doctor tells me to.

I don't use pain killers at all, but headaches are sometimes the exception. I rarely get a headache (maybe once a month?) but when I do, I know that it won't go away before a good night's sleep. So I either go to sleep in the evening or take an Aspirin or something when I'm at the office. I just can't work or even properly think with a pounding headache.

I have noticed how the vast majority of my American friends do not express any reactive need to unnecessarily take pharmaceuticals (especially painkillers, in the case of pain) when they have a medical problem. Does my single anecdotal datapoint negate your single anecdotal datapoint?

I guess we need a third anecdote to make a final determination.

I’ll throw another spanner in to mess things up: I am European and know other Europeans who feel compelled to take painkillers for any little thing (I personally will take them only if the pain is really severe or interferes with work or such, which is quite rare typically).

Anecdotally, it's fairly prevalent in Europe as well. Living in Europe, I know just as many Europeans who pop ibuprofen like candy compared to Americans.

Can you buy Ibuprofen in stores or do you need a prescription? In the US most stores have a big aisle with painkillers.

Speaking for the UK you can buy ibuprofen, paracetamol (acetaminophen) and aspirin off the shelf in any shop.

You're limited to 2 packs of 16 tablets each (for a total of 32 tablets) per transaction, in an effort to reduce the incidence of spontaneous suicide attempts.

You don't need a prescription for it in Germany (up to 400 mg AFAIK), but it may only be sold in pharmacies.

Ibuprofen, paracetamol and acetylsalicylic acid are generally available almost as easily in Europe as in the US.

EU pharmacists want your aspirin to come with megadose vitamin C ... which studies bear out as safer for stomach lining.

In Germany you can buy it at a pharmacy, you generally can't obtain medicine at a normal store.

Direct consumer advertisement of drugs is also illegal in Germany. (I think there's only 3 or 4 countries on the planet where this isn't the case)

On the other hand, at least in the cities there is a ton of pharmacies - sometimes even across the street form one another, and easily every few hundred meters along major routes. There are way too many. When I walk through downtown Nuremberg I walk past several of them, right on the main pedestrian-only street of the city. And they are all allowed to advertise in their shop windows. So that's some prime advertising space, right in the hard of the city. On my way to downtown, a twelve minute walk, I walk past four pharmacies if I take the route along the street (vs. the lake route, which is a park).

Also, they are allowed to advertise for things like cold medicine, when I still had a TV (log time ago, admittedly) I remember seeing lots and lots of such ads: "WICK MediNait cold medicinefor the night", list of ingredients: https://www.aponet.de/wissen/arzneimitteldatenbank/suchergeb... (active ingredients Paracetamol, doxylamine hydrogen succinate, ephedrine hemisulfate, Dextromethorphan hydrobromide-1-water)

> Direct consumer advertisement of drugs is also illegal in Germany.

Only for prescription drugs ("verschreibungspflichtig"), so no "ask your doctor if XYZ is right for you" bullshit.

Non-prescription drugs ("apothekenpflichtig") are heavily advertised in pharmacies, sometimes on billboards, and on TV. Most TV ads for drugs are running on ARD and ZDF [1] since that's what old people watch.

[1] Though only between 18:00 and 20:00, which is when the public broadcasters are allowed to air ads.

In the UK, ibuprofen, aspirin and paracetamol are sold freely everywhere (but only in small packs). Painkillers containing codeine are available over the counter, after talking to a pharmacist. Anything stronger requires a prescription.

The 500/5 cocodamols will cause liver damage before any codeine kicks in.

What is interesting is that if you really interesting is that a certain large pharmacy does a 200/12 ibuprofen + codeine combo.

I once had a prolapsed lower disc (from sport) and neck spasm (from stupidity) at the same time. Whilst I couldn't take naproxen (lots of reflux even with omeprazole), that and 500/15 cocodes with diazepam was the only way to get to sleep.

In the UK, you can buy a pack of 16 generic Ibuprofen tablets at the supermarket for as little as £0.25 ($0.35, €0.28). Similarly, Aspirin can be bought for as little £0.45 for a pack of 16 tablets.

You can't buy painkillers in stores in France but we have pharmacies everywhere. It's probably the same in most European countries.

In Ireland, ibuprofen and aspirin are available OTC in pharmacies, but only paracetamol is available in supermarkets.

Well depending on the surgery that might be advisable, it's an anti-inflammatory and heading off inflammation is usually beneficial.

Got shoulder surgery recently. I enjoyed taking hydrocodone even though I could prbly have gone without it. Made recovery that much more enjoyable, it was fun while it lasted :D.

This make me think: Could this behaviour be influenced by US-american pharma corporations being allowed to run (TV-)ads on prescription medications ?

Pharma ads play a role but hardly explain this behavior. I believe a primary aspect is simply that Americans (including myself) expect and are expected to fill every waking moment with productivity or similar, rather than having flexibility to take a few hours/days/etc off to allow for healing and/or exploration of causalities; we instead use coping strategies and even with lackluster results continue down that road, seeking more alleviation of symptoms - initial, and consequential side effects from treatments for initial - rather than examination of root causes (which are complex and individualized to a large degree).

It doesn't help when others influence by saying "just take ... for that." I can't begin to explain why others do so, except that people generally have good intentions and are empathetic?

TLDR: Americans often don't invest the time and resources to identify and eliminate behaviors/conditions that are the cause of their ailments, and instead cope with any "quick fix" drug/product/strategy that never eliminates the cause of symptoms and often introduces new issues.

Last two thoughts: Many in modern society are very averse to discomfort - understandably, but regardless of degree/origin - and many doctors are happy to feed into this behavior instead of educating the patient that pain is sometimes a part of the process.

Many in modern society lack (or do not have the energy for) self-awareness and/or critical thinking to examine root causes of ailments/symptoms, and instead trust that taking ... will help without understanding the actual mechanisms/effectiveness of the treatment.

I think a lot of this behaviour can be attributed to how the US treats sick leave - unpaid.

However, the quality and quantity of medication ads in the US has truly amazed me when I visited. I wouldn't want to be a hypochondriac over the big pond, because the TV ads were so suggestive.

Today I was walking around SF and saw a billboard for a medication, and it didn't say anywhere what the medication was for. Drug advertising in the US is simply baffling to me, and I'm American, even.

I think it has more to do with how readily available medication is in the US (Supermarket).

By the standards of many places in the world, medicine in the US is quite prudently distributed.

For instance I can buy antibiotics, or things like prozac at most any pharmacy. Pharmacies being a bit different than in the US. In many places prescriptions are not filled at pharmacies, but at the hospital itself. Pharmacies are often stores that sell only drugs, usually without prescription, as opposed to the US thing where you have a general goods store with a pharmacist filling prescriptions in the back.

And all the regular stuff acetaminophen/ibuprofen/etc are also of course available, though there is a difference that generally it is sold in blister packs rather than in the huge bottles of it you can buy in America.

I'm not sure it's a valid point since I can just enter in one of the 3 pharmacies near me and buy a box of aspirins for 2€. We don't have medications in supermarket but we have a LOT of pharmacies here (France).

It's still different. Needing to go to a specialized store with trained personnel to buy painkillers has a completely different appeal than just tossing bottles of painkillers into your cart next to milk and candy.

I think that's the point the parent is making, there's a lot more friction involved, you'd have to get out of your way to get large amount of drugs (amount in one box in the US is just way more than what you'd get in e.g. France).

E.g. the box of aspirin from the supermarket may have 500 pills: https://www.walmart.com/ip/Equate-Pain-Relief-Aspirin-Coated...

But can you buy a box of 1000 aspirin tablets? That would be $23 in the US: https://www.cvs.com/shop/cvs-health-ibuprofen-tablets-200mg-...

That link is for ibuprofen, not aspirin.

Aspirin is dirt cheap in the U.S.

the deal isn't the price, but the quantity: if you need 1,000 pills of any medication, you should be under medical supervision/follow-ups, not buying them like they were groceries.

Generally, sure. As for aspirin, though, if you're a couple on a common low-dose daily regimen, that's 730 pills in just 1 year without a single head or body ache.

Ibuprofen and the like are also available from the supermarket in most of Europe. Codeine and the like are not, as they're prescription only but it's not a big trip to go to a pharmacy anywhere.

I live in Europe now, but lived in the US before. The difference is that buying medications is part of weekly grocery shopping in the US more or less. It is also how it is advertised all over the place. Besides, many medications that are prescription here (or are just smaller doses) are available in large doses in the US in grocery stores.

That's bizarre and not at all a part of my experience in the US. I go to the supermarket when I need things. If one of those things happens to be a medication (because I have an immediate need for it), then I'll buy it. Otherwise, I won't.

I think this is probably quite accurate. Looking at tv in various countries, they just don't have the pill advertisements like America does. ask your doctor about...

> ask your doctor about...

That freaks me out. The doctor is supposed to tell me what to assume, not the other way around.

Also, I have seen too many stories of drug representative sellers with no background in medical sciences convincing doctors to prescribe a drug with many, more-or-less honest arguments.

The other bizarre and ludicrous thing about the constant "ask your doctor" refrain: how many US adults have a personal physician whom they see regularly enough to even be able to call the person "their doctor"?

I'm willing to bet most people have a more substantial relationship with the barista at their local Starbucks than whoever happens to be on duty when they need to go to the doctor.

When I was a kid we all (including my parents) had regular doctors that we had a relationship with. These days a doctor visit for me is rare (once every couple years), so I wouldn't say I have a strong relationship with my doctor, but I do go to the same doctor every time.

I think this is pretty normal; many insurance plans in the US have the concept of a "primary physician" who you nominate as your go-to doc for general issues. (It's easy to change, though.)

I do have more of a relationship with some bartenders at my favorite bars, though; you're right about that.

I think so.

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