Ketamine therapy is going mainstream
newyorker.com
newyorker.com
I had similar very positive + life-changing experiences from taking MDMA but it wasn't clinical.
Also unfortunately, I'm about out of the drug, and will soon need to either try and find a reliable source, or call it quits on this particular treatment avenue.
Edit: Also, unfortunately, the site has just dictated that I've used up all my comments for a while and need a timeout. Had I been warned that this would happen in advance, I'd have done something to prevent it. Unfortunately, they just stick me with this uninformative error message saying I'm "posting too fast," and disallow me from posting anymore for some period of time I'm also not privy to.
- Waking the Tiger: Healing Trauma and Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body by Dr. Peter Levine
- The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D
Some other keywords to research: complex trauma or CPTSD, somatic experiencing or somatic psychotherapy.
Here is one that points to the psychological effects of myofascial issues: https://www.researchgate.net/publication/233680399_Myofascia...
Take some drugs you'll get it
This is a large problem is psychology and it's made worse by the lack of research behind psychoactive compounds. That void gets filled by people who take the drugs recreationally and come up with this mythology type of explanations. As a scientist who studies drugs, biochemistry, and behavior; I want to move past this. I want people to have a clear understanding of how the brain works, and we don't get there by being vague.
Its likely that we don't have any research done into these psychological phenomena, partially due to the way research into these compounds has been essentially banned (DEA dragging their feet on applications or denying for arbitrary reasons)
I think a good example of terminology that has come from the drug use underground is that of "vibrations" It seems to me like the discussion of vibration is actually related to the oscillatory behavior of neurons and their networks. I don't know how we'll be able to dive into this idea and connect what people experience as "vibrations" to oscillatory behavior and their associated behavioral and psychological phenomena, but I think its a good place to start investigating as long as we solidify terminology.
I'm more than happy to hear different ideas and perspectives on these phenomena but I'll always ask clarifying questions. These questions help to get people on the same page so we can all deepen our understanding of the complex machinery that is the human brain.
The "gasoline poured into her veins" metaphor: Is that referring to physical pain, or something else?
It probably didn't make her more angry, just less able to resist expressing her anger.
As with any psychoactive medication, taking it too often sounds physically and mentally exhausting. In this specific case it’s even more unusual as all guidance I saw in regards to ketamine therapy mentions that the post-session period of integration is critical to the success of this whole process. So having sessions back to back is pretty unusual.
The second place I did it was willing to try repeating the exercise.
I think the first went out of business in the last year or so, but they were around for years, so they did get plenty of business for some time.
(I also always recall a couple of times I was there - the infusions were done in an office setting, with insulated but not totally soundproof walls, and sometimes one of the other patients was _VIOLENTLY_ loud, screaming repeatedly for long stretches.
...that said, I looked a couple times, and those patients were coming in and leaving unescorted, so they did not appear to be there under duress, and one might conclude they thought it was helpful despite that, which tracks with my own understanding of how it can be violently intense for people with trauma, but often the trauma is less sensitive, for lack of a better word, afterward.)
I'll also point to my comment[1] from a prior thread about ketamine for a summary of my own experience.
In my experience if you have mental health issues and are part of a herd, you're gonna have to find a new one if you get better.
At this point in my medical history, I’ve tried just about everything else, what have I got to lose?
I am curious, was your comment about trying Ketamine just a general nod or are you seriously considering it? Much of what I have read indicates psilocybin has a more long term and profound affect vs ketamine, are you still looking for further improvements?
With the psilocybin, I confess it was just shrooms eaten with a bottle of water. Not tasty. What I experienced was nothing short of profound. About an hour after swallowing four grams I started feeling giggly, and happy.
I looked at old photos of my cat that died some years back, and she started to pulse slightly and seemed to move almost in the photo, but that was the extent of the hallucinations. It's what happened next that changed everything.
I remember drinking some water and then going to lay in the bed. My brain started thinking about a very depressive episode that happened to me this year. I thought through it, specifically what it meant for my life, friendships, etc. This is something that would have left me crying in a dark bathroom in the middle of the night before, but this time, it didn't. I didn't feel the usual guilt, embarrassment, and humiliation about my past mistakes.
The best way I can describe it is this: I was walking alongside my depression, having a conversation with it, and at some point, my depression stopped and I kept walking. It was a sudden realization of "wow, that ..isn't making me depressed, or feel guilty, humiliated, etc. !"
About three hours after consuming the shrooms I came out of it and looked around my bedroom as if I was a different person; "holy crap this place is a mess!" I went downstairs and finally did the stack of dishes in the sink, put away the laundry, and spent hours just cleaning joyfully.
I was able to process considerable trauma that night, and my therapist said a few days later that I was a total 180 degrees from where I had been the week before. We've been very careful to monitor to make sure it's not just a manic episode. The positive has kept up. I've had a few down days, but that's mostly due to anxiety and relationship issues, which a little marijuana helps considerably.
Overall these past four months have been some of the best of my life. I wake up with a forward outlook. I can sleep easier, thoughts are no longer dwelling on me. I don't feel this weight on top of me, reminding me of my failures, fears, etc. Above all, I just don't feel like a sad sack all the time.
I've taken maybe two dozen medications in my life for anxiety, depression, and PTSD. Nothing can hold a candle to the immediate, calming effects of marijuana, but nothing has also come even close to the sheer relief from the shrooms.
Edit: Grammar and clarified a few things.
With all of that in mind and research indicating that you will continue to have this net benefit for up to 6 months, why try something new vs just take another trip?
Also… the dozens of meds is so demoralizing and exhausting. I hear you loud and clear on that front. Not to mention the years that go by while tweaking them… ugh.
The second trip was 6 grams, ground with orange juice. After ~20 minutes felt nausea but no happiness in this "come up" phase [0]. I tried reading Dune (again) on my phone but the characters would visually "s e p a r a t t e" and stretch out.
The peak [1] was much more sorrowful; I cried a lot. My trip sitter [2] said I vented a lot, almost vindictive in how I stripped away relationships, friendships, and people from my past that, well, I'd never gotten over. To me, it felt like I was shedding these heavy chains I'd been carrying around. I also, at long last, said "bye Felicia" to a an abusive, lontime "best friend" and walked away. Parse your contacts: How many that you never talk to, and have no interaction at all?
Marijuana was exceptional here for giving me a gentle cloud to settle on. In the words of Big Chris: "It's been emotional" [3] Since then mood has been the same as the last trip, all good.
[0]https://wayofleaf.com/psychedelics/what-is-a-mushroom-trip-l....
[1] https://wayofleaf.com/psychedelics/what-is-a-mushroom-trip-l...
[2] https://en.wikipedia.org/wiki/Trip_sitter
[3] "Lock, Stock, and Two Smoking Barrels" 1:21:54
+10 For including the citations on the various terms.
+100 for taking the time to share this second experience.
FWIW, a friend of mine is a fairly frequent 'traveller' (couple times a year). Every body type is different etc, but his recommendation to me has been: 1. Set and Setting are everything, if you have any doubts it isn't a good time 2. 0.25-0.5g is a micro-dose with no real trip but some potential chill effects. ~1.5-2g is a solid recreational dose. Any more and things can get weird. 3. If things do go sideways, milk can help (no idea of the chemical efficacy of this)
Sounds like it got weird for you, glad there weren't any long term side effects.
Trip reports: https://erowid.org/experiences/subs/exp_Ketamine.shtml
1. read Michael Pollan’s book, How to Change Your Mind
2. Look into the process of cultivating your own mushrooms at home - it’s ultimately very easy to produce your own medicine
Nitrous is also a dissociative, with psychedelic properties.
Alcohol can even push this boundary.
Managed ketamine therapy starts as low as $1200 for 6 sessions I believe.
This is terrible advice that needs to stop being perpetuated.
This system is not perfect but practically as close as it can get to a fully guided affordable session.
Never change HN. Even for many people in tech, this is not a trivial sum.
Aside from 5-HTP, I started taking oral ketamine for chronic neuropathic pain around 1-2 years back, and it's been absolutely transformational - I've suffered with depression for my entire life, even when I was a kid, and now for the first time ever I feel... like it's maybe not an issue! The dark feelings of sadness and loneliness, the random tears, the pointless futility of existence... those just aren't there anymore.
this is irresponsible advice for people who have mental illneses
But it did not fix my depression or make me feel less alone. I might feel connected to the universe -- for a time. But it eventually fades, and the old demons come back.
Sooner or later, you need to deal with the issues at hand. The reason you feel this way.
For me, going to therapy allowed me to address some of the root issues -- generational trauma, a lack of affection, perhaps chemicals in my brain -- and allowed me to start rewriting my story of myself.
I enjoyed my experiments with psychedelics, and I would not discourage anyone from using them. But they are not the cure-all many claim, either.
"Set and setting" is a frequent quip of the psychonaut that doesn't get enough respect. You must have intention. Psychedelics are like removing the bumpers from the side of a bowling lane - without intention you will just fall into the gutter (figuratively).
Therapy is vitally important, either externally or internally. One can certainly perform self-therapy, which is sometimes only enabled with the help of a mind-altering substance like Psilocybin.
I think you would be surprised to try them again. You have a lot more lived experiences under your belt, new perspectives, new/fewer biases, etc...
Defining or, rather, roughly sketching out, a mission might be one way to approach psychedelics. You don't want to follow it to the letter, to avoid self-limits, but at least define your attitude: are you looking for a master, an answer, a resolution? Do you want to feel what's inside of something, i.e. how your reactions are built, where this or that comes from? Just mildly keeping your goal in mind may set you to achieve the right result.
As a quick example of the outcome, at some point I felt my body telling me "man, what are you doing with this e-cigarette? Just stop putting this in me." In a few months I quit for good. Understand this might not be a demon as big as the one causing depression, but maybe this will help? Where did that guy came from?
A challenge in these conversations is that there’s still no real standardized way of speaking of these experiences. What you’re describing sounds like detachment to me which can vary to different degrees of course but what I would call “ego death” is the actual death of your ego, the dissolution of yourself: you stop existing and with it also any consciousness. In my experience there was really nothing left to witness in that situation as I was no more.
Talk therapy, becoming estranged from abusers in my family, and SSRIs helped me long term conquer my PTSD and depression.
I liken doing psychedelics in late adolescence to reading philosophy in late adolescence. Unfortunately late adolescence is the period where the majority of both psychedelic and philosophical experimentation happen, when both of these are much more useful after gaining some life experience.
If you haven't even spent time working on or struggling with your own depression and isolation, and are in fact still quite tangled up in the formation of these issues, psychedelics don't have much to offer you other than "fun". Likewise reading Nietzsche as an adolescent, you miss many of the subtleties that make his work truly revolutionary, for example misreading "god is dead" a proclamation of some sort of victory against religion, when Nietzsche is much more concerned about our loss of meaning. You can't really get at what Nietzsche is worried about until you've had your own, serious struggle with meaning as you get older and the reality of death hits you much harder than any adolescent can imagine.
As an adolescence you're still rapidly formulating your world view, there's not a whole lot to shake up that isn't all ready rapidly changing. An adolescent will learn far more by interacting closely with a group of people they normally wouldn't, or wandering around parts of a city they normally never go to, than doing any psychedelics. It's not to say they shouldn't experiment with psychedelics and read lots of philosophy, but these won't be really impactful until later.
I highly recommend everyone in their thirties and later revisit both psychedelics and philosophy. There's a lot more there than when you where younger.
What have you gained by trying them again as an adult?
I can understand your concerns about a "terrible trip", especially since these type of worries typically make me paranoid and anxious when I'm on cannabis. However, I've found that when I do shrooms the psychedelic experience always side steps these anxieties completely and reminds me that these concerns are not the core concerns I have.
What's different about doing shrooms as an adult is that I'm not like "whoa, all this stuff isn't real!", I already know that. It's for those times when I feel daily stresses slowly crushing down, am fully intellectually aware that these things are ultimately not important, but can't quite find the emotional release. Shrooms aren't a miracle cure, but typically I'll feel a bit refreshed for quite awhile. As a teenager shrooms are about changing your perspective of big, metaphysical things "whoa man!", as an adult they're about changing perspective on those small things "oh right, performance reviews really don't matter." The insights are the things you, for the most part, already knew, but have been too distracted by daily life to really realize.
I had bad trips when I was younger, but being older and knowing both myself and psychedelics better I find I am much better at keeping myself from spiraling out of control too easily, and much more deeply feel the wisdom of "there are no bad trips". The other nice thing about tripping as an adult is you have much better control over the scene portion of it.
The "insights" I gained certainly felt profound at the time, but they were kind of silly in retrospect. I'm actually cringing a bit right now remembering what I was like back then. I remember going on a first date with a girl the day after a particularly intense mushroom trip and trying to share my "wisdom" with her. She must have thought I was completely insane haha.
Sitting here now almost a decade since my last trip, I can't say it permanently changed my outlook on anything. I still dealt with a lot of depression and confusion in my 20s, just like anyone else. The things that really ended up moving the needle for my depression and anxiety were: quitting alcohol, lifting three times a week, therapy, getting married, and having a kid.
Self medicating with cannabis and alcohol are bad news bears too. I wouldn't advise doing anything without your doctor being in the loop.
I've looked. We tried shrooms once on a whim, in Amsterdam, and while it wasn't that interesting a trip, it did have the side effect of eliminating my wife's OCD for almost a full year. I wish they were easily available. I've even considered driving to that "church" in Oakland to get her something. I don't otherwise have the right kind of friends (or they are quite discrete about it despite my having mentioned it).
Or just drive up to Oregon where you can buy them (the fruits) legally.
One would just pour the liquid on china plate and put it on smallest temperature on a kitchener. Liquid would soon evaporate, leaving crystals ready for snorting.
Fun times. I'm glad they are over for me. I guess I'm cured :)
there's only 3 states where it is illegal to have those mushroom spores and I'm in one of them....
I can 100% get behind the idea that you want to find a psychiatrist that understands you or that you "connect" with, but if your gripe with your current one is that he won't prescribe ketamine even though you read online that it might help, I'd say reassess.
at the end of the day, you go to psychiatrists to access pharmaceutical treatments for mental health issues. if the one you pick doesn't prescribe something that solves your problem, it's rational to either try another one or stop seeing psychiatrists.
> he said he tried with a couple patients but didn’t see any long term results so didn’t want to put me on it
To me that's a very reasonable take if it's coming from a real psychiatrist, OP doesn't tell us his life story. The trained professional thinks there are better solutions for his patient because he tried the protocol on other patients and saw no long term results. If you read that statement and think "OP should try other psychiatrists" then to me that just sounds like you think ketamine is some kind of miracle drug.
As with everything else in life YMMV, but if taking drugs to address a specific issue (i.e. non-recreational), then listen to the person that spent +10 years studying to help you.
The internet has put a lot of health and treatment information into the hands of laypeople that did not go into the medical profession. Some of those people are more than capable of making decisions for themselves, but the field of medicine doesn’t seem to account for this yet.
Long term ketamine usage is not so well studied. Recreationally, using much larger doses, some people have issues with UTIs, bladder/kidney failure and addiction.
Years ago I remembered reading this article - https://www.nytimes.com/2015/06/28/magazine/i-dont-believe-i...
The one compound I've used (on and off, for maybe a few weeks at a time over the past 18 years) intermittently is Clonazepam. Recently however I don't find the dosage to be very effective, and reading the literature, upping benzo dosage has a high risk of increased dependency. I'd like to avoid that.
I happened to randomly start Googling about Lithium and stumbled upon Lithium Orotate, which is sold as a supplement pretty much everywhere. There's a little bit of literature on Pubmed, but not much.
I bought this - https://www.amazon.com/gp/product/B00PB4II68/ref=ppx_yo_dt_b...
And it arrives on Friday. The reviews on this and other Lithium Orotate seem almost too good to be true, but for $10, I'm willing to give it a shot.
I did however take 600mg daily of Lithium Carbonate for a long time and it really helped me with my anxiety, and, importantly, it reduced my suicidal thoughts/self harm urges to basically zero from multiple times a day. This isn't as low as the doses people seem to use with Orotate, but it's still "subclinical".
I'd say the bigger impact on me was def. psychedelics though.
Obviously, the effects will differ between people, but best to go into things with your eyes open and a professional to supervise things.
From my own experiences with atypical anti-psychotics, getting dehydrated or running low on carbohydrates can affect my motor control severely enough that I can't drive. (I always have water and energy bars on me.) It resolves within an hour after rehydrating.
Interactions with other medication or supplements can also be dangerous.
After starting the Lithium Orotate I noticed some subjective improvements in mental clarity and mood within a couple weeks. The effect is very small though and not comparable to that of my main medication. Although it's possible that I'm only experiencing the placebo effect, I suspect that the Lithium actually is helping somewhat.
The 5mg dose in most commercially available Lithium Orotate supplements is a couple orders of magnitude less than the doses typically used to treat bipolar, but I think it would still be good idea to bring it up with a doctor. Also, try to manage your expectations. It's probably not going to change your life all at once, but you may notice some small subjective benefits over the longer term, and the research on low doses of lithium being partially preventative against dementia seems pretty solid.
[1] https://en.wikipedia.org/wiki/Lamotrigine
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5365367/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994228/
[4] https://journalbipolardisorders.springeropen.com/articles/10...
I intend to try Lithium Orotate and see how I feel, as it seems like a safe first step.
Takes more of the latter form to be effective, and lithium toxicity is no joke- it’s landed a family member (who’s been on it for decades) in the ER multiple times.
Lithium orotate is safe at the doses on the label of otc supplements.
In my experience if has a subtle but distinct effect in terms of reducing anxiety. Particularly if taken with water on an empty stomach. Can’t speak to its effect on bipolar type issues.
Go to a doctor, and get set up correctly.
edit: For context, he subsequently complained of how big pharma was conspiring to destroy ketamine iv therapy access in order to better control the "legal ketamine" market.
IV bioavailability is 100%, intramuscular 93%, intranasal around 50%, and oral around 20%.
This is something I just don't understand about IV ketamine therapy - IV protocols vary wildly, and I haven't been able to find any reasons why IV would be more effective than any other route of administration with an increased dose.
Ketamine has been in production for decades as an anesthetic, so saying that it’s a fad because it won’t make companies rich is nonsense.
Many doctors won't have any problem prescribing them, as they can always say "it was <national drug institution> approved and the patient should stick to the prescribed dosage".
What the vast majority of people need in their lives are discipline and sense of fulfilling, which they won't get from drugs or other material things they can buy.
Depressed people cannot maintain the discipline required to undo their learned helplessness - which is burned into their neurons as structured physical loops.
There are neuronal changes that cannot be rapidly modified without drugs that release BDNF, like infusion-levels of ketamine.
In the time you aren’t treating your patient with the most effective systems, of which ketamine is one of them, they may do irreversible damage to themselves or others. All depression treatments should short-circuit to ketamine as a first line - the efficacy is incredible.
The greatest issue with ketamine infusions is that they cost $800 per session.
Which is not the topic of the article, nor am I debating that fact.
>Depressed people cannot maintain the discipline required to undo their learned helplessness Those deeply depressed people are not the ones I am mentioning in my comment. And as with any other serious disease, sometimes taking experimental treatments are worth the risk if more conventional treatments don't help patients improve.
If I wasn't clear enough, I'm talking about people who think they are depressed but would most accurately be described as "sad", for any given reason that could be happening in their lives.
Since your concern is for the patients health, and your recommendation is against the use of first line infusion therapy, and your alternative is a known positive recreational activity with the intent to build discipline; it is implied that you believe the infusion is not safe for the patients health in the particular circumstance of short-term sadness.
You are not debating the fact, you are simply dismissing the efficacy of the infusion with regard to assisting patients undergoing "short-term sadness", and working around it when confronted.
The mistake here is somehow believing that all patients can handle "short-term sadness" without undergoing a mental break; it is analytically correct to assault the issue on all available fronts, and if a small infusion dose assists someone in rectifying their issues, it should be done.
The patients perception of their mental state becomes their mental state, which is why psychedelic drugs have such a high efficacy in the first place, the BDNF literally rewires their brain and how they view their issues. So what exactly is implied when you say "Can't wait for regular people that have a few solvable issues in their life but perceive themselves as "depressed" to just take a shortcut where Ketamine, or whatever is the miracle drug at the moment, will fix everything." - these issues are perhaps solvable for you because you would view it how you view their "short-term sadness". This is not the case, each patient is N = 1.
For about an hour you are in this wonderful state. The nurse comes in to check on you every so often. I can barely speak but I'm able to give a thumbs up and mumble "yes yes doing great."
The end reminds me of that Guns n' roses song, "when you're high you never, wanna come down..." But even after the hour is over and you can walk again and you are safe to drive, you are very happy the rest of the day.
I will say Dr. Vu sells a lot of other stuff besides K shots so be careful what you agree to. It can get very expensive! But overall I think it's a wonderful service he is offering.
Anyone with access to a vial of ketamine could easily perform a single IM injection at home without paying thousands of dollars for the privilege.
When I asked about muscle vs vein he said a lot of K is lost in the process and not absorbed by the body, but enough is that it still works fine.
I'm more worried about people stop being able to afford it, going to black market and and up having a dependency.
https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
https://astralcodexten.substack.com/p/drug-users-use-a-lot-o...
It has no bladder problems, and shines light where ketamine is cold.
MXE is the perfect drug. 5g in a few months, stopped cold turkey, felt fine - due to the long lasting and dissipating metabolites that these drugs degrade into.
I am planning on getting some Ketamine soon for my own Christmas present. Too bad I can't have MXE, which is safer, better, and fuckn awesome.
you can even smoke it! (very small amounts. makes you feel like a golden greek god)
10 day regime of a small bump for breakfast had be happy for weeks.
do drugs, people
I don't do custom, especially from NL.
Good to know they are still around! May look into their new new new novel lysergamides.
Psilocybin is for depression, trauma, PTSD, addiction, coping with pain, and generalized anxiety disorder. One dose induced rapid growth of dendritic spine size by 10% and density by 10% in the frontal cortex within 24 hours and lasted at least one month (they didn't monitor beyond that). Depression is associated with synaptic atrophy in the frontal cortex.
Ketamine is for major depressive disorder, bipolar disorder, obsessive compulsive disorder, and social anxiety disorder.
Medical ketamine for depression could potentially be an even greater windfall than methadone was. There are a lot more people that can be diagnosed as depressed than as heroin-addicted. I supposed this is all working towards massive state subsidy.
Trying to guess what you mean: it isn't used as a local anesthetic, but always on the central nervous system, causing disociation in big dosis.
For depression they use much less than that, so many decades with heavy dosage it's a very convincing safety record.
There have been a few recent papers showing brain lesions in very, very heavy recreational users, but otherwise it appears to be a very safe drug.
Is ketamine going to make it less depressing that you work in ad-tech? Why not also microdose magic mushrooms as you work in ad-tech? Why not buy from your local farmer's market as you work in ad-tech? Why not volunteer for a local organization in your free time while you work in ad-tech? The problem is that you work in ad-tech. No amount of microdosing or macrodosing LSD or mushrooms or ketamine is going to change the fact that you probably have no social skills and your life work in ad-tech is meaningless, and having slightly more money than the average prole and being able to afford drugs they can't isn't going to make you happy.
I really dislike that phrase. It comes off as arrogant, condescending - dismissing the quite real change that these drugs can foster when used with a productive intention, in a proper setting.
Not everyone uses various substances for "fun". Some people use them to understand their existence better, or do help combat debilitating mental constructs and experiences.
No SSRIs worked, I'm simply immune to that shit. It makes me feel worse, even more suicidal than usual, even if taken long term. And withdrawals ain't pretty.
So, enter gabapentin and pregabalin. Which no doctors would prescribe as they're for those with epilepsy or something and I'm just a fucking idiot in their eyes.
No matter, I can buy it freely right now.
Both of them work on voltage gated calcium channels, something I do not fully understand.
But I do understand they work, and they work well. As long as I take either, I'm chill, content and even creative.
Doesn't help with attention/focus, but at least it works for the anxiety and depression.
Apparently they're prescription only because a small percentage of people reported euphoric feelings. Damn narcs lol.
Yes, when initially taken in high enough dosages, both gabapentin and pregabalin gave me very euphoric feelings, insane waves of energy, somewhat between alcohol and cannabis, really nice.
However that subsided after several months and now it's only the quiet chill feeling.
Withdrawal is fast, if you taper down over a week there are no effects. If you quit cold turkey, it's a few nights of nightmares or insomnia. Overall, really not bad compared to anything else.
So yeah, they work, they work well and I wish doctors actually put their brains to use and made them more readily available.
Just make them OTC because few people can put up with the regular begging they have to do for life changing medication.