Comment by thepasswordis | Hacker News Reader

Comment by thepasswordis | Hacker News Reader

I really wish I could just (safely) order whatever medications, tests, and treatments I want online.

Let me consult a doctor if I need one, but also: don't gatekeep treatment from me because the doctor is having a bad day, doesn't like me, etc.

I have a severe, debilitating anxiety disorder. It's extremely frustrating, and sometimes I will have to leave classes I'm teaching, social functions, etc. for no apparent reason because my body starts an anxiety attack.

This flares up once every 3-5 years and has for most of my life. The solution to this, which has worked for most of my life, is: xanax. Take a small amount of xanax before an anxiety trigger, do the trigger, and break the trigger->anxiety association/cycle. It takes like 3 doses total, and the rest of the pills go in the trash (or in the medicine cabinet, and then eventually the trash).

Almost every time I have to go through some weird and insulting dance with a doctor essentially pleading with them for this medication, I get told I'm a drug addict, and finally after explaining that no actually I'm a 40 year old semi retired founder/software developer, not a homeless unemployed addict, which is what your leading questions about what I do for a living led you to think, I might get a prescription for the drug that I have been taking rarely, but to great effect, for 30 years.

I *HATE* the medical system. I hate it. People talk about how the rich get access to some other medical system that gives them what they want with concierge doctors or whatever. Well I'm rich and I don't get that. I'd pay almost anything to just get a license that says "this guy is responsible, successful, and a massive contributor to society. Let him do whatever the fuck he wants and order whatever the fuck medications he needs."

You can just keep the pills. If you're really that strong about avoiding addiction why do you feel the need to throw them away?

I'm not sure where they said they got rid of them to avoid addiction: It is more that they have to convince medical staff that they aren't simply looking to get high but want health instead.

But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect. Plus, a lot of folks don't like to keep stuff they aren't using around the house - it is always a bit of upkeep or storage.

And that doesn't even get into it being safer around children. It is easier to prevent children from getting into such things if they aren't in the house.

FYI: Check with your pharmacy about bringing unused medicine to them to dispose of properly instead of putting it in the trash.

I am not a doctor or chemist so I do not want to speak definitively, but I highly doubt most common drugs (Xanax, Advil, etc) really lose much efficacy past their expiration date (at least within some reasonable time, like 10-15 years). Happy to be shown evidence otherwise. I wouldn’t rely on this for say, antibiotics to treat an infection, but I wouldn’t hesitate to take a 5 year old Xanax.

> But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect.

Evidence required.

Expiration dates are put on many things as a CYA, but I don't expect dry chemicals destined for human (or animal!) use kept in an airtight container protected from the sunlight to degrade within 10 years.

Should they degrade, the question is into what, and how much: 5% degradation into what the human body breaks the chemical into should have no consequence.

> FYI: Check with your pharmacy about bringing unused medicine to them to dispose of properly instead of putting it in the trash.

Or just keep it and use it as needed, solving both of your problems at once!

>But outside of that, getting rid of unused pills is good practice. These pills are going to expire. Once they do, you can no longer rely on them doing what you expect.

Disagree completely.

Source: retired neurosurgical anesthesiologist (38 years practice)

Reasons:

1) When you need those pills you won't have them

2) Properly stored pills (dark shelf/cabinet) lose potency/efficacy VERY slowly: perhaps 10%/year. So 5-year-old pills will still work fine. Take one, see if does what it did originally; if not, take another.

3) If you're traveling and need that medication, good luck. You'll wish you'd saved them.

Most medicine has expiration dates. If he needs it only every 3-5 years, it's unlikely the pills will still be usable.

> it's unlikely the pills will still be usable

Pills (and chemicals) are not SSL certificates: they don't cease to work at the expiration date + 1 second.

And in the US at least, FDA requires a max expiration date or one year, despite many being shelf stable for probably decades.

I know I read somewhere about morphine pills from WW2 medkits being found to still be useful 60+ years later - like say 30-50% of stated dose.

The US government tested a bunch of old World War II medication they found laying around, and it had something outrageous like 98% efficacy or whatever.

Maybe a liquid medicine would go bad but I suspect pills are forever.

> it's unlikely the pills will still be usable.

Yes it will. The pills don't actually expire. They will work unchanged for decades.

See: https://www.health.harvard.edu/staying-healthy/drug-expirati...

For medication like this, the doctor will usually prescribe a specific number of pills at a specific dosage. The number will rarely exceed what you ask for, and asking for large numbers of pills is treated (not unreasonably) as a sign of drug seeking.

This is true in general, but as a doctor, I've never written a prescription for only 3 Xanax pills. Usually more like 10 to 30 depending on the situation. The only time I write for a single digit number of pills is for antibiotics, where I know ahead of time exactly how many pills they will need.

Anecdotally I’ve received a script for exactly 3 Xanax pills. The eye surgeon prescribed them for my LASIK surgery.

This is also common for dentists and other outpatient procedures.

>and asking for large numbers of pills is treated (not unreasonably) as a sign of drug seeking.

Something that keeps tripping me up with the label of drug seeking, is that in this situation the person is correctly drug seeking in a situation they've previously had a specific problem diagnosed and have had positive experiences with a therapeutic. They simply need to subject themselves to the ritual, follow doctor's orders, and not look like they are drug-seeking to successfully drug-seek the therapeutic.

What bother me is the implicit confusion between seeking drugs to treat a specific problem, versus not. Confusion creates damage both ways, with an insufficiently individualized approach people subject to drug addictions may not be sufficiently protected (many are still successful finding someone who will fuel their addiction), while people not subject to drug addiction receive substandard care.

> the person is correctly drug seeking in a situation they've previously had a specific problem diagnosed and have had positive experiences with a therapeutic

I've been in this situation a few times as I've moved around the US for both xanax (as needed) and adderall (daily) concurrently.

The short of it is this: you just have to find the right clinician.

Because of how the system works, you're not limited to psychiatrists. Pretty much anyone with a prescription pad can dispense these in month-sized quantities (primary care, psychiatrists, prescribing nurses, even dentists).

Call providers and tell them explicitly what prescription you need and that you're having trouble finding a doctor to work with you and it's frustrating. A lot of them will say "oh, this practice isn't what you're looking for" and eventually you'll find one that says yes.

Try to think of it as "patient advocacy" instead of "drug seeking behavior" while you're having conversations with professionals.

> both xanax (as needed) and adderall (daily) concurrently.

I'm not a doc but something about that combo activates my fear response... how would that even work?

I take adderall most weekdays because I need to be reliable and on a schedule for work, but I usually take weekends off.

I take xanax when I have to go do something that causes me a lot of anxiety but is required (family function, some doctor appointments, etc) and to mitigate panic attacks when I feel them starting (which thankfully hasn't happened in a long time). But I'm not usually on adderall for those events, so there's not much overlap for interaction.

I spent way too many years pretending everything was fine when my head was spinning with anxiety or when I couldn't get motivated for work. Eventually I just sorted out what drugs modulated me successfully, realized that I don't have an addiction problem, and now I've got a system for managing my life better.

Ah okay, that makes a lot more sense than when I read concurrent as 'together'. Glad you figured yourself out and I can imagine that must be a drag to keep organized at the doc... reform is definitely needed there.

Do you have a regular doctor?

I'm in a simmilar situation and need a dose of Lorazepam about once or twice a year. However, I've never had the problem you describe. The first time I spoke to my primary care physician about this, we had a discussion about my options and I left the consultation with a prescription for a rather large dose of Lorazepam [0].

Since then, I've just called her office whenever I needed another dose, and told the receptionist that I was previously prescribed Lorazepam for X, and I need another dose because I will be doing X again. A couple of times, I also asked the receptionist to ask the doctor to lower the dose. I've never had any problem with this. I don't think my doctor has even asked to talk to me at all before putting in the prescription. (Although we have spoken about unrelated medical issues).

I assume that she just looked at my file; confirmed that she previously prescribed it and that I wasn't asking for it too frequently, then rubber stamped a new prescription.

On one occasion, I was speaking to a specialist (again, for an unrelated medical concern), and asked her for a prescription, because I happened to know I would be needing one soon. She glanced through my file and wrote the prescription without complaint.

I don't know what is going on behind the scenes, but I think what is happening is that I have a regular doctors office through which I coordinate all of my care. This means that whenever I speak with a doctor, they have a file on me that says "patient prescribed Lorazepam for X", so doctors seem willing to repeated what they have documentation about having worked before.

[0] Enough that she suggested I use a wheel-chair after taking it.

You can order unscheduled drugs from pharmacies in India like alldaychemist.com. That means no benzodiazepines, but there are drugs with off-label anxiolytic indications like hydroxyzine, propranolol, or clonidine to name a few. I don't disagree with you regarding our medical system.

>I HATE the medical system.

A teeny nitpick, it's never the system, its always collectively the people, and common people at that. I have toyed with the idea of getting a medical degree but it's a lot of time, effort and money, to get over the issues you correctly pointed out, but it appears that searching and finding a doc that is disgruntled with the 'system' and who might be co-operative with things that I need is higher.

The tests can be ordered though a few online services. You pick the lab test, a doctor rubberstamps it and then go to Quest or LabCorp to get the blood draw. A few days later they send you the results. I don't think you can bill the insurer but the costs are not always that expensive for some of the common tests.

Sorry to hear about the suffering you endure with your condition. Have you investigated any somatic work? How about psychedelics? Over the past 10+ years, I've gotten myself off a 200mg dose of Zoloft, along with Wellbutrin and Adderall through a combination of the above. I've seen others heal similarly.

Do you go to a different doctor every time, and is it a general doctor or a psychiatrist?

You can order xanax on the darkweb, FYI.

I mostly agree with you - the problem is that doctors are trained to deal with the lowest common denominator of patient: an addictive idiot who would kill themselves with benzos or opiates, given the chance. 90% of doctors are absolutely not equipped to deal with high-agency, high-intelligence patients. I've had a few doctors that were smart enough to work with me on experimentation or nonstandard treatment, but they are few and far between.

You can also order fentanyl labeled as xanax on the darkweb...

DNMs have minimal issues with adulterated drugs, especially compared to street drugs. They typically have extensive third-party testing.

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