November 16, 2005

"I acquire quite a few medications and then dispense them to my friends as needed."

Says Katherine: "I usually know what I'm talking about." This is, apparently, a big trend:
For a sizable group of people in their 20's and 30's, deciding on their own what drugs to take - in particular, stimulants, antidepressants and other psychiatric medications - is becoming the norm. Confident of their abilities and often skeptical of psychiatrists' expertise, they choose to rely on their own research and each other's experience in treating problems like depression, fatigue, anxiety or a lack of concentration. A medical degree, in their view, is useful, but not essential, and certainly not sufficient.

They trade unused prescription drugs, get medications without prescriptions from the Internet and, in some cases, lie to doctors to obtain medications that in their judgment they need.
Oh, these young people. They used to just smoke marijuana.


Goesh said...

Reefer madness may well have taken hold with some of the older generation. They may not be as open as the younger generation is about swapping pilld. I know several older people who do swap and dispense pills. Conversely are the doctors who will presribe what a patient asks for, though they are not abundant in my opinion.

Meade said...

I'm telling you -- it all starts with Halloween candy or that first sip of Pepsi...

HaloJonesFan said...

This would be along the lines of me going around giving out free insulin injections. "But that's stupid," people would say, "not everyone needs insulin injections!" Well...yeah, that's my point.

wildaboutharrie said...

Did this jump out at you because you have that as yet unfilled pain pill scrip? Tell your friends to get their own damn meds! Like it's that hard anymore.

Ann Althouse said...

Halo: Thanks for reminding me to rip that slip of paper up into tiny pieces as I did with the last 2.

SteveR said...

All that research takes the fun out of it, but I understand they feel they *need* them. The right to self-medicate, is that one of those hidden in the Constitution? Well at least we know how the 9th Circuit would rule.

Bruce Hayden said...

Or, you could make a little extra money on the side.

Bruce Hayden said...

I am really somewhat ambivalent on this (btw, interesting discussion on by Eugene today on Volokh on misusing words, including "ambivalent"). A lot of physicians really don't know all that much about the drugs they prescribe. That is why some practices are bringing in PharmDs to handle such. Often, they seem to depend on the drug reps - who have a serious conflict of interest (i.e. they are paid for selling the stuff). Add to this that there is a lot of drug information on the Internet these days. So, I would expect that at least some patients have a better idea of what meds they need than do their physicians.

On the other hand, I have seen it abused. I know of one older guy who fires his doctors if they don't give him the diagnosis that he expects. He tells them what is wrong with him, and they had better agree, or they get fired. Yes, he is smart, and does homework. But he has been wrong as often as he has been right.

My point in the later is that with the ease of information acquisition today on the Internet, we sometimes discount the expertise of people who have spent their lives in a certain area. Sometimes, they have forgotten more about your malady than you have learned about it on the Internet.

In the end though, I come down on the side of these kids. My libertarian side shows through again. If they want to kill themselves this way, then, fine, that is (IMHO) their perogative.

Icepick said...

Bruce Hayden wrote: My libertarian side shows through again. If they want to kill themselves this way, then, fine, that is (IMHO) their perogative.

If these people have insurance, they are quite likely going to stick someone else for the bill if anything goes wrong, not to mention driving up costs for their carriers by getting unneeded prescriptions.

Does your libertarian side think it's okay if we throw all of these people out of their insurance programs, because they're bad risks and are abusing the system?

Smilin' Jack said...

Well, what did you expect? As long as our government permits its subjects to eat and drink whatever they choose, some of them will be tempted to extend those liberties of ingestion to pharmaceuticals. Government must step up to its responsibility to completely and ruthlessly control every aspect of our lives...otherwise horror stories like this will continue.

Dave said...

When I was studying for the LSAT, a friend of mine recommended that I call her psychopharmacologist for what she called "costmetic psychopharmacology."

She explained that when she was studying for the MCAT, she had her psychopharmacologist prescribe her Adderall, and it helped her.

So I called the dude up, made an appointment, and he asked me a number of questions about my lifestyle, (illegal) drug use, and then performed what he called cognitive tests on me.

Once he was satisfied that all was good in the world, he wrote me a prescription.

As to whether it helped with my performance on the LSAT: not really. But I did score a promotion at work while on it.

Oh, and he went on and on about how you can't quit it cold turkey, and that there were all these withdrawal symptoms, etc.

But I quite it cold turkey and never looked back.

DaveG said...

If these people have insurance, they are quite likely going to stick someone else for the bill if anything goes wrong

While I don't necessarily disagree, that is a pretty slippery slope argument. Using that logic, I could go on all day about people living in flood plains, eating bacon, driving a car without airbags, jaywalking, parachuting, scuba diving, etc.

Insurance by its very nature is a shared risk.

vbspurs said...

When are people going to start operating on their buddies?


XWL said...

It's that damnable internet again. Everyone seems to think that they can educate themselves and make their own decisions about their own bodies based on their own research.

Personally, I think any adult should be able to buy anything they want when it comes to drugs (both licit and illicit).

As far as insurance, they would probably only reimburse people for prescribed medicines, and that would be fine, too.

Legalize the purchase of drugs, write big scary warnings to ward off lawsuits, and ban the direct advertising of same would be my solution, but then I'm crazy.

vbspurs said...

but then I'm crazy.

I got Percodan, Paxil or this bluey pill I don't know the name of, but my friend told me it works great. Say when!


Pooh said...

Dave, Adderal is most definitely cheating for the LSAT and or Bar'd be suspended 50 games by MLB.

On a serious note, is it possible that this is a consequence of the generally irrational and possibly completely corrupt stance of our government towards drugs of all sizes?

Prof. A brings up marijuana and that's a useful point in that I don't think there is a disagreement among rational people that treating pot and crack in roughly equivalent fashions while pot and alcohol are treated vastly differently is, at best, arbitrary. Once you are there in becomes easier to say "well, I can find out just as much about Welbutrin/Ambien, hell why not Oxycontin, as my MD, so who needs him and his gov't perscription pad?"

XWL said...

I meant crazy in the sense that I am a free-market libertarian who really trusts people to make their own decisions, even when those decisions may endanger themselves (and should only be punished if they endanger others in the process).

From the viewpoint of most people (it would seem) that makes me crazy, so I said that upfront, as far as meds go, sorry, don't need 'em, don't take 'em (not even aspirin for a headache).

(and yes, I know you were just cracking wise, I set them up, so that someone else can knock them down)

I do detect a certain degree of defensiveness from the medical profession when this subject comes up though, it would seem that they fear that most of their customers see them as mere pill dispensaries and should their gate-keeping function be ended then most visits to doctors would be cancelled.

katiebakes said...

The New York Times finally managed to identify a "trend", in my opinion, rather than just a "small but growing" population. I see this all the time among my friends (and I'm not saying I haven't been a recipient or a middleman from time to time.)

The question, in my mind, is this: If you can basically call up a doctor for the express purpose of having him prescribe something to you, as Dave accurately described, why not simply attain the pills through a friend? It doesn't seem to me like the doctor is doing much more than going through the motions.

Icepick said...

XWL, my defensiveness is coming from the employer side of the arguement. If people want to make their own medical decisions, fine. But don't expect the employers and insurance carriers to pay for the additional risks of such behavior.

If this becomes a larger trend expect some companies to drop their medical insurance (or at least curtail their drug benefits) and expect for consumers to pay even more in terms of premiums, co-pays, co-insurance, etc. Just because the medical inflation trend has been bad doesn't mean it can't get worse.

Undercover Christian said...

I'm with XWL. I don't have a problem with this. I would never start taking psychiatric medications without seeing a doctor, but if someone else wants to pop pills on his own, I think he should have the legal right to do that.

Incidentally I think psychiatric medications are already widely over-prescribed.

XWL said...

Expecting consumers to make their own decisions regarding drugs would end a whole class of defensive medicine and lawsuits.

I believe that would greatly reduce overall medical costs which would also reduce the cost of insurance.

Medical practice could focus on prevention and healing, not CYA tests and fears of lawsuits from both under-prescribing and over-prescribing (which hit doctors and providers at both ends).

I understand peoples concerns, but I think the effects stated are the opposite of the likely outcome.

(freer markets lead to lower prices, can't think of too many times where the opposite has proven true)

Icepick said...

Great idea, XWL. Now all you have to do is get everyone to drop their insurance (the carriers place too many barriers in the way of people excercising their free choices), get the government to close down Medicare and Medicaid, and we'll be on our way to truly free markets in health care!

I think I'll read up on do-it-yourself surgery. I'm thinking of opening a surgical practice in the newer freer marketplace. Victoria, got any good book recommendations on thoracic surgery?

Aaron said...

My fiancee is in her residency for Psychiatry and there are a few things she has mentioned worth passing along - 1) implicit in psychiatric medecine are issues of diminished capacity 2) GPs tend to not keep current with Psych meds and so many folk who are prescribed by their family physician are on older less effective drugs or drugs with more harmful side effects than necessary 3) she wishes all she did was give pills to pop 4) many folk are "just axis 2" - which basically means that they have no serious psych problems besides personality disorders 5) there are many scary outcomes if the diagnoses is wrong - certain neurological difficulties present the same as psych disorders - it would suck to take paxil for your mood and have it turn out you had a brain tumor. 6) crazy folk tend to run in packs - a person with psych issues probably has crazy friends and family - it might be good to have someone outside of their life monitoring their medical/psychiatric condition. All this is moot since I can have my fiancee give me drugs - best of both worlds! (Actually, she won't prescribe me anything - stupid ethical woman!)

brylin said...

Marijuana? Maybe I'm showing my age, but all we had was alcohol.

bookman said...

definitely true.... adderall has become a necessity for collegiate potheads

vbspurs said...

Victoria, got any good book recommendations on thoracic surgery?

Erm, gosh what a question. I could have a look-see and get back to you, Icepick. :)


M. Simon said...

The use of illegal drugs for self medication by individuals for medical problems is well known to doctors:

A well known secret

Of course the pharma companies dont like it. It cuts into profits.

The War On Unpatented Drugs

Fortunately in the case of the pharma companies government really does want to help.

M. Simon said...


Dr. Benjamin Rush a signer of the Declaration thought that self medication ought to be in the Constitution lest we have a medical dictatorship.

Addiction or Self Medication?

Evidently he could see farther than you can.

So maybe self medication is one of those IXth Amendment Rights after all.

M. Simon said...

Bruce H.,

Did you say drug reps and conflict of interest?

Have I got a story for you. It is why some stimulants are prescribed for ADD/ADHD and why others are illegal.

The War On Unpatented Drugs

It is what is called in the political trade: rent seeking. i.e. only a doctor can tell you what you need and only a pharmacist can give it to you. Assuming prior government approval for the drug in question. Which is why big pharma loves the FDA. With the DEA a close second.

M. Simon said...

Alex Harrison,

PTSD is widely underdiagnosed and undertreated. Despite that fact anti-anxiety drugs are one of big pharma's biggest sellers.

Did you know that tobacco is an anti-depressant?

Perhaps that is a real clue to the magnatude of the problem.