Once upon a time you could buy just about anything at the neighborhood drug store. “Doc,” as the pharmacist was called a century ago, could dispense medications like marijuana or opium. The neighborhood pharmacist was frequently consulted about a range of health problems and provided advice on how to use the remedies he dispensed.

Eventually the Food, Drug and Cosmetic act of 1938 limited the sale of dangerous drugs to prescription-only status. But the definition of dangerous is surprisingly arbitrary.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen were prescription drugs for years. Such pain relievers can cause serious side effects such as bleeding ulcers or high blood pressure and may even increase the risk for heart attacks or strokes.

These NSAIDs were eventually given the green light to go over the counter under brand names such as Advil and Motrin IB (ibuprofen) and Aleve (naproxen). Now anyone can buy these drugs in huge quantities.

With the stroke of a bureaucratic pen, the FDA changed the public perception of these medications. One day they were potent prescription pain relievers with serious side effects. The next day they were mild nonprescription headache remedies.

Americans tend to think of over-the-counter drugs as wimpy. They are not perceived as powerful as their prescription cousins and they’re also not seen as potentially dangerous.

Surveys have shown that less than one out of five consumers actually reads the information on NSAID drug labels. As a result, many people are unaware of the proper dose and possible side effects.

The FDA faces a difficult balance between making helpful drugs more easily available and making sure people know how to use them safely. That’s why the agency is beginning to look around the world to see how other countries handle this dilemma.

The solution appears to be a return to the old days when the pharmacist played a far more active role in dispensing drugs. Many countries including Australia, Britain, Canada, Denmark, France, and New Zealand allow pharmacists to dispense certain medications from behind the counter.

For example, the cholesterol-lowering drug simvastatin (Zocor) is available in England without a prescription. Pharmacists can perform a blood test in the pharmacy to see if a person would benefit from this medication. Advice and warnings are given in person and the pharmacist is available to answer questions.

If the FDA adopts this model, it could open the door to behind-the-counter sale of antiviral herpes medicines such as Zovirax (acyclovir) or Valtrex (valacyclovir). Other possibilities could include drugs for the flu such as Tamiflu (oseltamivir) or Flumadine (rimantadine).

In truth, this system has already begun. Decongestants containing pseudoephedrine do not require a prescription but can only be purchased by speaking with a pharmacist. The morning after pill (Plan B) is also only available from behind the counter.

If pharmacists actually counseled people on how to use medications properly, there might be fewer complications. Behind-the-counter dispensing could make many useful medicines readily available in a safer fashion.

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  1. BB

    Re: the coca-cola remedy for viruses and flu. Absolutely, I remember. I was born in Baltimore about 20 years before you and my mother always gave us children Coca-Cola syrup for colds and other minor illnesses. She was also a great believer in Vicks VapoRub for any bronchial malady. My uncle was our village pharmacist, who not only dispensed the medicine the doctor prescribed, but was a great source of all homeopathic remedies and advice for home-made health products. “Uncle Bob” was an important and valuable adjunct to the health care offered by our small town’s few physicians.

  2. CAB

    In Oregon, pseudoephedrine (the original form, not the “PE” variety) is now available only by prescription. The “PE” does nothing for me. I would take original pseudoephedrine if it weren’t so inconvenient to obtain it. My doctors seem to be reluctant to prescribe it, even though they know me well and must realize I am not a meth cook!

  3. mks

    I was born in 1955 in Homestead, PA. At that time, when I had the flu or a virus with nausea and vomiting, my mother could go to our local pharmacy (I do not remember the pharmacy name) and get coca-cola extract. She would pour it into a shot glass and give me a large glass of coke on ice. I would drink the coca-cola extract and then sip on the coke on ice. It was a wonderful remedy for easing the nausea and always stopped the vomiting within a day or less. But we can’t buy that product now, due to FDA restrictions.
    It works and I don’t see why a person can’t speak with a pharmacist after seeing a doctor to obtain this. I never had any adverse effects and since the nausea and vomiting were relived, I recuperated more quickly and did not get dehydrated. I wonder if anyone else out there remembers this remedy for viruses and flu.

  4. A reader

    Pseudoephedrine is not technically “behind the counter” in that it does not require a consultation with a pharmacist. It’s more accurate to say it’s “behind the register.” For example, at CVS, one gets Sudafed and similar products from the cashier at the front of the store, not from the pharmacist at the back of the store.
    In places where many drugs which are Over the Counter in the US are “behind the counter,” the pharmacist plays an important counseling and screening role. Yet my fear is that creating this new status in the US will give a green light to prescription drug companies that want to remove the doctor from the equation by removing the requirement for a prescription. The FDA is now re-considering a request it denied several years ago to make Mevacor, a cholesterol-lowering statin, available over-the-counter. Statins are a perfect example of a drug unsuited for “self-prescribing.”

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