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Everyone’s on drugs now, good god! Whether it’s prescription or non-prescription drugs, it doesn’t matter. They can’t seem to function without pills, nearly all of them. It’s really shocking. Seriously, I don’t remember everyone being on drugs when I lived in the U.S. When exactly did that happen? Americans seem to rely on drugs to get thru their daily lives now. This doesn’t happen in other countries btw. It’s very noticeable about the U.S. whenever I go back to visit.The amount of homeless people on the streets in cities everywhere is also shocking. Isn’t the U.S. supposed to be a rich country? They do have the money to prevent this, you know. There are far poorer countries out there who don’t have issues of strung out and mentally ill people, walking around on the streets constantly soliciting people and begging for money.The infrastructure is pretty lousy — broken down & no longer innovative. Old bridges & roads, slow broken trains, buildings look run down and small, etc. Weren’t we the forefront of development at one point? If you spend any time in the Gulf or East Asia or Western Europe these days and then you go back to the U.S. it’s hard not to think like, ‘Huh? Seriously? What’s all the fuss about? Streets paved with gold? Really? Where and how did we get such an amazing rep?’Portion sizes in the U.S. are insanely big compared to nearly every other country in the world. Americans, when they eat, eat A LOT in one sitting, wow. Not sure how they’re able to pack it all in but somehow they do. And, sure, all countries have overweight and obese people. But nowhere else in the world are there the kinds of morbidly obese, barely-able-to-walk kind of people that I only see in the U.S. You know, the ones that require a motorized cart to get around. Seeing that is very shocking, whenever I go back.Sorry if all of these are negative, they’re the ones that really stand out about America these days. I’m a very happy expat, especially these days, and I have no intention of going back to live there any time soon. Particularly given the current social problems in the country (shootings, health care costs, disappearing middle class, insanely politically divided nation, drugs, etc). Yes, there are wonderful things about the U.S. and about Americans in general, that I’ve posted about before but, these days, sadly, it’s both hard to see and remember those things :(

“WHAT ARE YOU UP TO?”Allow me to put that in context. I apologize in advance for the lengthy post.I suffer from chronic pain related to a back injury which is inoperable. I have been on multiple opioids over a period of 20 years. Around 10 years ago there was a lot of media attention about the crisis of untreated chronic pain and the fact that sufferers were not getting treated properly. This started a revolution in which suddenly if you were in pain, doctors were “shamed” into treating you (and in some cases even if you weren’t in pain). I believe most doctors that previously wouldn’t have prescribed anything stronger than ibuprofen or aspirin were now prescribing Percocet. Not out of genuine concern for their patient’s suffering but to avoid malpractice suits as a result of the constant media coverage.In my case I take as little pain medication as possible. 20 years ago I had a pain specialist I saw about every 90 to 120 days. Then my GP was suddenly able to prescribe my medication which he did for about 10 years. He knows me for 30 years and knows I’m careful and conservative with my medication. I am fully aware that I’m dependent on my pain medication from the perspective that I can’t function without the pain relief and because I would go through withdrawal without it. But I’m not addicted. In fact, I am prescribed more than I take 95% of the time. And as a result I have a “stockpile” of medication.As I’m sure many of you are aware over the last couple of years the media has once again jumped on the crisis “de jour” which in this case is now the “new” prescription opioid crisis. Now it is no longer important that people who’s lives are diminished by pain get their pain relief. The new mission is to stem the flow of prescription opioids. I think the main reason is the so called war on illegal drugs was a complete failure with little results to justify the massive cost.Please keep in mind that over the last 20 years I have taken just about every pain medication known and even some “off label” prescription medications to get relief. I tried Suboxone years ago when it was being used in Europe for pain long before being approved in the US. I believe I know more about pain and pain medications than most doctors. Tramadol is a synthetic opioid with seratonin and norepinephrine reuptake functionality. The 24 hour extended release version has four manufacturers in the USA of the 4 only 1 has the bioavailability equivalent to the rapid release versions. Ask 99% of doctors what Tramadol is and does and you won’t get that information I assure you.Recently (after 10 years) my GP received notification from the DEA telling him to cease and desist prescribing pain medications. He continued for another 3 months until they threatened to take his license. He then referred me to a pain specialist who I had a interesting conversation with. It went like this: Hi, I’m xxxxxx I was referred to you by Dr. xxxxx. Here is my medical records and a letter from Dr. xxxxxxx. I have been on xxxxxx for 10 years and get pretty good pain relief, have not had to increase my dosage in fact I take less most of the time. Dr.xxxxx replies, I’d like to change your medication to xxxxxxxx. I say, I tried it 12 years ago and it didn’t work well and I had to keep increasing my dosage. I’ve also tried xxxxx, xxxxxx, xxxxxx, xxxxxxx, xxxxxxx ,xxxxxxx and xxxxxxxx. Dr.: well I’d like you then to start a titration down from you current dosage with the goal of getting you off opioids. I reply, Why? For what reason? I’m on a stable dosage and It has worked for 10 years better than anything else. What is the alternative? Dr.: Your dependence on the medication is my concern. I reply : why? I’m here for pain relief not addiction counseling. There is a huge difference between dependence and addiction. Dr.: yes that’s true but I’d like to do 2 spinal blocks to see if you get relief that way instead. I say: I’ve had that procedure done 4x in the past 20 years without results. The top neurologist in the county Dr. xxxxxx has seen me and determined it’s a futile endeavor. Here is his contact information. Dr.: well I’d like to try anyway. In the mean time I’ll prescribe 1/2 of your current dosage and we will see how it goes. I say: I’ll go into withdrawal on that dosage (I admittedly did not mention my “stockpile”) Dr.: yes it might be uncomfortable for a while. I say: why would anyone do that on purpose? I won’t be able to work. I have to travel all over the country for my job. Dr.: you travel? You know you will have to see me every 30 days. I say: that’s impossible. My schedule simply doesn’t work that way and besides I’ve been on this medication for 10 years with no issues. Please read Dr.xxxxxx’s letter he addresses that. I’m hoping you aren’t that rigid and we can work around my work schedule. Dr: Well, here is a prescription for 1/2 your current dosage. I’m sure we can work it out. I’ll schedule you for Thursday the end of this month for the first block and for the second a week later which is a month from today.I got the two spinal blocks done despite knowing it was futile (it was). The second was on a Friday. Two days later on Monday my pharmacist called to say Dr.xxxxx did not send in a second prescription for the pain medication. I called him and reminded him it was due. Dr.xxxxxx: You need to come in for an appointment. I say: I just saw you two days ago. Dr.xxxxxx : yes but that wasn’t for a prescription. I said: you told me that you would work with my schedule. I’m 2000 miles away. Dr.xxxxxx: No appointment, No medication that’s how it works. I say: you are saying my choices are to fly 2000 miles to see you for 5 minutes or go into full blown withdrawal? Dr.: No I’m saying you need to see me to get a prescription. I said: go %^~€ yourself.Needless to say I reported him to the AMA for performing 2 spinal blocks after being told they wouldn’t work (he never called or consulted the neurologist) and for knowingly putting me at risk for withdrawal effects and for behavior more appropriate for a drug pusher than a doctor. BTW he billed my insurance $20,000 for two 15 minute procedures.Unfortunately, the new rules have created pain specialists that have everyone by the short hairs while at the same time has them watching their own asses so the DEA doesn’t label them as “Dr. feel goods”. Over the last year I’ve seen 12 pain management doctors. In most cases they were specifically treating only cancer patients (which I discovered they don’t mention unless you ask). Apparently this is a trend amongst pain management specialists because cancer is the one pain management area that the DEA will never touch and where they will allow any type of pain medication. Doctors practicing pain management for cancer are essentially immune to harassment from the DEA. Most were very nice and agreed that the medication I was on and the dosage was appropriate for my condition and the time I had been on my medication but under the rules of their practice they couldn’t help me. I understand completely why any pain management specialist would gravitate to this area of practice. I also sympathize with pain specialists that treat other pain issues because they are at risk of getting on the DEA’s (doctor police) radar. Everyone of them I saw tried to change my medication to either something stronger (morphine, OxyContin) or tried to “adjust” my dosage down or offered alternative medication I had already tried and knew was not as effective as my current medication or just plain dangerous. All of the doctors required a visit every 30 days (I assume to cover their asses). I also realized, telling a doctor who effectively has you over a barrel because of the new laws what he should do (even if it’s backed up by your history and current doctors) is a surefire wayNOT TO GET WHAT YOU NEED.Apparently having a medical degree makes some doctors believe they are a superior entity to common humans. I’ve had doctors ask me where I went to medical school in a sarcastic tone. But the last straw was a Dr.xxxxxx who after speaking to my GP, reading his letter, knowing my history and seeing me Said: I don’t know what you and Dr.xxxxx are up to but I’m not prescribing you anything. I said: What exactly are you implying? Dr. Asshole says, I’m not implying anything I’m telling you I won’t prescribe you anything. I said: I understand you. That is your prerogative. I’m asking you what you mean by “up to”. Dr.Asshole: this conversation is over and walked out. I can only assume he was implying that both a fellow board certified MD and his patient were trying to get him to break some sort of law or ignore his Hippocratic oath. I think he realized he was treading on dangerous ground and decided not to clarify his comment for fear of repercussions.The opioid crisis is very real. It was 20 years ago, even worse 100 years ago when children’s medication had opium in it and it still is. The current prescription drug crisis was partially created 10 years ago by the media pushing an agenda that got ratings. “People are in pain and nobody is doing anything about it. “ The media is now demonizing the very same doctors they previously demanded treat people with chronic pain with respect and compassion.The crisis is still very real but once again it’s shifted to illegal drugs. This is a huge problem for the DEA. They failed miserably in their efforts to curb illegal drugs. The end result of the media demonizing prescription drugs is a newly re-energized DEA clamping down on doctors that prescribe ANY of the medications on their arbitrary list regardless of circumstances.This has created a third crises. Law abiding legitimate pain sufferers who are no longer able to get proper care at a reasonable cost and input of effort. It’s far easier for the DEA to track doctors who DOCUMENT their actions as opposed to street pushers and they get to show results (we stopped 2567 doctors from prescribing opioids last month) they couldn’t possibly achieve with illegal drugs. Never mind the fact that the legitimate pain sufferers that doctors were treating are now caught in the cross fire. Especially if they are functioning working people with families and very little, if any spare time. Basically they now have to make 1 of 3 choices. Quit their jobs and manage their pain full time or look for illegal means to get the “medication” they need or find a pain specialist (not so easy in today’s big brother environment) This has created a huge increase in the use illegal drugs and overdoses as “newbies” try street drugs for the first time.In my case, as I previously stated, I have a stockpile of medication. Enough for about 2 years (10 years of taking less than I was prescribed). So far my search for a pain specialist has taken a year and 12 doctors with no positive results. I refuse to be reduced to showing up at the doctors office to grovel and plead for my monthly prescription. Nor will I be held on a leash that gets jerked every 30 days with no regard for my occupation. The thought of it disgusts me. I’ll go out on disability and become a burden to the same system that created this mess before I allow them to dehumanize me.I am not “up to” anything. I’m simply a human being that suffers 24/7 with severe pain. A person that until last year was perfectly happy to live with it and the medication required to manage it. Someone that was able to contribute to society as a result of that medication. I’m educated, well informed and proud. The system has created a situation where my doctor of 30 years is now prohibited from treating me. The same system forces me to go to strangers that the system also restricts and monitors like criminals and explain myself in the hope that one of them will accept what I and my doctor tell them without assuming we are “up to something” and then will be willing to take the chance that the DEA (doctor police) will approve of their actions.The system is broken. If government wants something to do I suggest they pass the equal rights amendment. In almost 100 years they can’t manage to pass it into law which is their supposed speciality. Perhaps they should try passing gun control on federal agencies like the EPA, the DOE and the FDA. Why do federal environmental, education and food & drug departments need SWAT teams? The second amendment states the PEOPLE have a right to bear arms not every federal agency in the USA. Isn’t that the domain of Homeland Security or the FBI?Please politicians, don’t flip flop the rules every time the polls tell you it’s the popular position. Every time you do, you screw it up badly. Leave things like medicine to the medical experts. At the very least, of you must go after the “bad apple” doctors, INVESTIGATE FIRST THEN PROCECUTE. We all know what happens on a witch-hunt.Thank you.UPDATE: I am now on Tramadol ER and weaning myself off the other “big bad” schedule II opioid I have been on for 10 years with excellent results. I made this decision because my regular GP can prescribe it. So far the results are positive. I believe it’s because of Tramadol’s excellent seratonin and norepinephrine reuptake properties are effective on nerve pain. It will be awhile before I know for sure but I’m optimistic.NOTE:ANY RATIONAL PERSON WILLING TO DO THIRTY MINUTES OF RESEARCH ONLINE WILL DISCOVER WE ARE BEING LIED TO. THERE IS NO PRESCRIPTION OPIOID “CRISIS”.ALSO:1.Thanks to the person that corrected my grammar, punctuation and spelling. I fully agree with you. I am challenged in these areas. Especially since I no longer have an assistant. I hope my message still got out even with the errors I made. I will let my post stand “as is” as long as the message is clear.2. I also wanted to thank everyone for your kind thoughts and wishes. This issue is apparently not limited to the USA. People have commented from as far away as Australia.3. For those of you that asked about Tramadol. Here is some of what is available online…..A) First the bad news. The media and the US government are delusional.The following segments are from Iodine.com. If you want to read the entire “article” just search Tramadol on their site.Finally, in 2014, the DEA finally changed Tramadol to a Schedule IV designation as a controlled substance. But the World Health Organization continues to classify the drug without restriction, under the belief that it would become much more difficult to obtain by people who need legitimate pain relief, according to the Wall Street Journal report.Finally? Finally? Continues? Under the Belief? What exactly is the WSJ trying to imply? That WHO is pushing drugs? It’s not a belief it will be much more difficult to obtain it’s a FACT!This is exactly what makes Tramadol so dangerous. Despite it’s reputation as being a “safe” opioid, it is still an opioid. These drugs have been massively over-prescribed over the past 20 years, causing an opioid crisis in the U.S. with thousands of people suffering the consequences of addiction, ruined lives, and death. In 2014 alone, more than 28,000 people died from opioid overdose — at least half of them prescription drugs, compared to street drugs like heroin (which are often the cheaper drug of choice among people who started with a prescription opioid).Iodine is telling us that there were 28,000 drug overdoses in 2014 and AT LEAST half from prescription drugs but NOT how many from Tramadol. That’s about 14.000 for ALL prescription opioids (maybe). WHO (World Health Organization) estimates that as much as 25% of the population in North America suffers with chronic pain. That’s 145 Million people. Assuming Tramadol was responsible for 1/2 of all the prescription drug overdoses (7,000) which is being overly generous since Tramadol prescriptions do not account for 1/2 of all opioid prescriptions. Tramadol overdoses only represent .0005 percent and ALL prescription drug overdoses amount to .001 percent of all people with chronic pain. Basically the risk of overdose from Tramadol (using generous percentages) is only .05 % as likely of causing death as all “unintentional accidents”. The risk of overdosing on ANY prescription drug representats only 1%. That puts the risk of a prescription drug overdose closer to getting killed by lightning than killed by cigarettes or alcohol.For the sake of perspective, unintentional injuries cause approximately 136,000 deaths in the USA annually.The above segment is not exactly objective reporting in my opinion. Reporting like this is exactly the problem. Drugs like Morphine, Methadone, Dilaudid and Hydrocodone are Schedule II. Because Tramadol is a schedule IV my GP can still prescribe it without fear of reprisals from the DEA. I don’t need to see a so called Pain Specialist every 30 days. As a result of poorly researched and bias reporting like this, I’m fairly certain it this won’t last much longer. The need for the DEA to justify its massive budget requires results that historically come only from attacks on legal, documented prescription medications. The results achieved from their conventional “war on illegal drugs” was, is and will continue to be a complete failure.When you actually consider the real world experience of people taking the drug, however, it quickly becomes evident that Tramadol, like other opioids prescribed for pain relief, also carries the trade off of dependency and withdrawal. Among the 50 or so first-person reports on Drug information, side effects, and reviews - Iodine.com, many Tramadol users cite these effects.50 people that apparently are not all using Tramadol. Really? Tramadol is a”weak” opioid which acts unlike any standard opiate. How many of the 50 people actually used Tramadol? Not exactly scientific given the scope of the prescription pain market. Dependence is NOT addiction and for those on long term medication for long term chronic pain withdrawal only comes into play if the medication is withheld suddenly. This is circular logic at its worst.On every page for an opioid drug at Drug information, side effects, and reviews - Iodine.com, we have placed a clear and emphatic warning about the risks of these drugs in a big orange box. For many people, these drugs serve a purpose, and are a necessary part of coping with pain. But people need to be careful before they begin using them, and they need to be aware that the drugs carry a significant risk of dependency that can squander lives. These are dangerous drugs that must be taken seriouslyHere, Iodine seems to be a little more reasonable and I agree with most of it until they confuse dependence with addiction. Addiction to anything can squander lives. Take your pick. Drugs, Gambling, Sex etc. Dependence does not squander lives. I’m dependent on my pain medication nor more than I’m dependent on food. Could I take less of both? Yes, but I wouldn’t want to live like that.There were 2,813,503 deaths in the USA in 2017. The CDC (cdc.gov) reports that 46 people die everyday in the USA from prescription drugs. That’s 16,790 per year (2018). Even with the increased pressure from the government over 4 years this is an increase from 2014’s 14,000 overdoses of 8%. The CDC DOES NOT say how many were using prescription drugs illegally and or recreationally nor do they say how many had legitimate prescriptions. Despite this the total is 16,790. This represents .0059% of all deaths in the USA based on 2017’s numbers and .0000296 percent of the population. The CDC tries hard to obscure this number. Because overdoses from all prescription drugs do not even rank in the top 200 for causes of death in the USA. If the CDC released the number of overdoses due to legitimate prescription users the numbers would be even smaller.Ask yourself these questions:Should the approximately 145 million people in the USA with chronic pain be made to suffer, denied medication or for that matter even inconvenienced because 16,790 people died from prescription drug overdoses?How many of those 16,790 did this to themselves through recreational and or illegal drug use? (I cannot find that statistic anywhere)Does the death of .0059% of all deaths in the USA constitute a crisis? If it does, tobacco and alcohol should be made illegal today. Especially since they serve virtually no medical purpose. Full disclosure: I smoke cigars.Will resticting the flow of prescription drugs reduce the total number of overdoses or will it simply increase the number of illegal drug overdoses?Will more productive lives be ruined by this action than lives saved?Is the restriction of prescription drugs worth the loss of productivity and quality of life for 145 million people? What impact will this have on the economy?If the CDC and the DEA elimated 100% of all prescription pain medications they MIGHT save 16,790 lives a year. How many of the 145 million chronic pain sufferers will have their lives ruined?B) Now for the good news. Some medical researchers are logical, methodical and rational instead of agenda oriented, deceptive and hysterical.For those of you that asked about ER vs IR Tramadol here is a independent study that specifically names particular brands and why some ER formulations are less effective than others. Some are delivering only about 1/2 of the dosage listed for several reasons. Please pay attention to how this abstract is worded compared to the WSJ, the CDC and just about everyone else justifying the opioid “crisis”.The entire abstract is linked here:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968086/pdf/jpr-7-149.pdfThe beginning introduction is below. They give a lot of statistical information regarding the impact chronic pain has on people, productivity and the economy.Journal of Pain ResearchReview of extended-release formulations of Tramadol for the management of chronic non-cancer pain: focus on marketed formulationsArshi Kizilbash and Cường Ngô-Minh Additional article informationAbstractPatients with chronic non-malignant pain report impairments of physical, social, and psychological well-being. The goal of pain management should include reducing pain and improving quality of life. Patients with chronic pain require medications that are able to provide adequate pain relief, have minimum dosing intervals to maintain efficacy, and avoid breakthrough pain. Tramadol has proven efficacy and a favourable safety profile. The positive efficacy and safety profile has been demonstrated historically in numerous published clinical studies as well as from post-marketing experience. It is a World Health Organization “Step 2” opioid analgesic that has been shown to be effective, well-tolerated, and valuable, where treatment with strong opioids is not required. A number of extended release formulations of Tramadol are available in Canada and the United States. An optimal extended release Tramadol formulation would be expected to provide consistent pain control with once daily dosing, few sleep interruptions, flexible dosing schedules, and no limitation on taking with meals. Appropriate treatment options should be based on the above proposed attributes. A comparative review of available extended release Tramadol formulations shows that these medications are not equivalent in their pharmacokinetic profile and this may have implications for selecting the optimal therapy for patients with pain syndromes where Tramadol is an appropriate analgesic agent. Differences in pharmacokinetics amongst the formulations may also translate into varied clinical responses in patients. Selection of the appropriate formulation by the health care provider should therefore be based on the patient’s chronic pain condition, needs, and lifestyle.Keywords: analgesics, opioids, chronic pain, drug delivery, pharmacokinetics, TramadolIntroductionThe two faces of painIt is useful to distinguish between two basic types of pain; acute and chronic. Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting – that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.1 Chronic pain is defined as persistent pain, which can be either continuous or recurrent, and of sufficient duration and intensity to adversely affect a patient’s well-being, level of function, and quality of life.2 A number of definitions of chronic pain have been described in published literature, ranging from persistent pain of at least 2 weeks duration, to continuing for longer than 6 months, to persistent pain that is not amenable to routine pain control methods.3,4 Given the debilitating effects of chronic pain and its impact on the quality of life, chronic pain is widely viewed by experts to represent a disease itself. It can also be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and in many cases may be resistant to routine medical treatments. It can and often does cause severe problems for patients. A person may have two or more coexisting chronic pain conditions such as osteoarthritis, rheumatoid arthritis, chronic low back pain, diabetic neuropathic pain, fibromyalgia, endometriosis, Crohn’s disease, and ulcerative colitis.3,5Focus on chronic painPain is an enormous global health problem. Although the burden of chronic pain worldwide is underestimated, it is anticipated that one in five adults suffer from pain and that another one in ten adults (approximately 60 million) are each year diagnosed with chronic pain that falls in the moderate to severe category.6,7 Even children are not spared, with 15%–30% of children experiencing recurring or chronic persistent pain.8 Pain that interferes with life also increases with age and in those with physically strenuous work or less education.11 The prevalence of chronic pain, defined by duration, in the World Health Organization’s (WHO) World Mental Health Surveys was 37% in developed countries and 41% for developing countries.8 In one survey, 19% of the general adult population of Europe had moderate to severe chronic pain for a median of 7 years and one in five of those had suffered with chronic pain for over 20 years.14 Age and sex variations in chronic pain prevalence are remarkably consistent across countries and populations.8 In the North American population specifically, it is estimated that between 12%–25% of the population in the United States and between 15%–30% of the Canadian population experiences chronic pain.7,9,10 In only about 1%–2% of the population with chronic pain does the pain result from different forms of cancer.6–8Chronic pain impairs everyday activities and quality of life. Psychological morbidities are often observed among patients with chronic pain, which can include depression and suicidal ideations.8 Chronic pain also carries a great economic burden.6,12 In a recent report from the United States, the estimated annual cost of chronic pain in adults including associated health care expenses and lost productivity was US$560–630 billion annually. Similarly, the annual cost of chronic pain in Canada, including medical expenses, lost income, and lost productivity is estimated to exceed US$10 billion annually, not accounting for social costs.7,9 The financial cost of chronic pain is estimated to be roughly the same as cancer or cardiovascular diseases.8,13The high prevalence and incidence of global chronic pain, its substantial and growing comorbidities, and its linkage with a myriad of social and economic determinants collectively provide ample justification for regarding pain as a public health priority. Three groups of conditions are large components of the burden of chronic non- cancer pain: osteo- and rheumatoid arthritis, injuries, and spinal problems.13 Other causes include headaches, diabetic neuropathies, toxins (eg, alcohol), neurological disorders, stroke, and human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS).

Because those are somewhat vague terms, I will assume “natural remedies” to mean everything that is not synthetic but also not prescription-only. This may vary from one region to the next, given how drugs are treated. Here are some of the reasons I have observed in talking to people, going through various branches of the medical system, reading peer-reviewed journals, and exploring the successes and failures of differing perspectives:Non-prescription substances still generally require background knowledge regarding how to successfully and appropriately utilize them. Not requiring a prescription does not mean applications are intuitive, or that risks are somehow lacking. Thus, “non-prescription” does not mean “no expertise or consultation needed, yay!” Finding competent and reliable help with non-prescription substances can be even more difficult than finding competent and reliable help with prescription ones—and that is already a total shitfest.Knowledge about the range and respective benefits of non-prescription substances is highly limited, on average, and it requires both learning and experience to figure out what might even be a good idea to use in most situations. Changing one’s entire approach to medicine, as to make the best use of non-prescription methods, means having a different lifestyle and practical culture. Many or most people are too integrated in or dependent upon a different lifestyle and culture.People may be doing what works as opposed to what has not worked for them. This is obvious, but not always the truth—some people persist in using drugs or approaches which are not helpful or are the opposite of helpful, so it is not as simple as a “one substance, one evaluation, one pass/fail conclusion” method of assessing health. Having an inadequate means of assessing the risks, benefits, and outcomes of prescription and non-prescription substances can contribute to unsuccessful use.Non-prescription substances can be costly, illegal, difficult to find, difficult to obtain, and/or require personal or professional work to turn a potential “remedy” into a properly prepared form of medicine. Because there can be a lot of time, energy, money, or know-how involved, this is oftentimes not feasible or not desirable—especially for people who don’t know what to be taking in the first place. For people who are interested but not personally knowledgeable, finding or hiring qualified individuals to do the locating, processing, and compounding of medical substances is not always workable.A lot of people reside in communities or cultures which do not offer education and access to non-prescription substances, or where the use of medicine outside of particular social institutions is disincentivized, disparaged, or punished. Lack of exposure, lack of logistical support, and ostracization are all strong forces. This is also true within non-prescription substance focused communities—support outside the mainstream system does not mean you will have an ideal philosophical or practical alternative.Perceptions of the efficacy, appropriateness, or usefulness of non-prescription substances have been poisoned by profiteering, pseudoscience, and cultural stigma. Much of the information and many of the products within easy reach—especially those being actively marketed—are an obstacle to better understanding non-prescription substances and finding something that is personally or more widely useful. These factors are a substantial part of why many people choose prescription drugs as well.We are in a society which more often stresses values that do not align with natural therapeutic goals. This means the infrastructure, industry, institutions, and attitudes most prevalent are geared towards synthetics, alternative philosophy-based prescribing practices, and a focus that does not stress safe, effective, sustainable medical substances on an individualized level or through experience-based understanding. The implications of this are complex and partly explained in other bulletpoints.Insurance rackets and the intense industrial and political involvement of special interest groups in shaping the way we handle and perceive non-prescription substances compromises features like education, access, and affordability, meaning prescription drugs are oftentimes the favored alternative even if they are potentially less appropriate or beneficial. Systemized medical care is not about the best results for all, and neither is for-profit non-prescription substance ‘education’ and product sales.So, in brief: the outsourcing of expertise, cultural convention, exploitative dynamics, cost and availability.