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It Isn’t Always Brain Surgery : A proposal for non-physicians to prescribe some medicines

Consumers will note that the box of Imodium A-D, an over-the-counter anti-diarrheal medication, includes the information “Imodium A-D caplets contain loperamide HCI, previously available only in a leading prescription product.” Counter-indications on the box give a clue to why this was once the case. They end with the warning, “If you are taking antibiotics or have a history of liver disease, consult a physician before using this product.”

There are no completely safe drugs. But clearly our society has changed its mind about how much protection to provide against the dangers of loperamide HCI. Once, a physician’s protection was necessary. Now, a label will suffice.

Broadly, these are still the two options. But on a scale of one to 10, could there not be a middle ground of protection between the zero of over-the-counter access and the 10 of physician prescription?

Perhaps there should be. As Times health writer Shari Roan reported Tuesday, a three-year state project in the early 1980s provided 16 to 95 hours of drug prescription training to various health practitioners below the physician level. Over a three-year period 1 million patients were treated effectively and safely in California.

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At a time when health care dollars are rationed and physician consultation is financially out of reach for many, prescription of stated drugs by such trained lower-cost professionals as nurses and physician’s assistants is an option that deserves serious and open-minded consideration.


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