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Three Letters Re: Stocking Up on Prescription Medicines
Jim,
In regards to stocking up on prescription medicine your readers may want to
use the book "Wilderness
Medicine"
by
William Forgey, M.D. as a good starting point. A couple of other "beginner
books" are "Where
There Is No Doctor"
by
David Werner and "Where
There Is No Dentist"
by
Murray Dickson. Amazon.com is running a special on all three books for $42. [JWR
Adds: The latter two books are available for free download, but
I recommend getting hard copies for your survival reference library.]
I took the book "Wilderness Medicine", to my doctor's office
and discussed the list of medicines Dr. Forgey recommends and my doctor advised
it was a very good reference. Our doctor advised a lot of the medicines listed
were included in his supplies that he keeps at home.
Included in the book is some information on multiple uses of the medicines
as well as alternatives if you run out of one of them.
My doctor also recommended the following prescriptions: Cipro, Tamiflu, and
Relenza.
We had to search for a preparedness minded doctor but they are out there if
you seek them out. Thanks, - Art
Mr. Rawles,
In response to Bryan’s request for a list of medications that may be
worth adding to your preps, the following is my humble reply. I am a pharmacist,
of the clinical variety (the kind that works in hospitals and clinics helping
docs manage acute drug therapy, as opposed to the community pharmacists, who
dispense drugs and valuable information to the public) with 27 years of hospital
pharmacy experience. Please don’t think that my recommendations are the “gospel
truth”. This e-mail is off the top of my head, and I’m sure many
others will add to, or detract from, my suggestions. If there’s one thing
I’ve learned over the course of my career, it’s that there are
very few definitive answers to medical questions.
Now, it should go without saying (but I’ll say it anyway) that these
recommendations are in no way meant to suggest that you should self-medicate
under normal circumstances. The safe and effective use of medications is a
risk:benefit game, best assessed by your doctor. No drug is absolutely safe,
and the proper diagnosis of illness and treatment with medications is an endeavor
that consumes lifetimes of study. Having said that, in a TEOTWAWKI situation,
the risk:benefit equation shifts, and sometimes the risk of doing nothing will
exceed the risk of using some drugs without the oversight of a physician.
To get started, as my good buddy and I always say, “you must define
your goal before you can hope to decide on the appropriate action”. So
here’s the goal: suggest some commonly available drugs (prescription
and over-the-counter (OTC))
which could be stored in preparation for foreseeable calamities in an extended SHTF or
TEOTWAWKI situation – either for self-medication, or for selection by
a “country doctor” who has the knowledge, but not the drugs. I
will focus on drugs that may have a chance of making a difference in acute
situations without heroic measure beyond the ken of most non-medical folks;
that is, no designer drugs for the syndrome of the week will be included. Also,
I will stick to generically-available drugs in order to seek cost feasibility.
I will avoid “controlled substances” (those federally regulated
by the DEA) – a
difficult obstacle when it comes to pain management, because we must exclude
all of the opiates. Also, though I use mostly intravenous medications in the
hospital, this list focuses on oral medications, for obvious reasons. Finally,
in TEOTWAWKI, we will simply have to accept that certain conditions lead to
shorter life spans, so drugs for the treatment of chronic diseases are not
included. Nutrition, trauma, infection are about all we can hope to impact – and
surgery is more important than drugs in trauma. Those with diabetes, severe
hypertension, heart disease, and other all-too-common chronic maladies will
have to wing it….not to say that it isn’t a good idea to have several
months of your specific medications on hand to get through a temporary interruption
in our normal flow of life.
I will resist the urge to get into details about bacterial resistance patterns,
differential diagnosis, viral vs. bacterial infection, dosing, duration of
therapy, etc. It would be much better to chat with your local medical person
about the specifics. These are just the very basics – I’m sure
a rational argument could be made for almost any drug.
ANTIBIOTICS – the breakthrough that promoted chronic diseases and cars
to the top of the mortality list
Ciprofloxacin (common brand name: Cipro) – usually dosed 500 mg twice
daily, this wonder drug covers a broad spectrum of pathogens, and is reasonably
effective in treatment of urinary tract infections, pulmonary infections, skin
infections, and gut infections. Bonus: can treat or prevent pulmonary anthrax
infection, prophylaxis against bacterial meningitis, and has a fighting chance
against gonorrhea. Sold by prescription only.
Cephalexin (common brand name: Keflex) –usually dosed 250-500 mg every
six hours. A reasonable choice for upper respiratory (ear, nose, throat) infections
and skin infections, including prevention of infections secondary to lacerations.
Small risk of problems in folks with severe penicillin allergy. Sold by prescription
only.
Metronidazole (common brand name: Flagyl) – usually dosed 250-500 mg
every six hours – This oft-overlooked drug has good activity against
the class of bacteria called “anaerobes”, and is useful in treatment
of diverticulitis, some gynecological infections, and would be a welcome addition
to cephalexin in the event that a “home appendectomy” is to be
tried on the kitchen table (just kidding…sort of). This drug can also
treat (or cause…go figure) a severe, and oft-fatal type of diarrhea,
called Clostridium difficile colitis (aka, pseudomembranous colitis). Don’t
mix alcohol with this one! But then, who will have booze in TEOTWAWKI anyway?
(no offense to the home distillers out there!). Sold by prescription only.
Amoxicillin (common brand name: Amoxil) – usually dosed 500 mg every
eight hours – Good for ear, throat, urinary tract, and some soft tissue
infections. If started immediately, may prevent bad infections secondary to
animal bites, including humans, but if the infection has already begun, bigger
guns are usually needed (different bacteria are problematic with various species,
but we’re talking generalities here). Bacterial resistance has cut into
the effectiveness of amoxicillin over the last 20 years, but it would sure
be better than nothing, especially in a more rural setting (the nastiest bugs
always hang out in crowds!). Sold by prescription only.
Other possible generically-available antibiotic candidates include good ole
penicillin (G or VK), ampicillin, amoxicillin/clavulanate (common brand name:
Augmentin), sulfamethoxazole/trimethoprim (common brand name: Bactrim or Septra – a “sulfa
drug”), and doxycycline (common BN: Vibramycin)
ANTIFUNGALS – just one
Fluconazole (common brand name: Diflucan) – About the only reason to
have this on hand is for vaginal candidiasis. (Ladies, you can probably diagnose
that one as well as your doc!). Other uses would be difficult to diagnose at
home. A single 150 mg tablet shows very good efficacy in this indication – but
I suspect that the 200 mg tabs would be cheaper to obtain in quantity, since
the 150 mg tablet is individually packaged for the indication. In this scenario,
an extra 50 mg won’t hurt. Perhaps one of my community pharmacist colleagues
could confirm or deny my suspicion. Sold by prescription only.
VITAMINS – much more important when on survival rations!
Multiple Vitamins – get several of the biggest bottles of a generic multi-vitamin
that you can find at the warehouse club. If you’re eating white rice
three times a day, a vitamin a day (or even three times a week) may dramatically
extend your chances of survival. OTC
Vitamin C (ascorbic acid) – Very good to have around when citrus and
greens are not available…remember scurvy? (Though I hear you could eat
a pine tree). A couple of big bottles of Vitamin C 500 mg could stave off scurvy
for your family for quite a while. A quarter of a tab a day would be sufficient,
probably less (Dietitians should fill in the details here). OTC
Vitamin D – If you’re expecting a nuclear winter, you’ll
need this in the absence of sun…but then again, after reading [Cormac
McCarthy's novel] “The Road”, I’m not sure I would
want to stick around for that one! OTC
ALLERGY DRUGS
Antihistamines – Of course, seasonal allergies will have to be tolerated,
but it wouldn’t hurt to have some diphenhydramine (common brand name:
Benadryl) on hand for particularly bad cases of poison oak and bad (but not
anaphylactic) bee stings, etc. Available OTC
Corticosteroids – Along the same lines as above, perhaps a few methyprednisolone
dose packs (common brand name: Medrol Dospak) would be good for more serious
allergic reactions. Sold by prescription only.
Epinephrine – Though I promised to “stay oral”, I must mention
Epi, because it is probably the only thing that may save someone experiencing
a bona fide anaphylactic allergic reaction (tongue swells, throat closes down…can’t
breathe). The injectable form in ampoules (1mg/ml) is much cheaper, but the
Epi-Pen product is a pre-filled syringe that is ready to go. Sold by prescription
only.
ANALGESICS (pain control)
Ibuprofen (common brand names: Motrin, Advil) – Pretty good for what
ails you, since we’re not talking about narcotics. Strengths are headache,
bone pain, tooth pain, and general sprains/strains. It’s a good anti-inflammatory
(unlike acetaminophen) and will bring a high fever down. Available OTC
Aspirin – Still good for headaches and fever (except in children--do
a web search on Reyes Syndrome), but beware the enhanced risk of bleeding if
used for pain secondary to traumatic injury. Though ibuprofen theoretically
can cause a similar problem, it’s much rarer than with aspirin. Bonus:
Though heart attack mortality will undoubtedly go back up to early 20th century
levels in TEOTWAWKI, a chewed aspirin tablet (325mg) at onset of chest pain
may improve your odds in the absence of any other medical intervention. If
an old bottle of aspirin smells strongly of vinegar, it is probably kaput…but
it wouldn’t hurt you to try it.
Hydrocodone/Acetaminophen (Common brand names: Vicodin, Lortab, Lorcet, etc.) – I
said I wouldn’t include controlled substances, so this one is not included….but
just so you know, this combination of an opiate and acetaminophen (Tylenol)
is probably the minimum analgesic intervention that would help much with traumatic
visceral pain. But the laws involved and the risk of misuse complicate the
issue greatly. Be sure you’re not putting yourself at legal risk before
deciding to get prescriptions for this, or the more strictly controlled analgesics
such as oxycodone/acetaminophen (Percocet), morphine, meperidine (Demerol),
and others.
GASTROINTESTINAL MEDS – “Keep it movin’ – slow it down”
Soluble Fiber (common brand names: Metamucil, Citrucel, Fibercon) – May
be essential to keep things moving in the early days of survival rations (though,
as it is oft pointed out on this blog, eat what you store and the transition
will be much smoother). Available OTC
Docusate Sodium (common brand name: Colace) – stool softener…’nuff
said
Loperamide (common brand name: Imodium) – this antidiarrheal could save
a life, but be sure to study up on when, and when not, to use it. In bacterial
enteritis it may do more harm than good. Available OTC, though if you have
a pharmacist friend, they may be able to order a bottle of the caps much cheaper
than the OTC boxes.
TOPICALS – Cuts, burns, and scrapes
Antibiotic Ointment (“triple” bacitracin/neomycin/polymyxin or “double” bacitracin/polymyxin)
Good to reduce the risk of infection in minor cuts and scrapes. Many folks
suffer a contact dermatitis when exposed to neomycin, so many docs are recommending
the double formula these days (common brand name: Polysporin).
Silver Sulfadiazine cream (common brand names: Silvadene, Thermazine) – A
lifesaver in severe burns, but you’ll need a big jar of it.
Eye Wash – It’s basically just sterile salt water, but good to
have when you need it!
Obviously, this is a starter list. I will apologize in advance for the glaring
omissions that I’m sure friends and colleagues will point out.
A word on stability – as we’ve discussed on this blog before, the
manufacturer’s expiration date has been found to have quite a bit of
wiggle room by our Department of Defense, that has, commendably, conducted
their own degradation studies in order to extend the shelf life of the military
drug stockpile, and thus save us poor taxpayers a buck or two. For obvious
reasons, this [Shelf Life Extension System (SLES)] data is closely guarded,
so we don’t know the specifics. A few details have leaked out, and it
seems that most drugs are “good” (meaning within a reasonable range
of their original potency – usually 90%) for years beyond the
labeled expiration date when stored appropriately. For most tablets and capsules,
cooler, darker, and dryer is better (low oxygen is also good). I would suggest
that you ask your pharmacist to add the manufacturer’s expiration date
to your pill bottle for a frame of reference. Many pharmacy computer
systems default to one year from the fill date on the prescription label, irrespective
of the actual date on the stock bottle. The bottom line is this: the
drugs on this list (with the possible exception of doxycycline) do not degrade
to a toxic compound; they only loose potency over time. If you refer to Mr.
Rawles’ excellent novel, "Patriots"
,
you will note how the characters titrated the dose up to allow for potency
loss post-expiration date. When to do this, and by how much is a crap shoot,
but in TEOTWAWKI it is better to have tried and lost, than never to have tried
at all!
Here’s hoping and praying that we all die in our beds at 101 years of
age, with our wives (or husbands) lilting voice in our ear, saying, “I
told you that you were wasting money on all that survival stuff!!!” Regards,
- SH in Georgia
Mr Rawles,
I'm a retail pharmacist working in Louisiana and am new to prepping. Many of
my patients come to me asking for advice on low cost medications that will
still yield positive outcomes. As a result I've gained valuable insight into
the potential for stockpiling medications on a budget. I hope this helps:
Stockpiling mediations for WTSHTF can
be a daunting task, even for those with an idea of their current medicinal
needs. For those currently taking prescription medication, the question is
usually affordability and accessibility. Most insurance plans will not pay
for supplies larger than 90 days, and paying cash for prescriptions is usually
cost prohibitive. While greater accessibility exists in countries such as Mexico
or Canada, crossing the border with large quantities of medication is usually
asking for trouble, thus requiring multiple trips. And while the lower costs
of medications outside of the US has been frequently touted, quality can be
suspect. Internet pharmacies in places such as India or even China will ship
to your front door, but only after paying a "doctor" for your required
by law "consultation", usually costing anywhere from 75 to 125 dollars.
So what are the options?
There is a two fold strategy regarding lowering your drug cost to allow for
cost efficient stockpiling. First, talk with your doctor or pharmacist about
generic medications. Generics save as much as 80% over their brand name equivalent,
are covered on every insurance plan, and because of the cost will allow for
bulk purchases. A prescription is good for one year from the date it is written,
so unless the medication is a controlled substance, you may purchase as much
as a years worth of medication at a time(provided your doctor has authorized
that many refills). Second, for those taking multiple medications, talk to
your doctor and pharmacist about decreasing the number of medications you are
taking by increasing the dose of others or changing the medications altogether.
This strategy can best be illustrated in the following example:
Patient "X" is a 55 year old Type II (non-insulin dependent) diabetic
with a history of coronary artery disease. His current medications are as follows:
Drug Condition Cost/month
Actos 30 mg diabetes $240
Zetia 10 mg cholesterol $110
Plavix blood thinner $170
Cardizem LA 240 blood pressure $125
Total medication cost/ month= $645
After consulting with his doctor and pharmacist, the following changes were
made:
Drug Condition Cost/month
Metformin 500 mg diabetes $4-$10
Simvastatin 20 mg cholesterol $4-$20
Warfarin 5 mg blood thinner $4-$10
Atenolol 50 mg blood pressure $4-$10
Total medication cost/month= $16-$50
These are cash prices, not insurance co-pays. Insurance plans would not allow
you to purchase medication for stockpiling purposes.
Also, in the same manner that firearms and ammunition should be purchased in "common
calibers" to allow for ease in buying or bartering, so should medications.
Even if you do not take maintenance medications it might make sense in the
long run to build up a supply. In much the same way as we seek out kindred
survival spirits in firearms,food storage, etc, it is possible to find doctors
that may write prescriptions for conditions that you could potentially (wink,wink)
develop. Medications used to treat blood pressure or diabetes will be in short
supply post-TEOTWAWKI,
and it will take several growing seasons for herbal remedies to make their
way through the production pipeline. Also, family members, friends and other "guests" will
undoubtedly forget their medications in their attempt to G.O.O.D..
Of the top 20 drugs prescribed in the US in 2007, four were for blood pressure,
three were for cholesterol, three for GERD (heartburn/ulcer), three for depression,
three for asthma/allergy, and one each for thyroid,osteoporosis, sleep and
blood thinning. For the sake of brevity, let's focus on the three conditions
typically undeserved by over the counter medications:
1) Atenolol: A common beta blocker medication used to treat blood pressure.
Common dosages begin at 25 mg daily to twice daily. Purchase the 100 mg strength
and cut them in fourths.
2) Metformin: Sulfonylurea class medication used to treat non insulin dependent
diabetes. While other drugs such as glipizide or glyburide are less expensive
they can also lead to hypoglycemia (low blood sugar) if dosed incorrectly.
Metformin does not have that problem. Can also help lower LDL (cholesterol)
and tryglycerides- but so will the average post-TEOTWAWKI diet. Dosages begin
at 500 mg, twice daily. Where possible, buy the 1,000 mg strength and cut them
in half.
3) Tramadol: Non-narcotic pain reliever. Does not have many of the sedating
side effects of Lortab, Vicodin, Norco, etc and is not a controlled substance.
Tramadol also does not cause the stomach problems (reflux, ulcerations) commonly
seen with ibuprofen, aspirin, and naproxen (non-steroidal anti-inflammatory
drugs (NSAIDS)). This will make them easier to obtain as most physicians are
more comfortable writing prescriptions for non narcotic pain relievers. Typical
dosage is 50 mg up to four times daily as needed.
There are thousands of over-the-counter medications used to treat an unlimited
variety of ailments. This can make stockpiling medications difficult. Every
health care professional has their personal recommendations, but the following
are the five OTC items that should be bought in bulk. They are cheap, effective,
and each covers a wide range of potential maladies:
1) Aspirin
Can be used to relieve pain, relieve inflammation, thin the blood and lower
fever (do not take on an empty stomach)
2) Benadryl (diphenhydramine)
Can be used to treat itching, rash, allergic reactions, and is the most common
ingredient in over the counter sleep aids (will cause drowsiness)
3) Pepto-Bismol
Can be used to treat indigestion, nausea, heartburn and diarrhea.
4) Neosporin
Antibiotic ointment for cuts, scrapes and burns
5) Primatene Mist
The only over the counter inhaler capable of minimizing the symptoms of or
stopping an acute asthma attack.
No first aid kit is complete without those five. - LA, R.Ph .
JWR Adds: In several places, "LA" mentioned cutting
pills in halves or quarters. This is best accomplished a with a tray-type pill
cutter, since cutting pills with a knife --especially those that are not pre-scored
for cutting--tends to be messy and inaccurate. Note that many drug companies
give away plastic pill cutters marked with their corporate logos as promotional
items, so the chances are good that your local retail pharmacist will have
some available,
free for
the
asking.
