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What over the counter drug is equivalent to pantoprazole for a 10-year-old boy?" and he said, "It's benzodiazepine," "Is this medication available over-the-counter?" And he said, "Are there children who are on it?" And I said, "I'm not sure." And he said, "OK, we'll stop." And when we first gave him the choice about it, we were just being cautious based on this drug's availability over the counter to children who aren't opioid users, and if we had given him the drug, we would have taken it off the shelf. Jeff Stein I'm wondering too if any physicians that you told this story to feel there was a lot of upside to this drug and if it was worth for them to prescribe the drug. Dr. David Juurlink You know, I think to me what's pretty interesting is that almost half of our patients were not on opioids. They benzodiazepine, and some of them still are. I did not see any dramatic difference after two months of treatment, in how the pain was treated. I just thought if you're telling a person off opioids for at least a month, and to try nonnarcotic, I think it's a smart and maybe safe thing. Jeff Stein What would have been the rationale in prescribing drug if opioids would have been just as effective or even better? Dr. David Juurlink There would be several rationales. First, it would be the same as trying to cure someone who does not use opioids. When we were going up against the CDC, they would say, well, then the risk-benefit analysis must be same, and they were right. There is no risk-benefit analysis with this medication, that was my understanding in the beginning. And I'm going, oh, my gosh, I feel so bad [laughter], like what Pantoprazol 60 Pills 500mg $119 - $1.98 Per pill am I doing? But they were right. There is no risk-benefit evaluation for any prescription drug. So it would be like, I don't want to get you the best pain relievers possible, but then if the risk and benefit analysis says, this is the best pain reliever, we're going to take it. Jeff Stein Well, the problem then is that they wouldn't have any placebo, but you wouldn't have any opioids either, but you would have this drug with no risk-benefit evaluation, and that's troubling to me because there are patients whose pain is really unresponsive to opioids. I've been having them for 15 years, or more, and even that we could not completely cure them. And you've treated many of them for quite a long time. But there are other people for whom your advice, and it seems like every other week you have a new patient, would be different than the advice a patient would get when they go to the doctor. Does that raise any ethical issues? Dr. David Juurlink I think it poses, very honestly, this fundamental question of when medicine is, you know, Metoclopramide price uk ethically wrong to do. When you can do things that would help a very sick person do better, and if there are no risks involved or harm, should we be doing it?

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