“Why don’t you want the clonazepam?”I experienced a wave of frustration as I repeatedly explained my hesitance to take drugs not typically meant for long-term usage to the porteña psychiatrist sitting in front of me. After a mere thirty minute initial appointment the previous week, I found myself walking out with a script for sixty 0.5 mg pills of clonazepam, more easily recognized in the United States by its brand name, Klonopin. Clonazepam is a benzodiazepine, a type of anti-anxiety medication. Some other well-known benzodiazepine medications, besides Klonopin, are Xanax and Valium. In the United States, most health professionals do not write out large prescriptions for benzodiazepines due to their habit-forming, easy-to-abuse nature. While Klonopin, being the lesser of the three evils, can be prescribed for more consistent, longer term usage than the others, it came as a shock for me when my new psychiatrist in Buenos Aires was so quick to prescribe the medication, simply to address a mild case of insomnia, without asking me about my history of drug or alcohol use.My personal experience in the doctor’s office – paired with my interest in the social sciences and psychology – initiated a curiosity in Argentina’s general perception of prescription drug usage versus that of the United States’. What I have found is that not only are drugs in general (antibiotics and medications used to treat mental illnesses) easier to acquire in Argentina, but prescriptions are not even required in many situations. I interviewed two NYU Buenos Aires (NYUBA) professors on the subject, and came across very intriguing and concerning responses. In comparison to a country like the United States, with its so-called “war on drugs” that lasted for decades, regulations are much looser here in Argentina.Dr. Fernando Rubinstein, a professor at NYUBA, the Director of Education at the Institute for Clinical Effectiveness and Health Policy in Argentina, and a general practitioner himself, says that the the perception of prescribed medications in Argentina is “quite different because prescription drugs in the States [are] much more controlled. For example, [in the United States,] when you have patients on certain medications, you have to refill their prescriptions, you need to approve their refills at the pharmacy, and the pharmacy will call you for verification.” That process doesn’t occur in Argentina. “You have to give them the prescriptions, of course”, he adds, “but some patients get their medication even without [a] prescription.”This becomes a problem for several reasons. For one, overuse or improper use of antibiotics increases the risk of drug resistance. Professor Pablo Carrasco, another professor at NYUBA and Director of the Foreign Languages Department at the Barceló Foundation, says, “es muy común que un ciudadano pueda comprar antibióticos sin una receta. Según he leído, ciertamente hay un aumento de la resistencia de las bacterias, razón por la cual cada vez las drogas son más fuertes.” “It is very common that a citizen can buy antibiotics without a prescription. As I have been reading, there is certainly an increase in bacterial resistance, which is the reason each time why drugs are made stronger” (translation mine).Similar concerns regarding the overuse and improper use of antibiotics exist in China. In 2011, a news article claimed that 80 percent of Chinese patients with the common cold request antibiotics and 70 percent of households keep a reserve of antibiotics, as they find it preferable to use them for self-treatment, rather than going to the doctor. More recently, research done by Fudan University found that in urine samples collected from a thousand schoolchildren in Shanghai, Zhejiang and Jiangsu provinces, 60 percent contained antibiotics. A rising NYU Shanghai senior, Richard Lewei Huang, had spent some time in Buenos Aires and happened to get sick during his stay there. He says that doctors prescribed him antibiotics with some hesitation after his second visit, while in China, someone with a moderate cold or fever could likely get antibiotics immediately without any further questions. He describes the (ab)use of antibiotics in China as a serious issue, but declines to comment further.Another issue that arises in Buenos Aires is the readiness and ease of access in obtaining medications such as benzodiazepines and tranquilizers. Prof. Carrasco notes, “Hay ciertos fármacos como el Lexotanil y el Valium, entre otros, llamados ‘psicofármacos’, que se pueden comprar libremente sin receta. Eso es un problema.” “There are certain drugs such as Valium and Lexotanil, among others, called "psychotropic drugs" which can be purchased freely without prescription. That is a problem” (translation mine). Dr. Rubinstein also affirms this concerning trend, saying, “middle-class people and high-class people probably demand quite a bit [of] some medications -- like tranquilizers [and] relaxants -- and physicians are quite open to prescribing them . . . we have probably an excess use of some tranquilizers or benzodiazepines here. They are prescribed by physicians, and maybe people are more used to using them [for] very long periods, which is not the usual indication for those.”Small, family-owned pharmacies are also very common here in Buenos Aires. Due to the lack of government regulations on patents, small laboratories are free to create their own generic versions of prescription drugs, referred to as “medicamentos genéricos” in Spanish. This results in a negative economic impact for the pharmaceutical industry, but increases the ease of obtaining certain medications. Professor Carrasco comments, “ciertos medicamentos son muy baratos y no son rentables, por lo que las farmacias prefieren venderlos aunque el comprador no tenga receta médica.” “Certain drugs are very cheap and [therefore] not profitable, so pharmacies prefer to sell them even if the buyer does not have a prescription” (translation mine).On the other hand, cheaper medication for certain conditions can definitely be beneficial for populations in need of medication to treat long-term illnesses. For example, an NYU Steinhardt rising senior student, Hannah Lochner, notes that the cost of insulin in Argentina is so much cheaper and available without a prescription than in the States. She says, “[The process] is much better in Argentina in my opinion . . . my copay for 4 months of insulin would be the same as 4 months over the counter here. or close, since I use about a box a month. Now, if I could get a prescription and use my insurance here it would be about half the price, I think, or maybe even less.”At the end of the day, prescription drug and antibiotic medication abuse and misuse can happen anywhere. Even though in some cases, readily available medication is a highly beneficial aspect of the drug policies here, it is obvious that in Argentina, reform within the medical community and increases in health-oriented policymaking are greatly needed. In my last psychiatrist’s defense, it is technically her job to see clients and prescribe medication, and in a society that normalizes the usage of drugs to this degree, it is almost inevitable that my experience is a common visit to the doctor’s office in Argentina. However, that doesn’t mean that health policies can’t be enforced to curb this growing crisis of over-prescription and over-use of both antibiotic and psychiatric medications. Health providers need to be held accountable for overprescribing drugs, and the public needs to become more informed on the public health and personal consequences of improper drug usage. This article was written by Katie-Rose Nunziato. Please send an email to [email protected] to get in touch. Photo Credit: Katie-Rose Nunziato