red22
Bluelighter
- Joined
- Nov 23, 2009
- Messages
- 2,061
Strict attitudes about prescribing that I've seen from clinicians prompted me to bring this up with ChatGPT, which yielded the below response. When I asked one doctor to raise the dose of Valium (5 mg), he said no, they're very strict. Another doctor said yes and proceeded to just give me 5 mg …
“Amused” is probably the right word — and also a little horrified.
If you dropped a modern regulator, pharmacist, or compliance officer into a clinic in the 1940s, they’d think it was the Wild West of medicine.
What prescribing looked like back then
In the 1930s–40s:
• barbiturates were handed out for anxiety, sleep, nerves, grief
• morphine/heroin derivatives were still used pretty casually
• amphetamines were sold for depression, weight loss, “pep”
• little documentation
• no centralized records
• no prescription monitoring
A doctor could literally write:
> “Morphine tablets — refill PRN”
And that was that.
No PDMP.
No audits.
No dose thresholds.
No cross-checking.
Things that would shock regulators today
Doctors:
✔ prescribed unlimited refills
✔ mixed sedatives + opioids routinely
✔ gave housewives amphetamines and barbiturates together
✔ ran what were basically personal drug formularies
✔ often dispensed meds themselves
It wasn’t considered shady — it was normal practice.
Why it changed
A few waves of catastrophe forced reform:
• barbiturate overdose epidemics
• opioid dependence among WWI & WWII vets
• amphetamine psychosis cases
• rising accidental deaths
Each crisis added another layer of regulation.
Modern systems are basically built on 80 years of “oh wow that went badly.”
From freedom to friction
1940s model:
> Trust the doctor completely
2020s model:
> Trust — but verify constantly
Not because doctors are worse now, but because history showed blind trust can get people killed.
Bottom line
If today’s regulators reviewed a random 1943 prescription pad they’d probably say:
“Half of this clinic would be shut down by lunch.”
And the other half would need DEA investigations
If you’re curious, I can walk through:
• specific drugs that were shockingly common back then
• famous medical disasters that caused modern laws
• when PDMPs and controlled substance schedules appeared
• how much autonomy doctors actually lost over time
It’s a fascinating (and dark) evolution of medicine.
Confidential file. Barbiturates (1955)
A filmed sequence dramatizes the problems addressed in the program: the story of a working mother addicted to barbiturates initially prescribed by her doctor.
“Amused” is probably the right word — and also a little horrified.
If you dropped a modern regulator, pharmacist, or compliance officer into a clinic in the 1940s, they’d think it was the Wild West of medicine.
What prescribing looked like back thenIn the 1930s–40s:
• barbiturates were handed out for anxiety, sleep, nerves, grief
• morphine/heroin derivatives were still used pretty casually
• amphetamines were sold for depression, weight loss, “pep”
• little documentation
• no centralized records
• no prescription monitoring
A doctor could literally write:
> “Morphine tablets — refill PRN”
And that was that.
No PDMP.
No audits.
No dose thresholds.
No cross-checking.
Things that would shock regulators todayDoctors:
✔ prescribed unlimited refills
✔ mixed sedatives + opioids routinely
✔ gave housewives amphetamines and barbiturates together
✔ ran what were basically personal drug formularies
✔ often dispensed meds themselves
It wasn’t considered shady — it was normal practice.
Why it changedA few waves of catastrophe forced reform:
• barbiturate overdose epidemics
• opioid dependence among WWI & WWII vets
• amphetamine psychosis cases
• rising accidental deaths
Each crisis added another layer of regulation.
Modern systems are basically built on 80 years of “oh wow that went badly.”
From freedom to friction1940s model:
> Trust the doctor completely
2020s model:
> Trust — but verify constantly
Not because doctors are worse now, but because history showed blind trust can get people killed.
Bottom line
If today’s regulators reviewed a random 1943 prescription pad they’d probably say:
“Half of this clinic would be shut down by lunch.”
And the other half would need DEA investigations
If you’re curious, I can walk through:
• specific drugs that were shockingly common back then
• famous medical disasters that caused modern laws
• when PDMPs and controlled substance schedules appeared
• how much autonomy doctors actually lost over time
It’s a fascinating (and dark) evolution of medicine.
Confidential file. Barbiturates (1955)
A filmed sequence dramatizes the problems addressed in the program: the story of a working mother addicted to barbiturates initially prescribed by her doctor.
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