UPDATE (4:10 PM ET August 9, 2017):

This story has been updated to include Fin Mox being listed as "currently unavailable" on Amazon.

For a sobering look at the state of healthcare in the United States, consider: Some people are so cash-strapped, and in such desperate need of medical care, that they're scoring—and then using—medications meant for pets.

Antibiotics aren't the most expensive prescriptions, but it's the trip to a doctor in order to get them that adds up to a hefty bill. One way people are getting around this?

Fish antibiotics. Bought off Amazon.

The world started to learn about the trend after Motherboard wrote up a Tweet from writer Rachel Sharp, in which she posted photos of a product on Amazon—"Moxifish"—and screengrabs of some of the reviews.

"How bad is American healthcare?," she wrote. "Read the reviews for aquarium antibiotics and decide for yourself."

Tweet may have been deleted

And lest you think this healthcare horror show is limited to a few freak use cases, think again: It wasn't hard to find several online forums dating as far back as ten years ago, questioning the use of animal medications.

On these forums, users discuss why they buy meds meant for pets (some buy them for "emergency bags" in case, you know, the world ends), and which meds they believe are safe to use. One forum revolves around using horse liniment for aches and pains.Another discusses buying over-the-counter pet antibiotics when they don't have insurance.

On Twitter, people have also detailed their experiences with taking or seeking out animal medications.

Tweet may have been deleted

Tweet may have been deleted

Tweet may have been deleted

One person we spoke to, Carrera Howie, said she used FishMox, a type of antibiotic sold at Walmart, when she had a urinary tract infection a few years ago. At press time, Wal-Mart has yet to respond to a request for comment on the issue.

Howie's parents were in the Army National Guard, and used their GI Bill to help her pay for college. This included a monthly stipend, but she'd just lost it when she contracted her third UTI in one year. Even withinsurance, Carrera Howie couldn't afford a visit to the doctor. Her mother recommended she take fish antibiotics, and gave her a bottle that she'd purchased from a pet store. She said she didn't know where the idea originated from.

"They worked incredibly," she told Mashablein an email. "The UTI was completely gone within a week and I didn't get another one for at least 4 more years."

She even said she'd use them again.

"Urgent care and doctors' copays are so expensive and it sometimes feels like I have to make a choice between having a provider and having groceries," she explained.

37-year-old Amy Wareham has also turned to fish antibiotics more than once to help cure an illness.

Wareham said went 10 years without insurance, and used fish antibiotics four times during that period to self-medicate. At the time, she compared the pills to pills her family members had gotten from the pharmacy, and claimed that they were identical.

Today, she has health insurance under the Affordable Care Act, and said she wouldn’t use fish antibiotics again—unless she became uninsured.

Kelsey Chapman, the Twitter user who said she "hit up a pet store last year for antibiotics" spoke with Mashablevia email about her experience. Chapman hasn't used fish antibiotics, but once sought them out once when she had a sinus infection. The store, which she didn't name, didn't carry the antibiotics.

"I was looking for fish antibiotics specifically, as there was the most information on those online," she wrote.

Eventually, Chapman borrowed money and managed to get treated at a clinic. She acknowledged in her email that taking medications not prescribed for a specific illness can be harmful.

"It’s pretty dangerous to delve into using antibiotics that may not be specifically formulated to fight off whatever infection it is you could be experiencing, especially when so many superbacteria have grown out of the overuse of antibiotics over the past few decades," she wrote.

The overarching theme for peoples' complaints stems from the costliness of our current healthcare system (a request for comment on the issue to the Department of Health and Human Services has yet to be returned).

In her response to Mashable, Chapman also pointed to the healthcare system as a problem.

"The American healthcare system is deeply flawed and forcing people to treat themselves in risky ways, and we need to change that," she wrote.

Howie held a similar view, pointing to her own experience as an example that others might face.

"I was at a point in my life where I couldn't afford a $40 urgent care copay, even with insurance and a job," she wrote, adding that she could have ended up in the hospital, which she definitelywouldn't have been able to afford.

In a phone interview, Daniel Freedberg, an assistant professor of medicine at Columbia University Medical Center's Division of Digestive and Liver Disease, spoke of the potential consequences that could stem from humans taking medications like fish antibiotics, such as dosing issues.

"I'd have no ideahow to dose fish antibiotics," Freedberg said, pointing to the differences in size and weight between humans and fish. "Antibiotics distribute within the body differently."

And he doubted that people without medical degrees would know how to do it, too. He said he doubts people would know how to properly dose the antibiotics when self-medicating. He also pointed out that antibiotics kill good bacteria inside you, too, and they also breed resistance to future antibiotic use.

In other words, you don't need antibiotics every time you catch a cold. This is something that Howie, who used FishMox, addressed in her response. She works in a pharmacy, and said people come in asking for amoxicillin for things like allergies, when in reality, all they need is something like Zyrtec.

"Overuse of antibiotics can lead to an immunity to them, and cause you to get sicker in the future if you don't use them correctly," she said. "Try to consult with a health professional before any antibiotic use."

Still, people complain that they need antibiotics despite their doctor's reluctance to prescribe them, which is another reason people have sought out alternatives.

Freedberg noted the increasing awareness among doctors about antibiotic stewardship, which are programs designed for "improving antibiotic use." The programs "optimize the treatment of infections and reduce adverse events associated with antibiotic use," according to the CDC.

And according to Freedberg, the awareness surrounding antibiotics may be why people find that their doctors aren't so quick to prescribe them the medicine. He also added that the preservation of antibiotics for people who truly need them is crucial.

"Perhaps in prior years there [was] less appreciation for the concept of antibiotic stewardship," he said. He added, "Usually doctors can describe why they're not prescribing antibiotics...for most people, it will satisfy them."

But that's not always the case.

Freedberg's advice for people who might turn to pet medication is to try to visit an emergency room, or a "doc-in-a-box" type of clinic. While you may get a bill afterward, he said, you'll at least be seen by a trained medical professional.

Otherwise, Freedberg advised remaining aware of the symptoms for upper-respiratory issues, and to stay hydrated, along with "all the things that your mother told you to do when you were a kid."

According to the Food and Drug Administration, its Center for Veterinary Medicine regulates animal drugs, including drugs for fish. They even have a database where you can look up approved medications. However, Moxifish, the medicine bringing this debate back to life, is not FDA-approved.

PetSmart, one of the stores named in online forums as a place people have tried to buy animal medications, didn't comment on the issue. We also reached out to Petco and 1800PetMeds for comment on the situation, but neither got back to us.

In a statement, the FDA said:

"Animal drugs should not be used to treat people and patients should talk to their doctor about what medication is safe for them. Specifically, with regard to fish medications, the agency is aware that animal antibiotics are sold in pet stores for use in aquarium fish."

The fish antibiotics in question are not on the FDA's list of approved aquaculture drugs, according to its site. Additionally, the FDA said it has safety concerns for fish, users, and the environment regarding drugs marketed for ornamental fish.

"The antibiotics available in pet stores or online for ornamental fish have not been approved, conditionally approved, or indexed by the FDA, so it is illegal to market them," they said in a statement.

To its credit, Moxifish clearly says its pills are not for human use. It does say they're for Aquarium and ornamental fish, though. Fin Mox says the same thing.

The FDA's Unapproved Animal Drugs page says:

"As required by the FD&C Act, new animal drugs must be reviewed by FDA for safety and effectiveness and obtain legal marketing status before they can be marketed."

But if antibiotics for ornamental fish aren't approved, how are they being sold?

Well, that's the thing: They shouldn't be.

Under the Federal Food, Drug, and Cosmetics Act, the sale of these antibiotics is illegal because they aren't approved, indexed, or conditionally approved. Not only are they considered unsafe, but they are also considered adulterated because they're considered unsafeunder section 512(a) of the law. Drugs considered adulterated are prohibited from being sold under section 301(a) of the FD&C Act.

In short: people are self-medicating with drugs marketed for animals that aren't FDA-approved and, as Sharp noted in her tweet, openly sharing their stories in Amazon reviews.

And that underscores exactly how drastic this trend has become.We took a spin around Amazon's reviews for Moxifish, and yep, there are several reviews from users writing about how great the product was for their "fish."

One reviewer said the Moxfish seriously helped their "fish" with wisdom teeth pain. 

Another reviewer's fish had sleeping troubles and a sinus infection. But with some of the medication, they were out building a shed and feeling better quite soon, apparently.

When seeing the "vet" was too expensive for its "fishy friend," this reviewer turned to Moxifish to cure a bacterial infection. 

But Moxifish isn't the only product with such reviews. Fin Mox, another type of fish antibiotic sold on Amazon, has similar reviews.

Reviewers used the antibiotics when their "fish" came down with bronchitis, or had infected gums.

In the days since this has gone viral, Amazon seems to have responded by taking Moxifish down from its site. But you can still view the reviews in Google's cache.We captured screenshots of Moxifish reviews through the cache. 

Amazon declined to comment. KMartalso sold the product on its site, though it currently says Moxifish is "temporarily unavailable" as of this writing. We've reached out to KMart for comment. As of Wednesday, Aug. 9, Fin Mox is listed as "currently unavailable" on Amazon. Though the products disappeared, or were unavailable online in the days since the story began trending, there's no confirmation if the tweet triggered the removal of the product. 

For those that pursue this line of "treatment," there's nothing nefarious in their intent; it's their way of coping with a healthcare system that they say they simply can't afford.

（作者：汽车配件）