Acetaminophen: Gateway to Crack

Writing in Sunday's USA Today, Dr. Marc Siegel offers a cautionary tale about the dangers of offering "harmless" drugs over the counter; namely, the nation's raging Tylenol problem:

Perhaps the most abused over-the-counter drugs of all, Tylenol and aspirin, respectively cause thousands of cases of liver damage and bleeding ulcers every year, partly because a physician isn't involved in regulating their use. When these drugs first came on the market, the extent of their side effects wasn't known.

A campaign to restrict them now would fail, but their patterns of use - and abuse - can be telling when considering whether to make other drugs available over the counter.

Siegel is worked up over efforts to make cholesterol drugs and Plan B (the morning-after pill) available over the counter. As Ronald Bailey explains, the Plan B issue is moral, not medical, but the FDA is working overtime to keep the drug out of easy reach.

Comments

[booty0]

Kerry, I don't see the connection between Tylenol and a highly addictive drug like crack. The reality here is that people are over-medicating with OTC drugs to control pain or symptoms of other ailments, as opposed to trying to get high. I had a relative die of liver failure that was later determined to be caused by a combination of acetaminophen overuse (for chronic pain) and alcohol abuse. Maybe this could of been avoided if he had been under more intense medical oversight.

[Ayatollah Usoe]

A doctor should know enough about epidimology to know that the experience of his one patient does not make a representative study.

He blames unsupervised treatment. I wonder if he would accept responsibility for deaths or ailments caused by his supervised prescribing?

To make believe that these drugs are unsafe is to ignore the largest scale clinical trials imaginable: Mevacor? was prescribed to lots of people for daily use for lots of years. These drugs are relatively safe. Nothing is save, (everyone will die) but these drugs have proven the safety and efficacy over time.

The doctor ignores one of the major pushes for over the counter availability ? as the government becomes the medical provider of prescription drugs for an ever increasing segment of the population, having an effective, unreimbursed medication would save us millions.

[Ammonium]

I blame Darwin.

[Evan Williams]

"Maybe this could of been avoided if he had been under more intense medical oversight."

No offense to your relative, but that "maybe" is pretty huge. The decision over whether to issue "medical oversight" should be a choice, either of the patient or of a more cognizant family member/caretaker. Your assertion that "maybe" it could have been avoided may not be wrong in and of itself, but it also begs the question: where do these second-guessing "maybe's" stop? "My husband died in a car accident because he wasn't paying attention. If only he had accompanied by a driving professional who could have administered operational oversight, then MAYBE he might have been saved..." This is an absurd declaration. Every day, there are things that we cannot possibly know of that might kill us. We might be killing ourselves right now. Who knows. We might die crossing the street. But just because some bad shit goes down (as you mentioned: drug OVERUSE and alcohol ABUSE), doesn't mean that "professional oversight" is necessary in everything we do that might result in bad shit. It is your responsibility to know whether overusing drugs and alcohol might kill you.

[The Wine Commonsewer]

Booty, lots of us have chronic pain and alcohol works nicely to manage it. But, with all due respect, a choice to seek medical oversight was available all along the way.

Kerry, I think Ron is mistaken. Just because Plan B revolves around reproductive issues doesn't make it a moral issue. More likely it's just plain and simple FDA foot dragging, ineptitude, and bureacracy (sp? never could spell that right).

[thoreau]

Wine Commonsewer-

First, I love your handle! I wish I'd been as creative when I chose mine. (Well, I could always change, but if I do I'll tell everybody rather than denying it when they figure things out.)

Second, no doubt some of the stalling on Plan B is good old bureaucracy, but there are people who (however rightly or wrongly) see it as a moral issue. I'm sure they play a role in the decision, given who's in the White House.

And I have no doubt that some of the "moral" opposition is funded by makers of competing products...

[Shirley Knott]

And let us not overlook the unintended consequences of mandated 'medical oversight'. Not least amongst them are the beliefs of many Americans that "if it is over the counter, it is safe".
One consequence of that is the occurence of soomeone taking large quantities (half a bottle to a full bottle) of Tylenol thinking that it might make them sick, but won't really kill them -- but will make their significant other(s) think they are suicidal.
The problem is that half a bottle of Tylenol will kill you, roughly 3 days later when your liver fails. A nurse with whom I worked (in a different industry entirely) was heartbroken in recounting tales of young people lying there waiting to die...
The other half of the "we'll keep you safe" message is "and everything we don't mess with is harmless", which we know not to be true.

regards,
Shirley Knott

[serafina]

The major opposition to Plan B is indeed moral, with 49 members of Congress urging the Bush administration to keep it available by prescription only, lest it lead to more promiscuity.

OTC medications always carry with them some risks to consumers, but the benefits of being able to take a mild pain reliever or decongestant without seeing a doctor wildly surpass the risks.

[The Wine Commonsewer]

Tho-row, thanks. I have been the wine commonsewer for a long time but up until recently just kept it at TWC, which are the initials I use most places, including here. Blame it on self promotion. VBG

I know that some of the folks that oversee the FDA are on record as opposing plan B for OTC for moral and/or religious reasons. But I don't think they have the numbers to sway the decision.

And, you could be right about the moral issue funding. Happens all the time. For example, the majority of Ca anti-gaming funding was provided by Nevada casinos. Then once the Indians got the dice, the biggies came in to help them manage the casinos.

I never miss the opportunity to publicize my regret for voting for Indian gaming. Like a good libertarian I voted for that foot-in-the-door not realizing the idiocy of giving Indians a monopoly on gambling. Although the blatant cheating and mismangement has abated some the reservations are still littered with falling down single-wides and the tribes have an incredible amount of bought-and-paid-for power in state government. What a mess. O woes me.

[speedwell]

I had a really hard time getting a certain drug we needed lately. They finally made one form of the drug (a less effective form) available over-the-counter. It is expensive--up to ten dollars per pill, standard dose one and a half pills. I was able to get it over the Internet for ten dollars for three pills from a distributor in Australia.

The really effective form requires a prescription (even the Australian firm wouldn't sell it to me without my health professional's permission); sometimes a separate consultation is necessary for each sufferer in a given household (and none of the three in my home who had the problem had any kind of medical coverage).

I'm talking about Drontal for tapeworms in cats. Is this crazy or what?

[Jennifer]

Is there ANY medication that won't kill you if you take too much of it? It's possible to overdose on my Flintstones vitamins, but that doesn't mean it should become a prescription-only drug.

[speedwell]

There have been people who have successfully committed suicide by overdosing on water. I don't mean drowning; I literally mean drinking water until it fatally disrupted their biochemical processes.

[trainwreck]

Off topic, but I saw the Supreme Court will allow police to use dogs to search vehicles during routine traffic stops.

Are the dogs trained to sniff for Tylenol?

[NoStar]

HEY! Just remember one thing about Plan B: It's for the children....especially the welfare brats I don't want to pay.

[Seamus]

speedwell: It's called dihydrogen monoxide and I want to thank you for adding to the lonely chorus of voices trying to get the public and our lawmakers to wake up to the *very* serious this chemical presents. (See http://www.dhmo.org/facts.html)

[The Wine Commonsewer]

Seamus, thanks for reminding us of that very funny web page.

Speed (hmmm, maybe we outght to check that boy's pupils) I know a guy who did his internship at a state mental hospital and he dealt with those people who were obsessed with drinking water (forget the tech term for it-dypsomania?). He said the staff would often find them with a lip lock on the faucet in the bathrooms and it would be nearly impossible to pry them away. And it was dangerous because these patients, er ah, clients, would just drink until their electrolytes became so imbalanced they would, in extreme cases, die.

TWC

[NoStar]

The worst and most prevalent gateway drug, dihydrogen monoxide. Every drug user first tried dhm.

If we can successfully rid ourselves of this menace, all our drug problems with disappear.

[thoreau]

Dihydrogen monoxide isn't going anywhere. The Man has too much invested in it. The Navy even conducts top secret tests on ways to control and exploit dihydrogen monoxide in time of war.

I hear they've even let it seep into our water supply!

[speedwell]

I did NOT MENTION dihydrogen monoxide, which I think you should take as evidence that I can exert restraint over my loud mouth once in a blue moon.

And thank you for reminding me to check my pupils... they're probably busy screwing up the database I so carefully trained them to use. 🙂

And I'm NOT a boy (though I have an ex-boyfriend who is a girl. Now. What was that I said about restraint?)

[NoStar]

speedwell, was the afore mentioned conversion performed by you in a fit of rage?

[Skeptikos]

Snopes says that Aliso Viejo almost banned it once...amusing piece...

I like what Shirley Knott had to say, after working with NSAIDs for 3 years, I was constantly amazed that everyone I talked to was ignorant of the "potential" dangers of everything from aspirin to advil...of course the warnings and inserts don't help much...and doctors don't help at all...I just had to yell at one I know who attempted to proscribe a cox-2 to someone who had some very major counter-indications, turns out, he'd never even read the product insert himself (but he felt perfectly comfortable perscribing it...lazy bastard). Personally, I just need honest information on these products. Even Vioxx is probably as safe as DHMO if taken in moderation. (it was only with repeat, and heavy usuage that the heart issue began to show...)

[Philip]

Is there ANY medication that won't kill you if you take too much of it?

Marijuana has an LD 50 too large to consume.

It's possible to overdose on my Flintstones vitamins, but that doesn't mean it should become a prescription-only drug.

Yes, the iron and/or vitamin A can definitely kill you.

[speedwell]

IS this thread all about me? No. Did I perform the act in question? No. He realized ten years or so after we broke up that this XY schtick wasn't his thing. And that's already more than you wanted to know.

[Jennifer]

Speedwell-
Every woman needs at least one hilariously bad ex-boyfriend story to be fully accepted into the Sisterhood; after perusing my collection of stories, I'm actually a little envious of yours. Be happy.

[Jeremy Nimmo]

There's still a difference between Plan B and Tylenol. Plan B can kill with one normal dose- and has historically been supplied without enough warning over its dangers.

[smacky]

WHA-? I don't think you know what you're talking about. I have never heard that about Plan B. And, yes, I have taken it. And, no, I'm not dead. (Yet!)

[smacky]

and believe me, I know illicit substances...they don't call me smacky for nothin'. (bad humor)

[The Wine Commonsewer]

Sorry Speed, it's sort of like being a guy named named Dana or Paige. Certain names just seem to lend themselves better to certain genders. Just my cultural bias I suppose.

And I still think we ought to check your pupils.

[John]

Yeah,

Lets get a doctor involved with getting aspirin. Afterall, a doctor being involved has certainly stopped people from getting addicted to perscription pain killers. You never hear of that happening. This is great idea, lets take everyone who doesn't have the time or the money to go see a doctor and make so they can't get an aspirin. Where do these clowns come from?