(Disclaimer – I am not a doctor and nothing on this page is professional medical opinion – just observations from a reasonably intelligent individual who has been reading up on this current event – I invite doctors and others to feel free to chime in on my opinion here in the comments, and correct any inaccuracies contained within!)
It looks like the FDA is poised to ban the painkillers Percocet (essentially Oxycodone with Acetaminophen) and Vicodin (Hydrocodone with Acetaminophen) because they both contain Acetaminophen.
Acetaminophen has been proven to cause liver damage, and is the leading cause of Acute Liver Failure in the United States.
Smart of the FDA to take this action then, right?
Yes!
From what I understand, if doctors need to prescribe Percocet in the future, they can simply prescribe Oxycontin and Tylenol separately, or other Oxycodone compounds. Similarly, in place of Vicodin, they could prescribe other Hydrocodone compounds with other drugs, such as Ibuprofen.
However, unlike Oxycodone, doctors cannot prescribe Hydrocodone by itself plus a Tylenol prescription separately.
This is because in the US, you cannot prescribe Hydrocodone without it being combined with another drug.
Why Hydrocodone is not available without other drugs such as Acetaminophen is the dark side of this story.
Up until now, the FDA has prohibited Hydrocodone (the opiate in Vicodin), from being sold in the United States *unless* it is combined with another drug as a compound – far and away, Acetaminophen being the most popular (and most dangerous).
The question is why did the government insist that, unlike the more powerful opiate Oxycodone (which is available standalone, as Oxycontin), Hydrocodone not be prescribed by itself?
From my amateur research around the net, the answer seems to be some unusually sinister legislation originating from The War On Drugs.
In some patients, Hydrocodone can be habit-forming, and its a popular drug of abuse. The FDA wanted to make sure there was something else in the drug that people *wouldn’t* want to take too much of to discourage abuse.
Introducing Acetaminophen.
Its been known since 1970′s that too much Acetaminophen causes the unwanted side effects such as stomach upset and liver damage. So the FDA figured if that was in there too, people wouldn’t want to take too much of it.
Basically, for all intents and purposes, the FDA made an important and popular drug more harmful to discourage abuse.
Besides the fact that this was completely unethical and has probably resulted in the unnecessary liver damage and deaths of countless Americans (the vast majority legitimately ill patients to begin with), there is yet one more irony to this approach:
Many Vicodin users and addicts likely have no idea whatsoever that the government put Acetaminophen in there in the first place, nor what the reason and consequences of the Acetaminophen component are.
In other words, instead of being dissuaded from abusing the drug as intended, most Vicodin users were likely just thoughtlessly destroying their liver.
Now, if your a drug addict, I’m sure you know that drug addiction can have serious consequences on your health and perhaps even cause death – the insidious point is that the devastating liver damage they were experiencing was a conscious and deliberate act of the US government, and not intrinsic to their addiction.
Of course, there are some savvy Vicodin addicts who know how (and why) to chemically remove the Acetaminophen before taking Vicodin (and why they should), but the complexity probably makes this a tiny and fortunate minority.
Now, this isn’t to say that up until now Vicodin would not have been a popular compound with doctors anyway even without the government ban (its very effective as a combination) – plus, Hydrocodone is available as a compound with other alternate drugs besides Acetaminophen as well (such as Ibuprofen).
The real problem is all of the people who destroyed their liver who might have otherwise been prescribed Hydrocodone standalone (as Oxycontin is today), and all of the drug addicts who destroyed their liver with Acetaminophen because there is absolutely no standalone Hydrocodone available on the black market.
In a sense, Acetaminophen was used similarly to the way the government used Paraquat on Marijuana farms – stop people abusing drugs by making them poisonous.
13 responses so far ↓
1 Bingle Dotingle // Jul 1, 2009 at 6:39 pm
FDA = TARD.
2 rachel // Jul 4, 2009 at 2:15 pm
everything you said in your article is very true I had a husband die from opiate. but what you have to rememberis there are alot more people dying from methadone and oxycotin then percocet or lortab. I have alot of knowledge in this area i have been dealing with addiction for years since i was raped and introduced to drugs by my father. These 2 drugs are not the us biggest problem we have here, oxycotin wasn’t even supposed to hit the us it was intended for europe only since junkies canbreak it down and shoot it. The government should worry about the economy and other problems we have here instead of trying to regulate drugs that are useful taking correctly.
3 Nick Dupree // Jul 19, 2009 at 10:45 am
Chris:
I blogged my two cents about this: Should Opioid-Acetaminophen Combination Painkillers Be Banned? YES.
I quote you heavily.
Thanks for a well-researched and insightful post.
Nick
4 Dave Thomas // Mar 31, 2010 at 1:47 am
Everything sounds reasonable other than the comment on people taking these pills and not knowing about the acetaminophen. If no one takes the time to properly research narcotics before taking them, they are completely at fault for any consequences. Anyone without the intelligence to do so deserves the consequences and the world would be better off without them. We have enough ignorance already, a little less would no hurt. Also if taken as prescribed the hydrocodone/acetaminophen would not do any damage. And once again if you are taking more than prescribed it is your fault an no one else s for what might happen. But that is o.k. I guess, lets just blame others for our own stupidity and take no responsibility for our own actions.
5 Tom // Apr 24, 2010 at 11:28 pm
This is quite the anti-government conspiracy theory and the author does not list or provide links to his sources when he claims that the US government intentionally “poisoned” Vicodin. I have no idea whether this is true but I can’t evaluate this conclusion without seeing some of the research done.
6 randy // Aug 4, 2010 at 7:56 pm
what is the easyest way to remove acetamiophen from vics or norcs?
7 Aaron // Aug 24, 2010 at 1:00 pm
It’s called “cold water extraction.” Look it up.
8 marina // Oct 29, 2010 at 1:00 am
THIS SCARES ME I’M ON HYDROCODONE SOR MULTIPLE SCRLROSIS AND RA I ONLY TAKE WHAT IM SIPPOSED TO BUT IM ON THE MAXIMUM DOSAGE MY LIVER HAS NEVER BEEN CHECKED IN 7 YEARS
9 Chris (Admin) // Oct 29, 2010 at 10:07 am
Marina, dont panic, just talk to your doctor.
10 StationStops // Dec 9, 2010 at 10:21 am
Tom – yes it is very conspiratorial but I make it clear I am not a doctor and this is all TTBOMK and welcomed professional opinion – maybe someone knows something I don’t and its not a conspiracy at all – I would welcome that information!
Dave – I agree addicts are of course entirely responsible for their actions, but poisoning addicts deliberately is an irresponsible act in itself.
I also do not agree all prescription drug users should be responsible for researching their drugs – thats what doctors are for. Pharmacology is an extremely complex and moving target even doctors must stay on top of.
Yes if you are otherwise healthy and able you should research, but many Vicodin patients are eldery, very sick, have no resources or family, some are illiterate – they should be able to rely on the FDA and doctors acting in their best interest.
As it stands, addicts have made access to pharmaceuticals an growing logistical burden for the elderly and sick.
11 Gregg // Jan 22, 2011 at 5:07 pm
It’s no secret that the reason acetaminophen is mixed with hydrocodone is to discourage abuse. As someone in the medical field, Vicodin abuse is a terribly rampant problem. I worked in a pharmacy for 3 years before attending medical school. We were a 24 hour pharmacy at a large chain grocery store/drug store. We were actually the company’s biggest retail store in their chain. Every day after midnight, the ER would release a veritable army of Vicodin addicts. Rather they were selling or abusing, they were clear to spot. This may sound judgmental, but it is not. I don’t judge people based solely on their appearance, but when I can see looking through their profile that they hit different ER’s and different ER docs 2-3 times a week for various stomach “pains” and cold like symptoms, something is up. And the damn ER docs just pump them out with an antibiotic and 20 or so tabs of Vicodin. This is just to show you how easily it is to get this drug as is. Oxycodone is a completely different story because of its C-II classification. Without going into much detail, C-II drugs (Ritalin is a common example, Fentanyl which is another pain reliever is another) are very highly regulated and much more difficult to get. This in contrast to anyone’s ability to walk into an ER, fake a stomach ache and pick up 20 Vic’s may help you see how much more dangerous Vicodin actually is to the general public.
For those using Vicodin genuinely, then they have been counseled on the dangers of overdose of Acetaminophen. For those abusing Vicoden, I’m sure they have been warned at one point or another, but ignore the warnings because of their addiction to the drug. Vicodin, being a highly habit-forming drug, can easily lead to abuse, even amongst well-meaning users. But for most people, the idea that abusing it highly will lead to liver damage helps persuade them from abusing the drug. Then there are those in society who are going to abuse this drug and others no matter what the consequences. These people are killing their bodies regardless, likely with other drugs. So I feel that the good of including acetaminophen with hydrocodone in Vicodin far outweighs what really amounts to zero negatives, because those abusing the drug and harming their livers are going to follow abusive, body-damaging behaviors anyways.
That being said, combos of the drugs with far less acetaminophen have been made for precisely your argument. And doctors worried about prescribing to potential abusers should use these formulations instead.
12 Rango // Mar 12, 2011 at 6:13 am
Dude, I have been taking vicodin for several years and knew about acetaminophen in it but I had no idea that acetaminophen does to a liver. NOT EVERYONE KNOWS IT”S DAMAGING! Who cares about the addicts when it’s poisoning the good people and elderly, that’s Fucked like everything in America! America is backwards!
13 Bianca // Mar 18, 2011 at 11:43 pm
@ Rango- I am 17 years old and know about the effects of acetaminophen. you either don’t read tylenol or other pain killer labels or you lack communication skills with your doctor, because he or she should have told you all the risks involved in taking vicodin- right after you asked.
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