You might have assumed this level of toxicity is relegated to hard-core opioid drugs. Well, here’s a kicker for you. A long list of prescription opioid painkillers, such as Norco and Vicodin HP, also contain (wait for it) a large dose of acetaminophen. You could be an addict of the poppy but be poisoned by the generic Tylenol lumped in with it. In 2016, the American Society of Addiction Medicine estimated that 2 million Americans had a substance use disorder involving prescription pain relievers.
You may be thinking, “Hey, I’m not addicted to painkillers. I am a responsible person who always reads the label. Let’s drink to celebrate!” Sorry, but here’s another worry. If you are a regular consumer of acetaminophen and a light or moderate consumer of alcohol, your risk of liver and kidney damage increases markedly. A 2013 study of 10,000 adults found that light and moderate drinkers who also take acetaminophen more than double their risk of kidney disease. Even when participants had only small doses of acetaminophen, kidney disease soared an average of 123 percent.
Why is acetaminophen so dangerous? Most of it is safely processed and passed in urine, but it all comes down to one bottleneck in the liver’s ability to remove a potentially toxic byproduct known as NAPQI. At recommended doses, the liver is able to neutralize NAPQI produced during metabolism of the drug, but in the case of an overdose, NAPQI builds up to dangerous levels, obstructs vital functions and eventually destroys liver cells.
Here’s another wicked twist. In one respect, it’s easier to kill yourself accidentally than it is intentionally. That’s because the antidote to acetaminophen poisoning is effective. If a loved one is found and brought to the hospital within eight hours of the dose, chances are they can be saved. However, for someone who’s been overdosing over the course of several days, they may not even be aware there’s a problem because the symptoms of acetaminophen poisoning are similar to the cold and flu symptoms it’s being taken for. In that scenario, by the time a person realizes they’re in trouble, the antidote is no longer an effective treatment.
Acetaminophen was developed in 1955 as an alternative to aspirin, which was known to be effective at pain relief but hard on the stomach. Despite acetaminophen’s official safety profifle, many experts had concerns early on. In the medical journal The Lancet, a 1975 editorial proclaimed that if acetaminophen were discovered “today,” it would not be approved for over-the-counter use. In 1997, The New England Journal of Medicine published a study showing that acetaminophen was the leading cause of acute liver failure at Parkland Memorial Hospital in Dallas, despite the drug’s “apparent overall safety.”
Today, acetaminophen is one of the nation’s most used drugs. In 2009, more than 27 billion doses were sold.
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