Is there a safe pain reliever?
Aspirin puts your stomach at risk. Acetaminophen can destroy your liver. Anything that alters the pain response more directly is potentially addictive. There is no completely safe drug you can take to relieve pain. Any pain-relieving drug is a calculated risk.
It’s something people are talking about after a drug safety panel concluded that millions of people are putting themselves at risk by taking too much acetaminophen — and this is occurring mainly because people don’t realize how much acetaminophen is in the drugs they take. The biggest damage comes from Percocet and Vicodin, prescription drugs marketed with a mystique meant to obscure the fact that acetaminophen is their main ingredient. To add to the confusion, discussions of these drugs often do not specifically mention the acetaminophen, referring to the exotic-sounding “paracetamol” or the very cryptic “APAP” instead. If you are an organic chemist, you might recognize these as synonyms for acetaminophen, but the rest of us may not immediately make that connection. It is an important connection to make, because anyone taking Percocet or Vicodin on the same day as an acetaminophen-based over-the-counter cold remedy (and these are some of the most popular drugs on the market) is probably getting too much acetaminophen. About one person per day dies in the United States from acetaminophen, and it is this combination of prescription and over-the-counter drugs that seems to be at fault in most of those cases.
Part of the solution is to stop using all drugs that, like Percocet and Vicodin, combine acetaminophen with narcotics. A patient can use these drug combinations more consciously by taking the two drugs in separate tablets.
Physically separating the two drugs does nothing to affect the way they function, but by leading to more conscious drug use, it permits people to be aware of the risks they are taking and make good decisions about those risks. Drug manufacturers have mixed feelings about this: they want to avoid having patients die as the immediate result of bad drug decisions, but they lose revenue if patients and physicians avoid risky drugs in situations where there is little to be gained by using them.
Johnson & Johnson, the largest U.S. acetaminophen manufacturer, is trying to walk a fine line with its advertising campaign that seeks to reassure drug users that its acetaminophen-based drugs, the various forms of Tylenol in particular, are safe if used as directed. This, of course, is not entirely true; not everyone who is hospitalized for acetaminophen-related liver damage took more than the recommended doses. But that aside, the conflicted message from J&J does not really help their case. They seem to be trying to say, “Go ahead and take Tylenol, it’s safe,” and at the same time, “If you get sick from taking Tylenol, don’t blame us.”
It’s a mixed message that has a jarring dissonance with the popular assumptions of the commercial drug culture. For half a century, people in the United States have, for the most part, taken acetaminophen whenever they felt like it, within the limits of the frequency schedule suggested on the drug’s packaging. The idea was that the drug was basically safe, “safer than aspirin.” Aspirin, of course, has dangers of its own, and now we are learning that acetaminophen is not necessarily safer than aspirin. Which pill is better depends on your individual situation, and is something you should stop and think about, and perhaps even seek medical advice. Recent polls are suggesting that the popular view of acetaminophen has changed abruptly in the week since the J&J advertising campaign began. People no longer think of Tylenol as “basically safe.”
Likely, this episode is also changing perceptions of drugs in general. If the drug that for years was marketed as the safest drug on the market is killing people every day, then every drug you take must be a calculated risk — as, of course, it is. As people pay more attention to the risks associated with drugs, they will use them better — but this also means they will use them less.