The sillier part of adding acetaminophen to hydrocodone and other opiates is that it's easy to remove the acetaminophen via cold water extraction. Thus, anyone looking to seriously abuse Vicodin can avoid the damage with just a bit of work.
Exactly. Anyone who wants to abuse opiates can do a simple cold water extraction to almost completely remove the acetaminophen in less than five minutes, or else they can potentiate them using the techniques here so they only need a tiny dosage:
What this means is that the vast majority of those dying are those using these drugs for legitimate medical problems. And it's not a small number of people either; 7,500 people in the US die each year from NSAIDs, and countless more survive but are permanently crippled.
The new government guidelines do absolutely nothing to fix the problem, they're just propaganda to support what is essentially a government campaign to poison the elderly and chronic pain patients.
Its not at all silly. Its an example of the law of untended consequences.
https://secure.wikimedia.org/wikipedia/en/wiki/Unintended_co...
The intent isn't to "poison the elderly and chronic pain patients" but it is the effect, and has been going on long enough, that like all the other unintended consequences of TWOD, are ignored by the Federal bureaucracy that benefits from it.
Exactly. If people believe the government is doing something bad on purpose they'll make trouble, whereas if they believe the government is doing something bad by accident they'll stay home and keep beating off to Fox news.
Hence the Iraq war, public schools, war on drugs, crumbling infrastructure, farm subsidies, ethanol subsidies, oil subsidies, health care system, prison system, food insecurity, etc.
Everyone wants to create laws based on 'intentions' and 'emotion', no one gives a shit about the evidence-based policies or bodies in the street.
Almost 1 in 3 Americans die from drug use or drug-related causes, and I really don't find that silly at all.
500,000 from tobacco and second-hand smoke. 106,000 from adverse reactions to prescription drugs in hospitals. 85,000 from alcohol and alcohol-related fatalities. 17,000 from illicit drugs. 7,500 from NSAIDs. 4,000 from HIV acquired from needle sharing, etc.
That means if we keep doing what we're doing now, if we don't change our policy on drugs, then of the 310 million Americans currently alive, at least 93 million will die from drug use.
Given the average US lifespan of 77, that's a full holocaust every 7.5 years. Obviously not every last death is avoidable, but the overwhelming majority of them are.
The ONLY solution is real education based on science, not propaganda. The drug war makes this completely impossible by A) banning science B) banning education C) banning treatment.
The fact is that drug addiction has nothing to do with the molecule, and so the way we are treating 'addiction' actually makes the problem vastly worse:
You just said there was a government campaign to poison the elderly. Your words. Instead of trying to back up this ridiculous assertion--which you can't--you trot out all these statistics about drugs that are not Vicodin, as if you think that's relevant. Then you equate this with the Holocaust!
The Holocaust, man! The fact that people die from tobacco smoke every year is comparable to the Holocaust! This doesn't even have anything to do with the original post! Tobacco has nothing to do with controlled substances in the first place! Are you out of your mind?
I won't even address the assertion that "addiction has nothing to do with the molecule". Since a drug consists entirely of molecules, your claim doesn't make semantic sense.
I find you ignorant, irrelevant, and offensive. Disgusting, even.
It's unpleasant for me to watch you willfully misunderstand Alex3917 with such vitriol.
It was clear to me from the beginning that he didn't mean the government literally had a campaign to poison the elderly, but rather, that that is the effect of poorly thought out, vindictive policies that the government has instituted. It's hard for me to understand how you could have misunderstood this.
You make such a big deal about his comparison of the death toll to that of the Holocaust, even though it was YOU, not he, who first brought the Holocaust up via your invocation of Godwin's Law.
Your refusal to address the assertion that addiction has nothing to do with the molecule is well advised, since you clearly didn't take the time to understand it. You may agree or disagree with his point, but it would be better to at least look at the links he provided before commenting; the second in particular, a study from Kaiser Permanente that discusses the origins of addiction, should make clear what he was talking about.
It's your final paragraph, though, that motivated me to write this reply. You find Alex3917 "offensive" and "disgusting"? What I find offensive and disgusting is dragging a controversial but interesting line of discussion down to the level of ad hominem attacks, strawman arguments, and deliberate misrepresentation of others' positions. That's not the kind of thing I come to this site hoping to read.
"It was clear to me from the beginning that he didn't mean the government literally had a campaign to poison the elderly,"
Well if that was his intent, then why did he write the literal opposite? It's quite easy to see why: it was to evoke an emotional response, to use grandiose sensationalist claims to either get people to read his comments or to back up or reaffirm his radical ideological standpoints. That's not the sort of thing I come to this site hoping to read. The point is that some policy decision have adverse effect; that fine, and exposing the exact mechanics is often enlightening. Phrasing it as 'oh we're being oppressed! We're living in the Maxtrix/1984!' is plain stupid.
a government campaign to poison the elderly and chronic pain patients
the war on drugs is responsible for vastly more deaths than the holocaust
drug addiction has nothing to do with the molecule
The above are things I do not come to this site hoping to read. These statements are not only false, but false in a particularly childish, self-righteous way. To affirm them demands an incredible misreading, or misinterpretation of the facts.
I find your interpretation of Alex3917's posts remarkably generous. It's not a "strawman" if the argument is actually being stated. I do not have the psychic powers to try and make sense of someone's scientific beliefs--if he has any that are scientific--based on a link and a semantically invalid sentence. I do not have the patience to scientifically debate someone who cannot make himself understood, who has no sense of what facts are relevant. And I do not have the generosity to take such infantile writing and divine from it some hints of reason, as you have.
I understand your distaste for insult, but I think there is a place for calling out nonsense for what it is. This discussion which you so dislike would have not gotten so far were it not for upvotes and support directed at this garbage. You cannot, if you value thought, defend such noise pollution on a website that is ostensibly for discussion.
Tobacco has nothing to do with controlled substances in the first place! Are you out of your mind?
Tobacco is regulated by the federal government. The only reason tobacco and alcohol aren't scheduled is because they are -explicitly designated in the Controlled Substances Act- to be regulated by existing commerce laws. To say tobacco has nothing to do with controlled substances is objectively false.
I won't even address the assertion that "addiction has nothing to do with the molecule". Since a drug consists entirely of molecules, your claim doesn't make semantic sense.
I'll address this for you. When people refer to something as addictive, they either mean a psychologically habit forming activity (psychological addiction) or a substance that causes withdrawal symptoms when the body abruptly stops receiving it (physical addiction).
Most of US drug policy, in particular the Controlled Substances Act, is designed to curb the abuse of recreational drugs. Does this sound like its addressing psychological addiction or physical addiction? Keep in mind that not only tobacco, but also alcohol, the only recreational drug those withdrawal symptoms are lethal, are deferred to other policies in the Controlled Substances Act.
So clearly, the statement "addiction has nothing to do with the molecule" is referring to psychological addiction. You assert this statement is false. You are saying that psychological addiction is directly related to the composition of the elements used in the addictive activity. To be consistent with this logic, you must also reject the following claims:
"gambling addiction has nothing to do with decks of playing cards"
"video game addiction has nothing to do with executable code"
"sex addiction has nothing to do with penises or vaginas"
Surely you must realize that the majority of people who try physically addictive substances do not end up addicted. It does not make sense to say the chemicals involved cause the addiction.
Acetaminophen is not an NSAID and your claim that there is a "government campaign to poison the elderly and chronic pain patients" is laughably absurd.
It's considered an NSAID for the purposes of tracking drug-related mortality even though it's not really an anti-inflammatory. To quote Wikipedia:
"It is classified as a nonsteroidal anti-inflammatory drug (NSAID) by some sources,[12] and not as an NSAID by others,[13] while most sources implicitly distinguish them, for example by mentioning both NSAIDs and paracetamol in the same sentence.[14][15]"
He mentions denatured alcohol which has been around for a century and includes chemicals to make it toxic or foul tasting.
He doesn't mention that during prohibition, the government attempted to discourage the redistilling of industrial alcohol by adding poison or upping the concentration of toxic denaturing chemicals, killing thousands of Americans.
Edit: I'm not sure what the entire story is. It seems as though 10% methanol is standard for denatured alcohol. Not sure if that was the case before prohibition.
> "Denatured" implies there has been some chemical alteration of the alcohol, but in fact it is just intentionally contaminated with toxic solvents like methanol or acetone.
That's not true anymore, at least in Poland and probably other eastern European (heavy drinking) countries. Due to denaturate usage by very poor alcoholics (they drink it through a slice of bread to filter the taste-altering substances), it's no longer intoxinated with deadly liquids.
So it seems our alcohol regulators understood the issue described in the article many years before.
Other way around here in Finland: in mid-90s, on joining the EU, their free market regulations dictated lethal denaturation agents could no longer be banned by national regulations, and deaths of destitute alcoholics spiked.
Sad to see an HN thread full of conspiracy theories and so little actual science.
Believe it or not, acetaminophen is an effective analgesic, and combined with hydrocodone it provides synergistic pain relief without any increase in side effects over the use of either agent alone. Here's a peer-reviewed 1980 study from the UK showing just that:
Private drug companies didn't pursue testing & selling hydrocodone/APAP in combined form because the government hates drug users. They did so because they can market a highly potent form of pain control. Not everything in life is a government conspiracy!
The linked study backs what was said in the article. The addition of acetaminophen provides little to hydrocodone.
The side effects in this study are short term, with 1000mg of APAP. I don't think anyone is too upset about a single dose like that. However, taking it repeatedly throughout the day, or over extended periods of time, the APAP does cause liver damage. Hence the FDA review and possible ban on certain combinations.
However, the drug scheduling laws are real. Hydrocodone by itself is Schedule II, whereas hydrocodone with APAP is Schedule III. What other explanation is there for classifying the same drug in combo as a lower risk, other than that there's a damaging part to it?
Acetaminophen is effective. Most professional guidelines on analgesia recommend the use of acetaminophen in addition to opioid analgesia.
The useful and perhaps unique thing about acetaminophen among pain killers is that it is well tolerated. Almost everybody from little kids to the very elderly can down acetaminophen without too many problems. This is certainly not the case with opioids. Dizziness, lightheadedness, feeling spaced out, nausea, vomiting, constipation, allergic reactions are not uncommon with these compounds, not to mention variability in effectiveness.
It is true that the majority of acetaminophen overdoses are accidental, which suggests that there is a major problem with how we distribute and use this drug. However most health professionals would take issue with describing it as a hepatotoxin. The large number of ER visits etc reflects the widespread use and easy availability of paracetamol. For example, where I work, there are at least as many presentations due to alcohol abuse (which is also available 'over the counter') as there are for paracetamol.
The funny thing about the article that triggered this thread is that your well-educated person with post-op pain is probably the ideal group to be using acetaminophen and opioid combinations.
http://www.ncbi.nlm.nih.gov/pubmed/19588335
"AUTHORS' CONCLUSIONS: Single dose oxycodone is an effective analgesic in acute postoperative pain at doses over 5 mg; oxycodone is two to three times stronger than codeine. Efficacy increases when combined with paracetamol. Oxycodone 10 mg plus paracetamol 650 mg provides good analgesia to half of those treated, comparable to commonly used non-steroidal anti-inflammatory drugs, with the benefit of longer duration of action."
"http://www.ncbi.nlm.nih.gov/pubmed/20393966
AUTHORS' CONCLUSIONS: Single dose codeine 60 mg provides good analgesia to few individuals, and does not compare favourably with commonly used alternatives such as paracetamol, NSAIDs and their combinations with codeine, especially after dental surgery; the large difference between dental and other surgery was unexpected. Higher doses were not evaluated."
Nobody is saying acetaminophen is ineffective, just that it's effects come with hepatotoxicity. A larger dosage of hydrocodone could have the same net analgesic effect without the huge negative effects.
Actually, the linked article is saying exactly that:
"I remember being annoyed that in order to get narcotic pain relief I was being forced to take a hepatotoxin that added little to the pain relieving efficacy of the opiate."
It's not like he did an n=1 study. He just assumed it wasn't going to work for him. My impression of the article, given that it doesn't really bring up data beyond the total number of acetaminophen-related cases of liver toxicity, is that the author believes he should be able to buy the drugs separately, and is denied this opportunity by the government. After that, he says everything he can to support his beliefs, and pooh-poohs arguments against it.
Oxycodone is a very good opioid and, if you aren't abusing it, it is affordable for most people, even if you don't have insurance (http://www.rxassist.org/Search/Prog_Details.cfm?program_Id=1...). But if you need it every day to support your habit, it's too expensive, so vicodin and its friends are the drugs of choice.
Warning: hydrocodone was well-tolerated by me, however I believe I incurred a small amount of ptosis (eyelid droop) as a result. If you take it, be on the lookout for the side effects.
Maybe I'm just in a strange mood, but that is one of the most bizzare statements (with context) that I've ever heard. It's like something directly out of George Orwell.
"Party officials recently voted to approve a measure that would decrease the amount of poison included in medicine."
ahem
"New techniques developed by party scientists have caused medicinal purities to reach an all time high!"
"Your weekly chocolate rations have been increased from 100 grams to 80 grams."
It's actually even more accurate than you might think, because APAP works by acting on the endocannabinoid system. Essentially acetaminophen works exactly the same as weed, the only difference between tylenol and weed is that one kills several thousand Americans per year and the other kills zero. Well actually there is one more difference: weed actually works amazingly well as an analgesic, whereas tylenol doesn't do anything. (Except kill people.)
Your statements about weed are very likely exaggerated in one direction, while the statements about acetaminophen are exaggerated in another. The cited journal article does not give full backup to the statements in your post.
"Paracetamol also modulates the endogenous cannabinoid system.[44] Paracetamol is metabolized to AM404, a compound with several actions; most importantly, it inhibits the uptake of the endogenous cannabinoid/vanilloid anandamide by neurons. Anandamide uptake would result in the activation of the main pain receptor (nociceptor) of the body, the TRPV1 (older name: vanilloid receptor). Furthermore, AM404 inhibits sodium channels, as do the anesthetics lidocaine and procaine.[45] Either of these actions by themselves has been shown to reduce pain, and are a possible mechanism for paracetamol. However, it has been demonstrated that, after blocking cannabinoid receptors with synthetic antagonists, paracetamol's analgesic effects are prevented, suggesting its pain-relieving action involves activation of the endogenous cannabinoid system.[46]"
And as I have posted before, marijuana is an anxiolytic, anti-inflammatory, anti-angiogenic, anti-viral, antibacterial, neuroprotective, and pro-neurogenesis. It's down the most important of any drug there is. Plus it increases your IQ by an average of 6 points, decreases your diabetes risk by 66%, and can be used to treat everything from Parkinson's to cancer. There is even some research suggesting that up to 50% of all infant mortality may be the result of marijuana deficiency.
> There is even some research suggesting that up to 50% of all infant mortality may be the result of marijuana deficiency.
I was going to ask what you're smoking, but then I realized that was a dumb question. :-)
I'm all for using pot for medicinal (and recreational) uses, but I think you've crossed the line from advocacy to cheerleading. Believe me when I say that if pot did all of the things you claim, I'd be in perfect health.
"Believe me when I say that if pot did all of the things you claim..."
Reality has a well known liberal bias.
"...I'd be in perfect health."
You get different benefits depending the quantity and method of consumption, so if you're just using it recreationally you're not going to see most (or any) of those benefits.
Citing Wikipedia for medical information on pot makes clear what kind of research process is necessary to conclude that pot is beneficial, which is not the conclusion of most people who have done the most careful research. (I'm a wikipedian, and I'm painfully aware of the research standards on the free encyclopedia that anyone can edit.)
I never cited Wikipedia on pot, I cited the Wikipedia summary of the research on tylenol-- after already linking to the most important of the original journal articles.
I also never claimed that smoking an ounce a week recreationally is a great idea, all I claimed was that you can potentially receive the benefits listed if you're using the proper dosage and method of ingestion.
What I did do however was to link to several hundred pages of academic journal articles about the medical properties and health effects of cannabis. So I don't see how you can believe that "people who study the issue carefully have come to the opposite conclusion" or whatever.
A bit like shooting someone who is attempting suicide. Prohibition v. 2 has proven to be just as disastrous as v. 1, when will there finally be enough political momentum behind ending it?
>...when will there finally be enough political momentum behind ending it?
I keep thinking next year... next year... but the reality is as people get older and have kids they start to view any sort of recreational drug as a threat to little Johnny. So that pot-head you knew in college? He's voting against every attempt to soften drug laws.
So total aside, inspired by the mention of denatured alcohol. How come you can buy bitters, which are up to 50% alcohol (i.e. 100 proof), without having to be of legal age?
During prohibition, certain bitters were legal because they were considered "nonpotable". Angostura falls under this category, whereas something like Campari or Fernet Branca would be considered potable. Basically they didn't think anyone would be able to drink enough to get drunk from it. I assume a similar logic applies today.
I tried to buy bitters at 4 am the other day and they wouldn't let me due to the alcohol content. Pretty stupid, since getting intoxicated from bitters would be about as much fun as drinking cooking wine.
So you can strip the lining in your stomach and intestinal track instead of blowing your liver. The article is correct: there is no value in adding anything to the hydrocodone and many possible down-sides.
In a hundred years from now. People will look back at the war on drugs and what else it's called in the various countries as a primitive and barbaric method.
You are aware that it is over 100 years now from the beginning of the war on recreative drug use? IIRC, the first restrictions were put in effect in the US in 1906.
Gah! I shared my concern with APAP with me doctor and she prescribed Norco which has a higher hydrocodone to APAP ratio. Not sure it's still Schedule III in the USA, but if so, there ARE alternatives which Gregory House (who should be dead by now) and those concerned with liver failure deaths should know about.
> Does anyone think cannabis is deadlier than Jim Beam?
I think the vast majority of the population of America thinks that, which is why cannabis is much more highly regulated. What he should have said was, "cannabis is less deadly than Jim Bean", and provided the evidence to back it up.
Not just opiates, cough syrup (with dextromethorphan) too. It's very dangerous for kids who heard of Robotripping but haven't had resources/time to learn that while DXM overdose will make you trip, acetaminophen overdose will slowly and painfully kill you.
