Acetaminophen turns up everywhere, in anything that bears any relation to making somebody feel better. It gets mixed into cough medicine, cold medicine, tranquilizers, migraine meds, and prescription painkillers. Sometime around thirty years ago, it suddenly replaced aspirin everywhere except in doctor jokes. This happened for several different reasons.
One was that the patent on aspirin had long since run out. So anybody could use it for anything. As a result, those who manufactured it couldn’t charge outrageous sums for it.
Another was that aspirin did, and does, have side effects. Most of them have to do with bleeding, especially in the digestive tract. People with ulcers are especially at risk from aspirin. And then, in 1963, aspirin turned out to be connected, in ways that are still mysterious, with Reye’s Syndrome, a sometimes fatal illness that attacks children and adolescents. So there are good medical reasons not to recommend aspirin for children and ulcer patients.
But the most significant reason for mixing acetaminophen with prescription painkillers has nothing to do with improving the effect of those medications, or avoiding the side effects of aspirin. Rather, it is added to legal oral medications so that turning them into illegal injected drugs will be difficult or impossible.
Now, the health care industry is starting to worry about acetaminophen. It too has side effects. In excessive doses, or in combination with even a small amount of alcohol, it can seriously or even fatally damage the liver. And since it turns up in so many medications, accidental overdoses can be tragically easy. Some experts advocate putting conspicuous labels on any medication that contains acetaminophen, and large-print warnings against overdosing. Others recommend simply eliminating it from any mixture to which it does not actually contribute anything useful. No doubt adding it to oxycontin or codeine was not originally intended to make those drugs more dangerous, but ultimately it does have that effect (rather like adding various poisonous substances to rubbing alcohol to keep it from being sold as a beverage without payment of the liquor tax..)
Mr. Wired suggests, if the pharmaceutical industry really wants to keep addicts from shooting up oxycontin or codeine from tablets, they could just as easily mix fiber into them—psyllium or whatever they use for Metamucil. Not only would it make the tablet uninjectable, it would also serve to counteract the constipating effect of many opiates. A whole new marketing gimmick, and one that would actually be useful to the patient.
The underlying question remains, however. The War on Drugs makes it a lot harder for real patients with real medical needs to get analgesics without risks to their health than for addicts to get their daily fix. Somehow I suspect that this is not what Hippocrates had in mind.