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Comment by tsimionescu | Hacker News Reader

It's not true, as "dangerous" doesn't mean what you seem to think it means. Just because Tylenol (acetaminophen) is highly toxic in actually quite small doses doesn't make it as dangerous as vicodin or morphine or heroin or meth or fentanyl.

A drug is dangerous when it is toxic at an easily obtainable dose AND there is a clear incentive for people to consume it in that dose, such as addiction and tolerance. While acetaminophen is unusually toxic at doses only slightly higher than regular treatment doses, there is actually very little that compels people to use those doses, and acetaminophen toxicity is not an epidemic-level health problem the way many other drugs have become.

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Acetaminophen overdose does actually have a surprisingly high rate of occurrence. A lot of people don’t realize how narrow the therapeutic band is.

Doubling your meds on a bad pain day can put you way beyond the safe limits. People think it’s safe because basically every other OTC has a huge therapeutic band, and double dosing is not recommended but not really dangerous.

CDC estimates it at 56,000 ER visits a year, 26,000 hospitalizations, 458 deaths, about a hundred unintentional deaths per year. As a point of reference, it’s about 3 accidental overdose deaths per child that dies from being locked in a hot car.

This sounds like a rationalisation to me. People take Tylenol for pain. If they're still in pain, they take more of it. Tylenol doesn't mitigate all types of pain so people might think they need more. This happens, and then they die. It happens surprisingly infrequently considering how abnormally dangerous the drug is, but it still happens.

Tylenol only works for relatively low levels of pain, which tends to be relatively short term. So abuse is not very common, and even with chronic pain, Tylenol overdosing kills quite quickly, it doesn't have time to become a habit that takes down entire families together with the chronic pain sufferer.

Either way, we don't have to assume, we can directly check the numbers. Per another commenter, Tylenol kills about 458 people in the USA every year. In contrast, death from overdose on illegal stimulants was estimated at ~33.000 people in the USA.

Now, is it fair to say that Tylenol is more dangerous than marijuana? Of course. But to say it's more dangerous than most illegal drugs? Obviously not.

I am not a physician, though I have a Masters in Biomedical Science and was a paramedic for 14 years.

I have a very difficult time taking an argument plausibly that compares Tylenol (acetaminophen, an antipyretic analgesic) to illegal stimulant use (immediately following a discussion on fentanyl, which is an opioid - about as close to opposite a stimulant as possible) - i.e. generally amphetamines.

Or comparing Tylenol to marijuana in a very apples and oranges comparison - Tylenol's dangers come from very direct hepatotoxicity (i.e. liver damage), versus marijuana's most real risks coming from impairment and intoxication (driving, judgment, panic) and their effects than toxicity of the drug itself.

It's all mixing and matching in a way that doesn't make for a sensical argument.

I was responding to someone who said Tylenol was more dangerous than "most illegal drugs". Since the only danger of Tylenol is death from overdose, I searched for some data on deaths from Tylenol overdose and deaths from illegal drugs - and happened to find data for deaths from "illegal stimulants" grouped together - so used that.

Of course, most illegal drugs, even very light ones like marijuana, have other risks, like DUI or the general ills of addiction (money issues, increased criminality from the desperation of getting another hit, etc). But even ignoring those, I thought the death numbers make it very clear that Tylenol is nowhere near "less dangerous than most illegal drugs".

I wonder what the death rate on those other stimulants would be if they were issued the same way, in regulated pharmacy stores.

I know that a lot of illegal drug overdoses are caused by people who thought they were taking a normal dose but got the wrong substance, wrong amount or wrong concentration from their dealer - who in many cases also didn't know about the discrepancy because of unreliable supply chains and difficulty of testing, both caused by illegality.

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