Hacker News Reader

Comment by dionidium | Hacker News Reader

Let's not forget about the shameful inclusion of acetaminophen (at least partially, explicitly) as a harmful deterrent against opioid abuse. Serial abusers mostly know about this (and have strategies to mitigate it), but kids popping their mom's Percocet with a Bud Light have no idea how harmful that combintaion is. That it's unnecessarily, intentionally harmful is, again, shameful policy.

http://healthland.time.com/2011/01/13/fda-cuts-acetaminophen...

View on HN

That's one of my pet peeves too. In the UK, the sales of paracetamol/acetaminophen was a few years ago restricted - pharmacies can only sell 32 pills at the time; other stores can only sell 16 at a time. This was done to cut the number of (accidental or intentional) overdoses, and is credited with having saved hundreds of lives despite obviously being trivial to "work around" by going to multiple stores.

So it is government policy here to consider paracetamol a dangerous, lethal drug. It's far easier to seriously harm yourself with than codeine. But of course, codeine is far more likely to lead to addiction.

That they then considered it a good idea to - when legalising the sale of painkillers that includes codeine - require mixing the highly addictive but relatively safe drug with ones that are far more lethal at low doses (paracetamol or ibuprofen) says everything about how drug policy is set based a core view based on seeing drug addicts as immoral, and drug abuse as an evil in itself where it's apparently ok to harm the addicts or let them die if it reduces addiction.

You're right. It's shameful.

This was done on purpose? I have seen paracetamol/tramadol combinations to get a synergistic effect (not sure that it works though). But what is the rationale here? "You got an addiction problem, so we're going to fuck your liver while we're at it" ?

Paracetamol/acetaminophen does appear to have synergistic effect with codeine as far as I'm aware, and the combination is often prescribed for severe pain (the prescription-only variation - at least in the UK - has a far higher codeine to paracetamol ratio), but the requirement that they are combined is clearly to deter abuse of the codeine.

The irony is that paracetamol overdoses are far harder to treat and far more likely to lead to death or severe long term damage than opioid overdoses...

In the UK, codeine on it's own is still a controlled substance to the point where if you extracted the codeine from a single pill (possibly two, not sure of the exact limit) of the combination products, possession ould get you arrested, while you can go and buy packets with a total of 64 pills (32 each of ibuprofen and paracetamol combined with codeine) at the time from your local pharmacy no questions asked.

Basically there seems to be a bizarre belief that addicts will act as rational actors when faced with the knowledge of this mix, despite the fact that most other drug policy is based on the assumption that drug users - addicts or not - are incapable of making decisions about harm on their own.

This becomes even more bizarre in places like the UK, where there have been restrictions on the number of paracetamol pills that can be sold per transaction because of the amount of harm caused by accidental or intentional paracetamol overdoses.

Reply on news.ycombinator.com