“If you keep track of what you’re taking, none of this is an issue for you”

An FDA panel’s recommendation to withdraw Vicodin, Percocet, and other opioid-plus-acetaminophen painkillers seems calculated to “sacrifice the interests of consumers who follow instructions for the sake of consumers who don’t”, says Jacob Sullum. ER blog Crass-Pollination has some thoughts as well.

11 Comments

  • The real question in my mind is why multi-ingredient painkillers were ever allowed by the FDA to begin with. Presumably a pharmaceutical company went to the agency and said, in effect, “We want to combine an ingredient which can cause fatal liver damage in the same pill as a highly addictive drug which people will want to take in escalating doses. Got a problem with that?”

    A sane response might have been, “Are you out of your minds?”

    But for inexplicable reasons no one saw a problem. Which just demonstrates the uselessness of “FDA approval,” and the general risk of trusting a paternal government entity to “know what’s best.”

  • Charles

    The reason for combining things in one medication is convenience. Duh. Like as in I don’t feel like taking five pills when i can take one.

    As for the FDA’s position, the answer is greater personal responsibility. Sheesh. i am sick of this attitude that the world has to be “child proofed” because a few idiots can’t follow simple instructions.

    But i might add that maybe we should simplify the instructions too, which of course means we need to get control of our out of control tort system that makes endless instructions necessary.

  • One of the reasons that acetominophen is combined with the narcotic is potentiation of the pain relief without needing to increase the dose of the narcotic. These medication were designed for short term relief especially after surgery where the combined medications were more effective than either alone. This is why acetominophen is used instead of ibruprophen. (Ibuprophen increases bleeding post-operatively). The problem now is that so many people are taking narcotic pain medication chronically. So in true government fashion, rather than tackle the main issue of narcotic overuse and addiction, they are choosing to go after the medication.

  • therockmorton

    i believe you have that backwards when i give blood they tell me to take ibprophen and avoid acetominophen cause acetominophen is the blood thinner fyi not trying o be rude

  • Acetaminophen doesn’t inhibit clotting, but ibuprofen does (aspirin even more). A Mayo Clinic article on blood donation recommends against taking aspirin or ibuprofen for 24 after donating.

    I wonder if banning narcotic/acetaminophen combos will paradoxically lead to overdoses in some situations, once patients start trying to juggle unknown quantities of pills?

  • Acetylsalicylic acid (aspirin) works to reduce the stickiness of platelets in the blood, this reduces clotting. Ibprophen blocks this mechanism for several hours after it is taken. Acetominophen does not affect the clotting process.

    The whys and whereforeto’s of combining drugs are fairly obvious, certain drugs interact with each other to increase the effectiveness of one or both, combining two or more ingredients into one pill controls the process, too much of one may actually reverse the process, etc., etc., etc.

    For all their faults, and there are many, in this case one regulatory agency (FDA) is far superior to 50 (one for each state). PERIOD. The only party to benefit from the latter are the trial lawyers.

    For all of our “can’t we just get along” human bodies are in many ways an experiment of one. I may have an adverse reaction to a drug that saves your life. Should you be allowed to die, because I am one of a million with with a bad reaction. A big dose of common sense is sometimes needed to navigate through life toward the eventual demise in spite of all our advances in the medical arts and science.

  • Mr. Platt, I kindly recommend you rethink your point. Consider the following:
    How wise is it to combine a highly flammable liquid with a two thousand pound projectile and allow a sixteen year old to guide it down the street at up to fifty five miles per hour a mere six feet away from another projectile going precisely in the opposite direction? Presumably this might be insane, as well?

  • A lot of our docs over-prescribe narcotics for everything from bumps and bruises to twisted ankles to chronic back problems to carpal tunnel syndrome. You name the issue (contrived issues included), someone is taking a narcotic for it c/o our docs. Doctors who already don’t really know the appropriate use of narcotics will most certainly start prescribing higher and higher doses of narcotic since they are not artificially limited by the Tylenol content. You’re taking 8 Hydrocodones/day and that’s not working? Well, just take 14, not working? Well, 16! And so on and so forth.

    The prescription pill addiction issue is huge, and this, if approved, will certainly prevent some unintentional liver damage from taking the pills recreationally, but it will also cause far more addiction and dependence.

  • Tylenol has been on the market for decades. When ill effects are spotted after so much use they result more likely as the dregs of data mining or statistical noise.

    I fear that the “Naderites” and crazed environmentalists have overtaken our agencies. These people will quote all kinds of studies and conclude that air valves in bicycles are a public health menace. They fight logging knowing full well that the inventory of dead trees (pine beetle) are going to burn in wild fires. They are the American version of the Taliban

  • “Tylenol has been on the market for decades. When ill effects are spotted after so much use they result more likely as the dregs of data mining or statistical noise.”

    I’m not in favor of banning much of anything least of all valuable pain killers that can be used responsibly but the relationship between acetaminophen and hepatotoxicity has been known for decades and acetaminophen overdose has long been a leading cause (if not the number one cause) of acute liver failure.

  • In the spirit of July 4th, high-powered explosive commercial celebratory devices have been available for some time now (with warnings in English, Chinese, and most recently Spanish). You throw the “M-whatever” after lighting it – holding on to it makes for a bad ABC After School Special. You read the warning, and from that point forward, you’re on your own (just like little white hang-over pills).