When thinking of drug risks, people often think about the opioid crisis. Many people believe that over-the-counter (OTC) medications are safe for use, and they can be, as long as people carefully follow the instructions on the bottle. However, following the instructions can be hard, and overdose with OTC medications is common. The most dangerous of the OTC medications is acetaminophen (sold under the brand name Tylenol as well as generics), the leading cause of acute liver failure in the US.
Now a new liver transplant controversy in Canada has renewed calls for tighter control on this pain medication. Whether or not these controls ever come to pass, this is a reminder that, whenever possible, drug free pain relief should be preferred.
Controversial Policy Highlights Harms
The controversy began when Inuk activist Delilah Saunders went to an Ottawa hospital where she was diagnosed with acute liver failure. She was told that she would need a liver transplant, then she was reportedly told that she wouldn’t be placed on the list to receive one. That’s because she had a history of alcohol use in the previous six months, even though her acute liver failure was caused by acetaminophen, which she had been taking to control jaw pain.
Although Saunders has since recovered, the disparity between her rejection and the reason for her injury has caused many people in Canada to call for tighter controls of acetaminophen, or, at least, better education on the harms associated with the drug.
How Serious Is the Problem?
Many people may wonder whether this is a problem that really needs to be addressed. Any drug has a potential risk for overdose. The fact that some of these people overdose on acetaminophen may not require any additional attention.
However, one big difference is the sheer scale of the problem, which, admittedly, nobody knows for sure. Acetaminophen likely accounts for between 30,000 and 100,000 emergency room visits a year in the US. It accounts for about half of all cases of overdose-related acute liver failure, and 20% of people needing a liver transplant. That’s a high proportion for something that is supposed to be a “safe” drug.
Some steps have already been taken to try to counter the risk. One is to limit the dosage of acetaminophen used in prescription medications that may accidentally be taken with OTC painkillers. Another is to clearly label when prescription medications contain acetaminophen. We don’t know the extent to which these steps may have helped control the problem.
This also neglects the number of serious complications and deaths that come from other acetaminophen side effects like Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), as well as pregnancy complications and other risks. .
Reduce Your Dependence on Pain Drugs
Although this issue highlights the risks associated with acetaminophen, it should be noted that other OTC medications including ibuprofen also have serious risks. Since all these drugs come with risks, it may be best to focus on reducing your dependence on them altogether.