DrugBuyers.Com: The Scourge of APAP

I came across this in a news group archive, and even though I realize that most DB members are already aware of this, I found it so intriguing that I couldn't resist posting it.

Newsgroups: sci.med
Subject: Re: Fiorinal/Fioricet
Date: 28 Jan 1998 20:29:49 GMT

In writes:

Does anyone know why Fioricet is non-controlled whereas Fiorinal is a scheduled drug? I know the only difference between them is Fioricet contains APAP and Fiorinal contains ASA. I've discussed this with other pharmacists with no specific answer given. I was asked this question by a nurse practicioner the other day and was unable to answer so would appreciate your help. Thanks in advance.
>
> R.Dyer, RPh

The cruel reason is that the FDA uses APAP for narcotics (including barbiturates) in much the same way methanol is used for ethanol. To wit: as a toxic "denaturation" agent to make sure you don't, or can't, take too much before your liver rots or your kidneys quit. The APAP therefore makes the difference between a lot of schedule II and III drugs. FDA's reasoning is that these drugs *can't* be greatly abused for very long, or the user will be dead or disabled, which is a perfectly fine outcome in the war on drugs (see "war on people"). Now, if you accused the FDA of this deliberate policity, it would deny it, since of course there are an awful lot of former Darvon abusers on chronic renal dialysis. But that's the way it is.

Steve Harris, M.D.

Here's my question and comment on this... can it possibly be that the government agencies who decide how medications are formulated are so utterly cynical? Do they so thoroughly despise those who would abuse (or simply overuse) or in many cases, those who might actually REQUIRE long-term pain management with narcotic pain medications, who are unable to "qualify" in the opinions of their doctors for stronger medications with only one active ingredient like OxyContin, that they consider them to be worthy of death?

As I said I think most people who use this board are aware that heavy, long-term use of medications like Lortab and Norco which contain apap (acetaminophen) can damage vital organs, especially the liver. However, there may be some who aren't aware of it, and I think it is a good idea to occasionally raise the subject to make sure that anyone who doesn't know, who may like to know, becomes informed about it.

The fact is that 3 grams or more of apap per day (less in some cases) can be dangerous, and very importantly, the longer the period of time it is used, the more the risk increases. There are supplements that can reduce the danger, and which can even act to reverse the damage. Here are the ones I know of, more information about them can be found on the internet.

S-adenosylmethionine (Sam-e): This supplement has strong liver-protective properties, and reportedly can even promote regeneration of dead cells.

N Acetyl L-cysteine (NAC): Precursor to the primary enzyme produced by the liver used in metabolism of apap. Low levels of this enzyme results in toxicity.

Milk Thistle (silymarin): Effective liver cleansing herbal supplement.

I once lived next door to a lady with liver disease who was on the transplant list. Getting up off the couch and walking across the room was a full day's supply of energy for her. I moved before she got her transplant, so I don't know if she got it. The point is that liver damage is nothing to fool around with. I realize that many people simply don't want to know or be reminded of this problem, and won't appreciate being reminded... many of us simply have no recourse, and are stuck with accepting the risk of high levels of apap. I profoundly sympathize, and in no way intended to cause anxiety. If you are concerned, just take a little time to check into the supplements, I have heard from reliable sources that they can make a huge difference.

Attention needs to be given to the rules requiring that opiate medications like hydrocodone have secondary active ingredients added. Cases of the damage resulting from this practice need to be called to the attention of government agencies, and changes need to be made, like making 10/80 or at least 10/160 sizes to be made available. They finally got around to making 10/325 hydro and percocet, perhaps they will eventually go a step or two further.

Note: Do not consume alcohol in any amount while you have apap in your system, it produces a toxic chemical that kills liver cells. This has been known for years, but this warning was only recently added to apap product labels.

Here is some text from the kind of legal statute they use to require this (adding extra ingredients to pain medications):

"if the ingredients are included therein in such combinations, quantity, proportion, or concentration that vitiate the potential for abuse of the substances which have a stimulant or depressant effect on the central nervous system."

Vitiate:
1 : to make faulty or defective
2 : to debase in moral or aesthetic status
3 : to make ineffective