Typically, if a drug produces any kind of recreational effect, then it has potential for abuse and can be addictive. This is also true of drugs that don’t produce any euphoric effects and serve to assist with a psychological or physical problem. But what about acetaminophen, which is also known as paracetamol? Is acetaminophen addiction real and if so, how big of a problem is it?
Is Acetaminophen Addictive?
This is a contentious issue. What we can say for sure is that paracetamol addiction doesn’t exist in the same way that heroin addiction and cocaine addiction does. In other words, it is not going to produce debilitating withdrawal symptoms that cause the user to relapse in order to avoid “dope sickness”. However, there is a certain element of psychological addiction associated with acetaminophen.
It is possible to become reliant on something that has a positive effect on your body. If you take something everyday that helps to cure you of a particular ailment, in this case mild to moderate pain, then you can become reliant on the instant pain relief that it provides. Take it away and you’re left to deal with that pain on your own, which can potentially produce feelings of dependence, at least theoretically.
Acetaminophen Addiction Because of Codeine
When people talk about acetaminophen addiction or paracetamol addiction, they are typically referring to over-the-counter medications that contain opioids as well as acetaminophen/paracetamol. The user may not realize that they are addicted to the opioid as opposed to the acetaminophen, either because they are not sure what the opioid is or don’t realize that the dose is at high enough levels to cause dependance.
In the US and the UK, it is possible to get fairly high levels of opioids in acetaminophen containing medications. Opioid addicts are known to buy these in large quantities and use an extraction method that removes the acetaminophen and leaves the opioid, but there are also users who risk taking the tablets without an extraction, getting a stronger dose of the opioid but also getting a dangerous amount of acetaminophen in the process.
For instance, drugs like Co-Codamol, an OTC pain killer in the UK, contains 8mg of codeine and 500mg of paracetamol per tablet. If you were to be prescribed codeine itself as a painkiller the dose would range from 15mg to 60mg, which would equate to between 1,000mg and 4,000mg of paracetamol. This mean that at the lowest dose you are giving yourself the maximum recommend dose of paracetamol and at the highest dose you are essentially taking an overdose that could seriously harm your health.
There are similar preparations in the US, but because of the opioid epidemic in the US, OTC drugs like this are not as readily available. Conversely, it is much easier for users to acquire actual preparations of pure, strong opioids on the street and through their doctor, negating the need to take such extreme risks.
There should be no withdrawal symptoms from paracetamol. However, if someone has been using it for a long time and suddenly stops, then there might be some rebound issues. The main issue will be a return to the symptoms that they took acetaminophen to eliminate in the first place. This is likely going to be some kind of pain, such as a headache or skeletal pain.
If they have been abusing the drug then they may also suffer side effects associated with a damaged liver. In any case, anyone who has become reliant on the drug for whatever reason should consult with their physician before they take any further steps. If you are concerned about the health implications of excessive paracetamol use then let them know and they should be able to find an alternative medication for you. Of course, NSAIDS and opiates have a long list of side effects and other concerns as well—it’s all about weighing up risk vs reward and determining the best possible solution.
Is Acetaminophen Safer Than Opiates?
Yes and no. This is not an easy question to answer and in truth it all depends on who you ask. If you run this question by an official medical authority then they will answer in the affirmative, but only because acetaminophen has no potential for abuse or addiction, whereas opiates do. However, if you take addiction and abuse out of the equation and look at these drugs in small doses for occasional use, the potential liver damage that acetaminophen can cause makes it considerably more dangerous than opiates.
This is why many countries are now recommending a maximum dose of 500mg as opposed to 1,000mg and why the opinions of medical professionals the world over are changing drastically from standpoints of “acetaminophen is perfectly safe” to “acetaminophen may cause serious, unrealized harm even with therapeutic doses”.
The Dangers of Acetaminophen
The main issue with Acetaminophen is the liver toxicity, which can occur in surprisingly low doses. In fact, it has been said that even someone who is consuming therapeutic doses on a regular basis can be gradually doing serious harm to their liver.
The risks increase when large doses are taken and when it is taken with alcohol. There is also an increased risk of liver damage from paracetamol when the user has liver disease or other liver issues.
Should I Stop Taking Acetaminophen?
The short answer is no. The truth is that most drugs have side effects and there is a long list of worrying data out there concerning everything from Valium to valerian. It’s just the way things are and the way our bodies deal with medications. If there is a positive effect then there is likely a negative one as well, because nothing exists to perform a single positive function and the benefits form the drugs are basically happy accidents of nature or science.
You should certainly avoid taking too much acetaminophen and make sure you only take it when you absolutely need it. Never go over the stated dose, do not drink excessively when you take it and don’t overdo it. Some experts recommend taking it every 6 hours instead of 4, some say you should never go more than 2,000mg a day regardless of how much you take, but everyone agrees that anything more than 1,000mg in 4 hours is potentially dangerous.
As a painkiller, there is very little out there that compares to acetaminophen . It works quickly, with few side effects and with no risk of physiological addiction and as well as treating pain, it’s also great at treating fevers. If you have ever had a fever and have taken acetaminophen to cure it, then you will know how much of a life saver it can be.
Paracetamol is here to stay and paracetamol is thankfully not a huge threat or—if some experts to be believed—a threat at all. We all just need to be a little more knowledgeable about the drug and to understand that it’s not the completely harmless medication we all think it is.