Misc How Many Deaths From Acetaminophen Are There A Year, Really?

[SpunkySkunk347]

Felt like this needed to be in the original post:

A main metabolite of acetaminophen is toxic to liver tissue on contact. Any amount of acetaminophen damages the liver.

The liver does have enough enzymes for a few grams of acetaminophen to metabolize it and its toxic metabolite, but after about 3-5 grams this enzyme becomes increasingly occupied in a sense, and the liver 'runs out' of it and has to begin making more.

Anything above 4 grams is causing a more substantial level of damage to the liver.

4 grams a day will kill the liver eventually.

6 grams every day will kill the liver a little more rapidly (a year and a half or so).

8 grams a day will kill the liver in less than a year, even just a few months, and can be a lethal single dose

8 grams at once can be lethal, and is approximately where the bell curve for lethal dose becomes apparent

10 grams a day will kill the liver in just a few months, and even from a single use (now substantially on the bell curve for Lethal Dose)

12 grams is well up on the bell curve for Lethal Dose

14 grams is on the other side of the bell curve for Lethal Dose (14 grams will kill most people who take it)

20 grams at once is almost certain death

These numbers are pretty much what most people have stated the dangerous/lethal doses to be over the years, and staying below them has kept many of us alive.

You SHOULD be doing a Cold Water Extraction if you're going to take large amounts of opioids paired with acetaminophen.

Remember, any large single dose of acetaminophen causes long term damage to the liver (4 grams or more, like someone with a tolerance who takes nine 5 mg hydrocodone 500mg acetaminophen pills to get high, which is 4500mg of acetaminophen).

It takes years, even decades, for the liver to recover from the damage that large doses of acetaminophen do to it, If The Liver Can Even Recover At All

Remember, 4 grams a day is different from 4 grams at once.

Taking 4 grams at once every day will kill the liver a LOT sooner than 4 grams taken over the course of each day.

The first number that turns up on google is a lie (the top link, you know, the paid for one); it says something like 300, but I distinctly remember a number around 40,000 annually when I first heavily researched the topic in the mid 2000s

So either A) people started reading about the dangers of acetaminophen online, all started doing cold water extractions, and quit dying from it.

Or B) there is a massive cover up ongoing that might have something to do with liver availability and black market donor lists for non-donors having their organs donated anyways.

The LD50 for humans is somewhere around 12-14 grams; 20 grams is pretty much guaranteed death... 12 grams is certainly well on the bell curve, and 20 grams is certainly past the top of it and on the other side of the bell curve.

That's one bottle. One effing bottle. One bottle of thirty to sixty 5/500s taken over a friday night and a saturday morning, or a bottle or two of cough syrup.

Then consider that there's enough opiates and opioids imported into the country legitimately for every man, woman, and child to be able to be on a standard dose of opioid/opiate pain medication all hours of the day. So statistically, we're either all opiate/opioid users or 1 out of 8 people is taking 8 times the amount they're supposed to.

And there are new users every day.

One statistic doesn't make sense: there are ~40,000 deaths from liver failure per year, yet only ~8,000 transplants performed. Why? Those are relatively small numbers, and with 2.8 million deaths per year, there should be no shortage. This suggests that transplant numbers are covered up due to the 'non-donor' phenomenon, where people who don't list donor on their license have their organs donated anyways, leading to fake numbers for anything connected with the issue.

According to numerous links on google, "Acetaminophen overdose is the leading cause of acute liver failure."

Given the sheer metric tonnage of opiates and opioids consumed annually I'd place the actual number of acetaminophen overdoses as somewhere in the hundreds of thousands. Of these, probably 60% are treated with antidote relatively early, and roughly 35% include things like chronic overdosing and require transplant, which has a mortality rate of something like more than 10% - giving us an estimate for deaths with a failed transplant at 3,500-10,000 already. Add in a few hundred who never made it to the hospital, another few hundred who although they made it to the hospital their condition went untreated (no antidote and no liver waiting list), and then tens of thousands (give or take) who die before a new liver can arrive and be transplanted.

Even with the numbers that DO exist, 40,000 deaths from acute liver failure a year and acetaminophen being the leading cause of it suggest a number far greater than just a few hundred.

Unbelievable the amount of cover-ups.. where do they even stop?

 

[Jabberwocky]

A.P.A.P


A.Possible.Astronomic.Percent

 

[ChemicallyEnhanced]

The first number that turns up on google is a lie (the top link, you know, the paid for one); it says something like 300, but I distinctly remember a number around 40,000 annually when I first heavily researched the topic in the mid 2000s

So either A) people started reading about the dangers of acetaminophen online, all started doing cold water extractions, and quit dying from it.

Or B) there is a massive cover up ongoing that might have something to do with liver availability and black market donor lists for non-donors having their organs donated anyways.

The LD50 for humans is somewhere between 12 and 20 grams... 12 grams is certainly well on the bell curve, and 20 grams is certainly past the top of it and on the other side of the bell curve.

That's one bottle. One effing bottle. One bottle of thirty to sixty 5/500s taken over a friday night and a saturday morning, or a bottle or two of cough syrup.
Then consider that there's enough opiates and opioids imported into the country legitimately for every man, woman, and child to be able to be on a standard dose of opioid/opiate pain medication all hours of the day. So statistically, we're either all opiate/opioid users or 1 out of 8 people is taking 8 times the amount they're supposed to.

And there are new users every day.

One statistic doesn't make sense: there are ~40,000 deaths from liver failure per year, yet only ~8,000 transplants performed. Why? Those are relatively small numbers, and with 2.8 million deaths per year, there should be no shortage. This suggests that transplant numbers are covered up due to the 'non-donor' phenomenon, where people who don't list donor on their license have their organs donated anyways, leading to fake numbers for anything connected with the issue.

According to numerous links on google, "Acetaminophen overdose is the leading cause of acute liver failure."

Given the sheer metric tonnage of opiates and opioids consumed annually I'd place the actual number of acetaminophen overdoses as somewhere in the hundreds of thousands. Of these, probably 60% are treated with antidote relatively early, and roughly 35% include things like chronic overdosing and require transplant, which has a mortality rate of something like more than 10% - giving us an estimate for deaths with a failed transplant at 3,500-10,000 already. Add in a few hundred who never made it to the hospital, another few hundred who although they made it to the hospital their condition went untreated (no antidote and no liver waiting list), and then tens of thousands (give or take) who die before a new liver can arrive and be transplanted.

Even with the numbers that DO exist, 40,000 deaths from acute liver failure a year and acetaminophen being the leading cause of it suggest a number far greater than just a few hundred.

Unbelievable the amount of cover-ups.. where do they even stop?

Not necessarily fatal, but the "toxic" dose of acetaminophen is 20mg/kg body weight.
Which would be 10g for me. I have taken up to 11.5g without ill effects apart from a general malaise the next day.

I think one of the biggest issues is acetaminophen being unnecessarily added to opioids (Vicodin, Co-Codamol, Percocet etc).

 

[Keif' Richards]

I totally understand that this is a matter of curiosity for you OP, but I just want to ask you to follow me for a second. Our first and foremost goal/mission/purpose is to help our peers, that is, adults who have chosen to use drugs recreationally do so in as safe a manner as possible. One of the reasons that we don't just allow any and all threads is because, there are people out there who have questions and concerns that could effect their health and well-being imminently. You see, we only have limited space here. That guy who might be on the verge of death might not be getting the exposure needed because we're discussing something that we're curious about, but doesn't actually effect our well-being.

The thing is, if we're merely trying to operate based upon our proscribed goals and guidelines, we can pretty easily leave this as:

Acetaminophen (Tylenol), a versatile and effective mild analgesic is unfortunately Hepatoxic (toxic to the liver) and for that reason, it's usage should be limited to the lowest possible effective dosage. If one is dealing with combination products a la Percocet/Vicodin/Lortab or what have you, when using higher dosages of the Opioid in question, the Acetaminophen should and can be removed/separated by means of a Cold Water Extraction. Resources regarding how to perform a CWE can be found here on Bluelight and in many other spots.

I feel we can leave this one at that, no?

 

[Xorkoth]

I rather disagree... we don't actually have limited space here, and discussion of the understated dangers of acetaminophen does contribute to harm reduction. People can get the information you stated above from static sources like psychonautwiki and plenty of other places. Part of the point of Bluelight is that we can discuss things with a more fine-toothed comb here. A lot of people are entirely unaware of how toxic acetaminophen really is. It's pushed as a safe pain-killer by its producers but it's not. I think discussing this is harm reduction moreso than a brief blurb about CWE. I mean yes absolutely, we should tell people who are asking, and it should be (and has been) mentioned in this thread, that if you're taking prescription opiate pills, they should be taken via cold water extraction. But there's no reason to stop the discussion there.

 

[ChemicallyEnhanced]

20mg/kg would give a toxic dose of 1g for a 50kg person. So you're saying you weigh 500kg?

Probably look at those numbers again.

Sorry, I meant to say 200mg/kilogram. I weight 50 kilo's, not 500 haha. I could be in the world records with that kinda weight!

 

[ChemicallyEnhanced]

IMO Acetaminophen is completely ineffective for pain - except for pediatric pain - my psych doctor told me he agree's and even my G.P. agree'd any benefit any adult claimed to have from paracetamol was almost certainly placebo effect.
It is, however, an excellent anti-pyretic.

 

[ChemicallyEnhanced]

I dunno, my grandpa swore by it (brand name US-made acetaminophen ('Tylenol')). He worked heavy manual labor all day (builder, worked with his hands all day until he was nearly 70) and swore by two brand name Tylenol 500's. Nothing else worked for his body being in pain after a long day of physical work. It's heavily genetic, same with Ibuprofen. Works for some really well, and for others not at all. Misinformation is rife though. People say Tylenol is really bad for the liver (which it is) and Ibuprofen is bad for the stomach and kidneys (again, true)... newsflash, Ibuprofen is terrible for the liver as well, but someone with only those first two pieces of information might think they are "safe" as long as they don't experience stomach upset etc.

No need to tell me, I take Naproxen and my G.P described it as an "activity increaser" rather than a pain killer. He said I'd feel the same amount of pain overall but I could walk maybe 45 minutes instead of 15 minutes before my knee gave out. He said only take it if I was in pain *and* needed to be active that day. He also said to always take 20mg Omeprazole on the days I was taking Naproxen, to help protect my stomach.

 

[Ne0]

I've taken 5g acetaminophen at once (30mg codeine with 500mg acetaminophen, so 300mg codeine) often (but not in row two days, having break at least 3 days if I abuse codeine), and my liver tesest are very good accodring to doctor. I thinkl the LD50 starts from 7g taken at once. Max daily dose of acetaminophen is 4g .

 

[ChemicallyEnhanced]

I've taken 5g acetaminophen at once (30mg codeine with 500mg acetaminophen, so 300mg codeine) often (but not in row two days, having break at least 3 days if I abuse codeine), and my liver tesest are very good accodring to doctor. I thinkl the LD50 starts from 7g taken at once. Max daily dose of acetaminophen is 4g .

They're now saying the safe upper limit for acetaminophen is 3g a day after thousands of people died from liver failure due to taking paracetamol at the recommended dose of 4g/day. It was a chronic thing, in patients who had been taking it at 4g daily anywhere from several months to several years.

 

[Ne0]

They're now saying the safe upper limit for acetaminophen is 3g a day after thousands of people died from liver failure due to taking paracetamol at the recommended dose of 4g/day. It was a chronic thing, in patients who had been taking it at 4g daily anywhere from several months to several years.

Ah yes, I do this maybe two or twice a month, so I should be safe. I usually never take acetaminophen, I think ibuprofen is much more better for low pain. I think the chronic patients died because they took over 5g in 24h period. They say not over 4g daily it means 24h, but people might think if they have taken 4g afternoon, next morning it's new day so they can take it again. so in the end they take 8g in 24h period.

 

[ChemicallyEnhanced]

I dunno, but in this study I read (I'll try and find the link, but I read this several months ago) none of the patients ever took more than 8 500mg acetaminophen in any 24hr period.

I avoid it at all costs but like you say, two or three times a month if I ran out early on my script I can take 32 Co-Dydramol in two days (that's 16g acetaminophen total).

 

[Ne0]

I dunno, but in this study I read (I'll try and find the link, but I read this several months ago) none of the patients ever took more than 8 500mg acetaminophen in any 24hr period.

I avoid it at all costs but like you say, two or three times a month if I ran out early on my script I can take 32 Co-Dydramol in two days (that's 16g acetaminophen total).

Why you are not doing cold water exctraction? I take 10 30mg codeine + 500mg acetaminophen tablets because I've done this 10 years every now and then and my liver is in very good shape, I never take two days in row. 16g acetaminophen in two days sounds way too high, it can damage you're liver. I also drink very rarely so that helps too.

I've found that 5 g acetaminophen gives some nasty feeling compared to CWEd codeine. I can get unlimited amount 8mg codeine + 500mg acetaminophen, that I always CWE, takes only 30min, I do it 3 times and get all the codeine. Once in Thailand I bought pure 50mg codeine tablets, I took 500mg with 400mg tramadol and got very nastu histamine reaction, had to take strong anti-histamine medicine and went to wait in gay bar heh.

 

[Xorkoth]

Yes there is absolutely no reason not to do a cold water extraction, super easy (dissolve the pills in a glass of cold water, stir a few minutes, wait for the acetaminophen to settle at the bottom, drink the water and leave the undissolved powder at the bottom, you'll get all the codeine/opiate because it dissolves while the other does not so you don't get any of it). Just because you don't experience noticeable side effects from 16g of acetaminophen, it doesn't mean it's not hurting your liver and will contribute to eventual liver disease.

It is harmless taking the recommended dose as a once-in-a-blue-moon when pain is so excruciating one *must* take something. Taking Tylenol, to your average citizen, is a pretty "serious" affair. They're not trying to get high, it's relatively expensive compared to food and it's seen as medicine i.e. something taken when you're in relatively serious pain.

Agreed, as a once in a while thing, it's pretty harmless. But a lot of people take NSAIDs daily for pain. I know 2 of my friends have manual labor jobs and take 3200mg of ibuprofen a day each. If they were taking the equivalent of acetaminophen, that would be what, 12g a day or something? There are people that do this, probably a lot of people if just 2 of the people I know do it (they know enough to use ibuprofen instead which works better for pain IMO anyway, but some people just think "Tylenol" when they think pain relief over the counter, because of advertising or lack of knowledge).

 

[ChemicallyEnhanced]

Why you are not doing cold water exctraction? I take 10 30mg codeine + 500mg acetaminophen tablets because I've done this 10 years every now and then and my liver is in very good shape, I never take two days in row. 16g acetaminophen in two days sounds way too high, it can damage you're liver. I also drink very rarely so that helps too.

I've found that 5 g acetaminophen gives some nasty feeling compared to CWEd codeine. I can get unlimited amount 8mg codeine + 500mg acetaminophen, that I always CWE, takes only 30min, I do it 3 times and get all the codeine. Once in Thailand I bought pure 50mg codeine tablets, I took 500mg with 400mg tramadol and got very nastu histamine reaction, had to take strong anti-histamine medicine and went to wait in gay bar heh.

Years before I even abused opiates or was ever prescribed the strong opiates, I was prescribed Codeine (it was 8 years ago so I really don't recall what for). I couldn't sleep one night and remembered that codeine made me tired so I started taking one every 20 minutes or so figuring I'd take them until I felt I could sleep. I had a total of 300mg over maybe 2 hours and suddenly my skin felt hot and very, very itchy. I was bleeding in my places from writhing at the skin. I couldn't see as well so I looked in the mirror and my eyelids were swollen and my whole face was puffy. I got so week I couldn't even sit up, I had to shout to my parents to call an ambulance. They told my mum my blood pressure was like 48/36 and that they had brought it UP to that. In the end my whole face swelled up and I spent about 24 hours in hospital being given fluids and huge amounts of anti-histamines.
Weirdly: it also got very severe diarrhea - from codeine!
Was that the same horrible kinda histaminergic reaction you had?

 

[Ne0]

Years before I even abused opiates or was ever prescribed the strong opiates, I was prescribed Codeine (it was 8 years ago so I really don't recall what for). I couldn't sleep one night and remembered that codeine made me tired so I started taking one every 20 minutes or so figuring I'd take them until I felt I could sleep. I had a total of 300mg over maybe 2 hours and suddenly my skin felt hot and very, very itchy. I was bleeding in my places from writhing at the skin. I couldn't see as well so I looked in the mirror and my eyelids were swollen and my whole face was puffy. I got so week I couldn't even sit up, I had to shout to my parents to call an ambulance. They told my mum my blood pressure was like 48/36 and that they had brought it UP to that. In the end my whole face swelled up and I spent about 24 hours in hospital being given fluids and huge amounts of anti-histamines.
Weirdly: it also got very severe diarrhea - from codeine!
Was that the same horrible kinda histaminergic reaction you had?

I got super itchy, very red face and had some trouble to breath (tramadol might have to do with it too) I quickly went to buy hydroxyzine and took good amount of it, took about 30 minutes before all the side-effects went away. I also get little bit milder version of the histamine reaction from 300mg codeine but it goes away in 30 minute. Didn't have diarrhea.

Codeine shouldn't turn into morphine anymore if you take it again after 20 minutes, I have to wait at least 6 hours before it has effect again.

Agreed, as a once in a while thing, it's pretty harmless. But a lot of people take NSAIDs daily for pain. I know 2 of my friends have manual labor jobs and take 3200mg of ibuprofen a day each. If they were taking the equivalent of acetaminophen, that would be what, 12g a day or something? There are people that do this, probably a lot of people if just 2 of the people I know do it (they know enough to use ibuprofen instead which works better for pain IMO anyway, but some people just think "Tylenol" when they think pain relief over the counter, because of advertising or lack of knowledge).

That sound crazy amounts of ibuprofen, it can cause kidneuy failures in long term.

 

[ChemicallyEnhanced]

Is Hydroxyzine OTC where you are?

 

[Ne0]

Is Hydroxyzine OTC where you are?

Not at my current location, but I was staying in Thailand at the moment, there it's OTC like tramadol at the time (that one not anymore legally) and of course under the desk pure 50mg codeine pills, can say I was nodding most of the time. Also pregabalin and gabapentin are OTC there.

 

[blythe5050]

I got super itchy, very red face and had some trouble to breath (tramadol might have to do with it too) I quickly went to buy hydroxyzine and took good amount of it, took about 30 minutes before all the side-effects went away. I also get little bit milder version of the histamine reaction from 300mg codeine but it goes away in 30 minute. Didn't have diarrhea.

Codeine shouldn't turn into morphine anymore if you take it again after 20 minutes, I have to wait at least 6 hours before it has effect again.


That sound crazy amounts of ibuprofen, it can cause kidneuy failures in long term.

No one in their right mind should be taken that much ibuprofen you think that if you take acetaminophen and ibuprofen in large amounts that it’s not as dangerous as opiates but it is. So tired of doctors thinking that is the answer when it just causes more trouble

 

[blythe5050]

Yes there is absolutely no reason not to do a cold water extraction, super easy (dissolve the pills in a glass of cold water, stir a few minutes, wait for the acetaminophen to settle at the bottom, drink the water and leave the undissolved powder at the bottom, you'll get all the codeine/opiate because it dissolves while the other does not so you don't get any of it). Just because you don't experience noticeable side effects from 16g of acetaminophen, it doesn't mean it's not hurting your liver and will contribute to eventual liver disease.

Oh wow I didn’t know that maybe I’ll try it next time I am taking 150 mg of tramadol twice a day with two 650 Tylenol to control pain you don’t get much of a buz but it does work for the pain. When my tram runs out then I have to go and buy some perks to get me through till the next prescription comes