Ow! My liver hurts ….


I’m just sayin’ ….

So anyway, I had a tooth extracted earlier this week. All praise to the good dentist, who did a properly excellent job. And he was even nice enough to prescribe some hydrocodone. The pharmacy I use managed to cough up twenty generic hydrocodone/APAP (7.5×750 mg) for about fifty-five cents apiece. Eleven bucks? Twenty vics? Why would I say no?

(Cue ironic music.)

    TAKE ONE TO TWO TABLETS
    BY MOUTH EVERY 4 TO 6
    HOURS AS NEEDED FOR PAIN

Now, let’s just stop and think about this for a moment. Watson 387 - Generic VicodinThe first thing I’m not going to do is suggest that I’m not concerned about drug addiction. But in my corner of the Universe, it is a fact of life. And I will be so happy if we end up with unadulterated opiates for pain management.

Yes, I will be quick to acknowledge the risks of addiction in chronic pain management, but that is happening already. I have friends who manage their aches and pains—legitimate or otherwise—with black market pills. Some of them are already up to methadone. Let that say what it will: I don’t deny it is properly indicated for pain relief, but it’s fucking methadone.

I could have cleared about ninety bucks if I turned those twenty pills to market. They would have moved in less than a day, and I could turn that around for a quarter of marijuana and gas money for the pickup.

I could have, but I don’t do pills much—legitimately or otherwise. So … yeah. Cheap hydrocodone, and why not? It’s been a while. I have an excuse. Not a good one, mind you, but it is an excuse: I have a note from my doctor, and that’s all anyone needs.

Brain cells help, though. Especially if you slaughter them habitually. But here’s the thing: how often does anyone actually do the math?

The word “milligrams” sounds nice, to be certain, but the maximum recommended dose of acetaminophen, the other component in these pills, is four thousand milligrams. For those of my fellow Americans who have reached the twenty-first century without even a rudimentary grasp of the metric system, that’s four grams. Oh, wait. Um … okay. You know that eighth of pot you picked up last week? That’s only three and a half grams. Damn it. If you’re a stoner, you probably already know that. So, yeah, in case it slipped your mind ….

Let’s see … oh, hey, a sugar packet. Three grams.

Anyway, yes, let us do the math. Note the dosage and prescription information above:

  • 750 x 4 = 3000
  • 750 x 2 x 6 = 9000

Simply put, if I take the minimum prescribed dose, that’s three grams of acetaminophen. I can honestly say that the amount of this otherwise common analgesic I took on Tuesday exceeds what I took through the whole of 2009. And, probably, 2008. Combined.

‘Nuff said? I think not.

Because if I take the maximum prescribed dose, that equals nine grams of acetaminophen, over twice the recommended dosage.

It seems to me that addicts are addicts. They’re going to shovel in their pain meds regardless of need, and generally without consideration of what else is in there. Unlike heroin, one can reasonably calculate the additives in their Vicodin™.

If they are addicted to opiates, yes, this is a problem.

If they are addicted to opiates, and are popping vics, not only are they caught up in addiction, but they are slaying their renal system, as well. Acetaminophen overdose costs about four hundred lives and brings another forty-two thousand to the hospital each year in the United States. Dr. Lewis S. Nelson, a toxicologist at New York University who served as acting chairman of the FDA panel that recommended the removal of Vicodin and Percocet from the market, explained:

“People often don’t know what products acetaminophen is in …. It isn’t that hard to go above the four-gram dose. If you took a couple acetaminophen for a headache until you got to the maximum dose, and then maybe later you take Tylenol PM and some Nyquil for a cold. And your back hurts, so you take Vicodin — by now you’ve probably gotten to a seven-gram dose.”

And I’ll bet it gets even easier to overdose on acetaminophen when your doctor prescribes nine grams a day. I mean, really. Seriously. One of the first things I did when I picked up the prescription was the math. And I ended up with the lowball three grams. It took a few minutes for the other figure to sink in, and probably out of a sense of disbelief.

Nine grams? I know there are plenty of people out there who question their doctors, but there are also plenty who don’t. They just nod and take their medicine, and I can’t even fault the doctors specifically.

Nine grams? And this is legal? Hell, this is ethical? That is, it doesn’t violate any sacred oaths of medicine you might have taken to prescribe a liver-killing overdose? And then there’s Congress, the FDA, and, naturally, the industry lobbyists who made it so.

Okay, okay, enough with the stammering disbelief. This is how it goes; I ought to be accustomed to such absurdity by now. But as we move forward into a new era of health care, the question persists. There are plenty who disdain the costs of nicotine, alcohol, and other drugs in terms of healthcare outlays. And the cost of care at the end of our lives is high enough to stoke the Palinite “death panel” paranoia. And ask around. Many people are still confused as to what the recent health reform bill will do about rising costs, despite the answer being, quite clearly, nothing. So in all of this cost-consciousness, how much do those forty-two thousand hospitalizations for acetaminophen cost? Yes, I’m suggesting we set aside the emotions of personal tragedy and the obscene squandering of human life, and just think about the money for a moment. We have to deal with this issue at some point. “By the grace of God almighty,” sang Roger Waters, “and the pressures of the marketplace, the human race has civilized itself; it’s a miracle.”

Quite obviously, the emotions of personal tragedy and the obscene squandering of human life just don’t sell in the United States. Ask the Christians about their abortion protests, the gruesome photos, and occasional fetus in a jar. All that sort of thing gets them is the occasional spectacular embarrassment when one of their ilk goes terrorist and kills a doctor or bombs a clinic. Ask American liberals about our wartime adventures in Iraq and Afghanistan. Sure, a hundred thousand dead civilians is less appalling than a million, but stop and think about it for a minute. Setting aside the fact that we’ve been expected to believe the hundred thousand figure for seven years—I mean, you’d think it would have grown some over time, right?—how does it go that we’re supposed to shrug and say, “Oh, it’s only a hundred thousand. That’s alright, then.” The drug war in Mexico has taken at least 14,000 lives in four years, over twice what we’ve spent in military blood in our overseas crusades.

So the idea of four hundred dead for acetaminophen overdose just doesn’t seem to measure up. Forty-two thousand hospitalizations mean even less in the public discourse than the nearly thirty-six thousand wounded American service members in our wars; they don’t register at all unless the argument gets deeper than politics or media are willing to delve.

But what about the money? Direct costs, lost labor, ripple effects? What is the burden on transplant resources? The untold story of these drugs is the acetaminophen. Or the ibuprofen. I grew up in the Seattle area; I remember Kenny Easley.

Yes, there is an addiction problem. Drug addiction is a long-known character in the human drama. We need not surrender to it, but neither can we afford to let addiction obscure other problematic issues. Yes, you’re gobbling your hydrocodone like a glutton. Yes, you’re that high. Yes, it feels like being sunshine at least until you stop breathing. Yes, you’re an addict. But even after you get help, wrestle with your demons, and finally kick the habit, you’re going to need a new liver.

I’m just sayin’ ….

Really, it’s just two words: Nine grams.

I have no solutions. If I come up with anything, of course I’ll let everyone know. But in the meantime: If 4000 mg is the threshold, then why does my prescription recommend over twice that number?

My liver hurts just thinking about it.

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One thought on “Ow! My liver hurts ….

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