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Comment by sguelich | Hacker News Reader

Sad to see an HN thread full of conspiracy theories and so little actual science.

Believe it or not, acetaminophen is an effective analgesic, and combined with hydrocodone it provides synergistic pain relief without any increase in side effects over the use of either agent alone. Here's a peer-reviewed 1980 study from the UK showing just that:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1430165/

Private drug companies didn't pursue testing & selling hydrocodone/APAP in combined form because the government hates drug users. They did so because they can market a highly potent form of pain control. Not everything in life is a government conspiracy!

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The linked study backs what was said in the article. The addition of acetaminophen provides little to hydrocodone.

The side effects in this study are short term, with 1000mg of APAP. I don't think anyone is too upset about a single dose like that. However, taking it repeatedly throughout the day, or over extended periods of time, the APAP does cause liver damage. Hence the FDA review and possible ban on certain combinations.

However, the drug scheduling laws are real. Hydrocodone by itself is Schedule II, whereas hydrocodone with APAP is Schedule III. What other explanation is there for classifying the same drug in combo as a lower risk, other than that there's a damaging part to it?

A study on post-partum pain from the 1980s?

Try this one, a meta-analysis from 2000 on post-op pain: http://www.ncbi.nlm.nih.gov/pubmed/10796810

Acetaminophen is effective. Most professional guidelines on analgesia recommend the use of acetaminophen in addition to opioid analgesia.

The useful and perhaps unique thing about acetaminophen among pain killers is that it is well tolerated. Almost everybody from little kids to the very elderly can down acetaminophen without too many problems. This is certainly not the case with opioids. Dizziness, lightheadedness, feeling spaced out, nausea, vomiting, constipation, allergic reactions are not uncommon with these compounds, not to mention variability in effectiveness.

It is true that the majority of acetaminophen overdoses are accidental, which suggests that there is a major problem with how we distribute and use this drug. However most health professionals would take issue with describing it as a hepatotoxin. The large number of ER visits etc reflects the widespread use and easy availability of paracetamol. For example, where I work, there are at least as many presentations due to alcohol abuse (which is also available 'over the counter') as there are for paracetamol.

The funny thing about the article that triggered this thread is that your well-educated person with post-op pain is probably the ideal group to be using acetaminophen and opioid combinations.

Upvoted, but what TFA is claiming is that codine w/o acetaminophen is roughly as affective as the combination, which isn't addressed in that analysis.

http://www.ncbi.nlm.nih.gov/pubmed/19588335 "AUTHORS' CONCLUSIONS: Single dose oxycodone is an effective analgesic in acute postoperative pain at doses over 5 mg; oxycodone is two to three times stronger than codeine. Efficacy increases when combined with paracetamol. Oxycodone 10 mg plus paracetamol 650 mg provides good analgesia to half of those treated, comparable to commonly used non-steroidal anti-inflammatory drugs, with the benefit of longer duration of action."

"http://www.ncbi.nlm.nih.gov/pubmed/20393966 AUTHORS' CONCLUSIONS: Single dose codeine 60 mg provides good analgesia to few individuals, and does not compare favourably with commonly used alternatives such as paracetamol, NSAIDs and their combinations with codeine, especially after dental surgery; the large difference between dental and other surgery was unexpected. Higher doses were not evaluated."

Nobody is saying acetaminophen is ineffective, just that it's effects come with hepatotoxicity. A larger dosage of hydrocodone could have the same net analgesic effect without the huge negative effects.

"Nobody is saying acetaminophen is ineffective"

Actually, the linked article is saying exactly that:

"I remember being annoyed that in order to get narcotic pain relief I was being forced to take a hepatotoxin that added little to the pain relieving efficacy of the opiate."

It was ineffective for the author of the article. That doesn't mean it's ineffective for everyone.

It's not like he did an n=1 study. He just assumed it wasn't going to work for him. My impression of the article, given that it doesn't really bring up data beyond the total number of acetaminophen-related cases of liver toxicity, is that the author believes he should be able to buy the drugs separately, and is denied this opportunity by the government. After that, he says everything he can to support his beliefs, and pooh-poohs arguments against it.

Oxycodone is a very good opioid and, if you aren't abusing it, it is affordable for most people, even if you don't have insurance (http://www.rxassist.org/Search/Prog_Details.cfm?program_Id=1...). But if you need it every day to support your habit, it's too expensive, so vicodin and its friends are the drugs of choice.

Warning: hydrocodone was well-tolerated by me, however I believe I incurred a small amount of ptosis (eyelid droop) as a result. If you take it, be on the lookout for the side effects.

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