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It's a piece of legislation I fully support. Some Irish legislation carries a whiff of nanny-stateism, but I really can't imagine why a household would ever need more than 24 paracetamol pills in a week. I think implementing something similar in the US would be a no-brainer, especially when you consider paracetamol poisoning is the leading cause of death by acute liver failure. I assume a significant portion of that is accidental: because it's an OTC drug, a lot of people severely underestimate how toxic it is. My dad (PhD in organic chemistry) says there's no way it would have been made available OTC if it was discovered today. I always urge people to use ibuprofen instead when possible.
Four people with headaches easily covers that. And 24 pills is still enough to kill you, painfully. Making the vast majority of people who just want to keep APAP around the house go more often to the store and pay a higher per-unit price just to slightly inconvenience those who want to die isn't reasonable. Nor is it reasonable to go full retard like with pseudoephederine and have a registry to make sure no one is buying a fatal dose by going to multiple pharmacies.
Tylenol is somewhat uniquely dangerous, it would possibly not have been approved as over the counter in the U.S. in today's regulatory environment.
This is for a couple of reasons.
-The therapeutic and toxic range are way too close (aka it's really easy to overdose accidentally, which does happen).
-It has significant interaction with some medical problems (aka liver metabolism). This is admittedly pretty minor in most situations.
And most importantly:
-Tylenol overdose is one of the worst possible ways to die. It is long, and slow, and for a while you think you are fine. This gives people lots of time to decline in misery knowing they made an irreversable choice. It's awful. Most other forms of overdose kill you quickly or rapidly alter your sensorium.
This creates agony on the part of the victim and their family, and also a significant amount of angst and distress in the healthcare team.
If you like you aren't paying for the minor inconvenience of harder to pull out of the packaging pills vs. fewer suicides, you are doing to reduce clinician burnout and doctors and nurses in the workforce longer.
It's also expensive to manage.
I'm not sure we'd have any OTC drugs in the US starting from zero in today's regulatory environment. Analgesics especially even get banned for prescription use (like the COX-2 inhibitors), because regulators refuse to consider that trading off risk of death against pain is valid in the first place.
That's a failing of today's regulatory environment, and has no bearing on whether I should be able to buy a big bottle of death.
My APAP related disgust is reserved for drug warriors who ensure that oxycodone with APAP is the most available formulation of oxycodone, because they consider people trying to abuse it dying horribly to be a feature and not a bug.
I think these days they would argue that the reason is mostly because of synergistic analgesia (which is not incorrect) but yes I agree it's a questionable cost/benefit.
But ultimately society is organized around tradeoffs in your rights to enable you to have rights and the conveniences of civilization. Having to deal with mildly annoying blister packs or smaller bottles doesn't seem like a high price to pay for the amount of pain you can prevent.
Yes, that's one reason the combinations are popular, but not the reason oxy with APAP (Percocet) is so favored over oxy with ASA (Percodan, no longer available) or oxy with ibuprofen (Combunox, no longer available). That's drug warrior pressure.
No, society is organized around what those with power want.
There is a bunch of research out there suggesting that OTC and milder agents are just as good as stronger agents for managing acute pain. Example:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786200
Lots of research. You might not find that research convincing but it is absolutely out there.
Additionally APAP is a safer choice than ASA or Ibu if taken as prescribed, which is easier to ensure in an acute course (less potential for severe side effects or interaction with chronic medical conditions).
Yes, I'm aware of the risible drug warrior shit research. The drug warriors would love to eliminate legal opiods entirely, and they will lie about this being no loss, because they're drug warriors and do not care about pain as long as they can fight drugs.
I don't know a single person in clinical medicine who wants to eliminate opioids and while I'm sure there might be some crack pots that's an extraordinary claim that requires some evidence to be taken credibly.
Reactive under-prescribing in some outpatient settings is certainly a problem but that's not really your claim.
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