One thing to note- Many versions of Codiene pain relievers have acetaminophen (called “paracetamol” elsewhere). A does of as little as 2X the RDA can cause catastrophic liver damage, esp when combined with booze.
wiki:*Paracetamol is contained in many preparations (both over-the-counter and prescription-only medications). In some animals, for example cats, small doses are toxic. Because of the wide availability of paracetamol there is a large potential for overdose and toxicity.[19] Without timely treatment, overdose can lead to liver failure and death within days; paracetamol toxicity is, by far, the most common cause of acute liver failure in both the United States and the United Kingdom.[20][21] It is sometimes used in suicide attempts by those unaware of the prolonged timecourse and high morbidity (likelihood of significant illness) associated with paracetamol-induced toxicity in survivors…The toxic dose of paracetamol is highly variable. In adults, single doses above 10 grams or 150 mg/kg have a reasonable likelihood of causing toxicity.[22] Toxicity can also occur when multiple smaller doses within 24 hours exceeds these levels, or even with chronic ingestion of doses as low as 4 g/day, and death with as little as 6 g/day.
In children acute doses above 200 mg/kg could potentially cause toxicity. This higher threshold is largely due to children having larger kidneys and livers relative to body size than adults and hence being more tolerant of paracetamol overdose than adults.[23] Acute paracetamol overdose in children rarely causes illness or death with chronic supratherapeutic doses being the major cause of toxicity in children.
Since paracetamol is often included in combination with other drugs, it is important to include all sources of paracetamol when checking a person’s dose for toxicity. In addition to being sold by itself, paracetamol may be included in the formulations of various analgesics and cold/flu remedies as a way to increase the pain-relieving properties of the medication and sometimes in combination with opioids such as hydrocodone to deter people from using it recreationally or becoming addicted to the opioid substance, as at higher doses than intended the paracetamol will cause irreversible damage to the liver. In fact, the human toll of acetaminophen, in terms of both fatal overdoses and chronic liver toxicity to habitual abusers of pain medication, likely far exceeds the damage caused by the opioids themselves.[24][page # needed] To prevent overdoses, one should read medication labels carefully for the presence of paracetamol and check with a pharmacist before using over-the-counter medications.*
Americans, etc please read acetaminophen where it says paracetamol.
Note that Vicodin contains (wiki)Hydrocodone (which) is a semi-synthetic opioid derived from two of the naturally occurring opiates, codeine and thebaine.
As for Tramadol:"Tramadol … is an atypical opioid which is a centrally acting analgesic, used for treating mild to moderate pain. It is a synthetic agent, as a 4-phenyl-piperidine analogue of codeine,[1][2] …Dependence
*Some controversy exists regarding the dependence liability of tramadol. *Grünenthal has promoted it as an opioid with a lower risk of opioid dependence than that of traditional opioids, claiming little evidence of such dependence in clinical trials. They offer the theory that since the M1 metabolite is the principal agonist at μ-opioid receptors, the delayed agonist activity reduces dependence liability. The noradrenaline reuptake effects may also play a role in reducing dependence.
Despite these claims, it is apparent, in community practice, that dependence to this agent does occur.[17] However, this dependence liability is considered relatively low by health authorities, such that tramadol is classified as a Schedule 4 Prescription Only Medicine in Australia, rather than as a Schedule 8 Controlled Drug like other opioids (Rossi, 2004). Similarly, tramadol is not currently scheduled by the U.S. DEA, unlike other opioid analgesics. Nevertheless, the prescribing information for Ultram warns that tramadol “may induce psychological and physical dependence of the morphine-type”. In addition, there are widespread reports by consumers of extremely difficult withdrawal experiences. [18]
A controlled study that compared different medications found “the percent of subjects who scored positive for abuse at least once during the 12-month follow-up were 2.5% for NSAIDs, 2.7% for tramadol, and 4.9% for hydrocodone. When more than one hit on the dependency algorithm was used as a measure of persistence, abuse rates were 0.5% for NSAIDs, 0.7% for tramadol, and 1.2% for hydrocodone. Thus, the results of this study suggest that the prevalence of abuse/dependence over a 12-month period in a CNP population that was primarily female was equivalent for tramadol and NSAIDs, with both significantly less than the rate for hydrocodone”.[18]
