Misuse of over-the-counter pain medication is potential health threat

May 30, 2012

A significant number of adults are at risk of unintentionally overdosing on over-the-counter (OTC) pain medication, according to a new study in the US by Dr. Michael Wolf, from Northwestern University in Chicago, and his colleagues. Their work, looking at the prevalence and potential misuse of pain medication containing the active ingredient acetaminophen as well as the likelihood of overdosing, appears online in the Journal of General Internal Medicine.

Many adults in the US regularly use OTC containing the acetaminophen, the most commonly used OTC pain medication in the US. They take it either on its own or in combination with other drugs, which may also contain acetaminophen. The ease of access to OTC drugs presents a challenge to as many individuals may lack the necessary skills to self-administer these medicines appropriately. Indeed, individuals make independent decisions that match an OTC product to a self-diagnosed symptom or condition. Worryingly, acetaminophen overdose is the leading cause of .

Wolf and colleagues interviewed 500 receiving care at outpatient general medicine clinics in Atlanta and Chicago between September 2009 and March 2011. Over half the patients reported some acetaminophen use and 19 percent were 'heavy users' i.e. they had taken it every day, or at least a couple of times a week, during the previous six months.

The researchers tested whether these patients understood the recommended dosage and were able to self-administer OTC acetaminophen appropriately. Firstly, could they work out the proper dosing of a single OTC medication over a 24-hour period? Secondly, what was the risk of patients 'double-dipping', or simultaneously taking two acetaminophen-containing products, and thereby exceeding the recommended dose?

To assess proper dosing, the participants were given five OTC drug bottles and, for each one, were asked to imagine that they took the first dose at time X, and wanted to take the maximum dose of this medicine in one day. They were then asked to show the researcher how many pills and at which times they would need to take them for a full 24-hour day.

To assess 'double-dipping', the patients were told to imagine they were taking a maximum dose of a primary OTC drug and asked whether it would be safe to also take a second medicine with the primary medicine - both of which contained acetaminophen.

Wolf and team found that nearly a quarter of the participants were at risk of overdosing on pain medication using a single OTC acetaminophen product, by exceeding the dose of four grams in a 24-hour period; 5 percent made serious errors by dosing out more than six grams. In addition, nearly half were at risk of overdosing by 'double-dipping' with two containing products.

The authors conclude: "Our findings suggest that many consumers do not recognize or differentiate the active ingredient in OTC pain medicines, nor do they necessarily closely adhere to package or label instructions. Given the prevalence of the problem, risk of significant adverse effects, and lack of a learned intermediary i.e. a physician to guide decision making and counsel consumers on proper use, we believe this to be a serious public health threat requiring urgent attention."

Explore further: Public confused about ingredients in pain relievers

More information: Wolf MS et al (2012). Risk of unintentional overdose with non-prescription acetaminophen products. Journal of General Internal Medicine; DOI: 10.1007/s11606-012-2096-3

Related Stories

Public confused about ingredients in pain relievers

May 3, 2011
People take billions of doses of over-the-counter pain relievers like Tylenol every year, but many do not pay attention to the active ingredients they contain, such as acetaminophen, according to a new Northwestern Medicine ...

Johnson & Johnson cuts maximum Tylenol dose to prevent overdoses

July 28, 2011
(AP) -- Johnson & Johnson said Thursday that it's reducing the maximum daily dose of its Extra Strength Tylenol pain reliever to lower risk of accidental overdose from acetaminophen, its active ingredient and the top cause ...

Red flags on pain reliever safety

July 19, 2011
For many people, pain relievers are wonder drugs, allowing them to carry on with their lives despite disabling arthritis, for instance, or recurrent headaches. But all pain relievers, whether sold over-the counter (OTC) or ...

Patients may receive too much acetaminophen in hospital

May 23, 2012
(HealthDay) -- Roughly 2.5 percent of admitted hospital patients may receive more than the safe daily cumulative dose of the pain-reliever acetaminophen, best known as Tylenol, on at least one day, according to a new U.S. ...

Better labeling could help thwart acetaminophen overdose

May 3, 2011
While well known for relieving everyday aches and pains, few realize that when misused, acetaminophen can lead to acute liver failure and even death, often due to accidental overdose by an uninformed consumer. A new small ...

Recommended for you

Mind-body therapies immediately reduce unmanageable pain in hospital patients

July 25, 2017
Mindfulness training and hypnotic suggestion significantly reduced acute pain experienced by hospital patients, according to a new study published in the Journal of General Internal Medicine.

Study suggests ending opioid epidemic will take years

July 20, 2017
The question of how to stem the nation's opioid epidemic now has a major detailed response. A new study chaired by University of Virginia School of Law Professor Richard Bonnie provides extensive recommendations for curbing ...

Team-based model reduces prescription opioid use among patients with chronic pain by 40 percent

July 17, 2017
A new, team-based, primary care model is decreasing prescription opioid use among patients with chronic pain by 40 percent, according to a new study out of Boston Medical Center's Grayken Center for Addiction Medicine, which ...

Private clinics' peddling of unproven stem cell treatments is unsafe and unethical

July 7, 2017
Stem cell science is an area of medical research that continues to offer great promise. But as this week's paper in Science Translational Medicine highlights, a growing number of clinics around the globe, including in Australia, ...

Popular heartburn drugs linked to higher death risk

July 4, 2017
Popular heartburn drugs called proton pump inhibitors (PPIs) have been linked to a variety of health problems, including serious kidney damage, bone fractures and dementia. Now, a new study from Washington University School ...

Most reproductive-age women using opioids also use another substance

June 30, 2017
The majority of reproductive-age and pregnant women who use opioids for non-medical purposes also use at least one other substance, ranging from nicotine or alcohol to cocaine, according to a University of Pittsburgh Graduate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.