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PostPosted: Wed Dec 30, 2009 9:24 pm 
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In reading the posts not only here, but on so many similar sites, I am just amazed at the amount of drugs that we have all consumed. Just seeing, for the ten thousandth time, someone who was taking 100+ mg of Vicodin a day, I really wonder how in the hell more people do not have liver damage. As readers may (or may not) know, opiate abuse/use by itself will typically not destroy someone's liver. However, Acetaminophen is a whole other story. And this stuff is a large component of Vicodin, Percocet, etc. In fact, there has been a healthy increase in the discussion over taking out or limiting the amount of Acetaminophen that will be allowed in some of these drugs in the future. It has now been well documented that APAP is injuring or destroying many more livers than we have previously been aware. When I hear stories of people ingesting 20 or 30 hydrocodone or oxycodone tablets in a day, I just can't imagine how they got away with it. Or perhaps did they? Will many abusers be facing liver disease or failure sometime down the road? Or did all of those tablets not contain any Tylenol?

Anyhow, all of this has just really made me curious - curious enough to ask all of you how much APAP (Acetaminophen) you consumed along with opiates. Or did you not take "actual" Vicodin - and rather just straight and pure hydrocodone or oxycodone? I have heard of methods to get rid of APAP at least from Vicodin. Is that what some of you did? I would really appreciate hearing your stories. I know it may not deal directly with what all of us our trying to accomplish, but I still think it's enough on topic - especially if it is something that we may need to worry about in the future - to warrent a discussion thread. Should a liver function test be something that some of us need? I can tell you that my Suboxone doc actually discussed some of these things with me during my first visit with him.

So let's hear your stories... Did you stress your liver with too much Tylenol or not?


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 Post subject: Apap
PostPosted: Wed Dec 30, 2009 10:35 pm 
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Great post!

Yes, I was one of those who when I could not get any thing else (when fent, oxy, dilly, etc wasn't around, in between scripts) and my scripts were days or week(s) away, I would eat 10/325 percocets like you wouldn't believe. Vicodin's a bit too. They were my last resort because I could usually only get the 10/650 or 10/660 or 7.5/750 (vics). But there were times when I did eat them too. I rather not go into the exact numbers of what I did consume, but simply: way too much. According to the stories and what the safe 24 hour dose is for APAP (~4g), I really should have overdosed, or died. I am 6'1, 180. No alcohol. The reason why I started opiates is for chronic pain. Before I actually got my 1st MRI and even before first Dr. appointment, I was eating too much over the counter APAP which was the other reason for starting narcotics for pain meds besides the actual pain.....all though not in the same excess as with the perc/vics, that was just out of control, insane amounts.

I do not know if I caused damage and down the road will find that out. I am actually afraid to get tested for liver function. I am pretty healthy for what I put my body through, besides my messed up back and I guess my lungs from smoking.....I don't have any 'symptoms', I don't think. I read online somewhere (can't remember) that signs for liver problems can be 'black tarry stools' =nope, I do not have; yellow skin/eyes = nope; dark urine = nope...I drink alot of water but is light usually anyways; etc etc etc.

If anyone knows what else I should look for please let me know! I know I should just get liver function test, or whatever it is.



I think, and not just because of what I did, that drug companies should limit the maximum amount of APAP in a narcotic combo product should be 325 mg. We could probably save some livers and lives!

This is such a short version of what happened. I completely summed it up and left out important facts, but i'll leave it at this for now. I can't wait to see the other responses! Thanks

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PostPosted: Mon Jan 04, 2010 6:00 pm 
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Wow! I am pretty surprised that there hasn't been any replies yet! I know its only been a few days and its the Holiday's/break from school and stuff, but I figured many of us on the forum have had the APAP issue. Maybe not. Well, I guess consider this a 'jumpstart' for the thread hopefully. I am curious to here other's experiences....Thanks!

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PostPosted: Mon Jan 04, 2010 7:11 pm 
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I was just thinking today about the effect on kidneys. Don't opiates themselves damage the kidneys? My drug (tramadol) didn't have any apap in it ...i dont think anyway.... but I always worried about kidney issues.


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PostPosted: Tue Jan 05, 2010 9:07 pm 
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I wonder all the time how im still alive. Before suboxone, If I ran out of 15's or 30's, and could only get my hands on some vic 5's (M357's) I would eat 60+ per day to stay away from withdrawl. I would eat so much that the APAP would make me sick for days.
I remember one time I ran out of my DOC for 3 days. I bought 120 of the M357's hydrocondone 5/500. I ate 70 of them on the first day and got sick as hell. The next day I read online about the "water trick" and did that with the remaining pills. Later that night I started thinking about it and was worried I may have miss the "good" part and ate the APAP anyway. All at one time. I spent 4 days weak and sick, Even after I got my DOC I was still sick.

And this is the screwed up part! I was sick for 5 days total, and possilble OD on tylonal maybe lost a few years of my life. AND it was still much much better then 2 days of withdrawls. God I hate this stuff :evil:


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PostPosted: Tue Jan 05, 2010 11:46 pm 
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I lost count of the Norcos or Vic's I took daily.

But I DO remember that my family doctor (unaware of my addiction) found my liver was enlarged. Afterward, it went back down to normal size.

So I guess - again - I was lucky.


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PostPosted: Thu Jan 07, 2010 11:38 pm 
When I was using, the main drug I took were norco 10/650's. It took a minimum of 10 to get me high, and I had to take these every 3 hours. And I had to dose 5 or 6 times a day. So, as far as Acetaminophen, that's 650x10x5 per day. And I was a daily user for YEARS. OMG, that's 32,500 mg of APAP a day. God in Heaven! I never bothered with trying to seperate the APAP from the hydrocodone because all the procedures I found on the Internet to do so said that about 10% of it would be lost by the process. I did, however, overdose many times and wake up in intensive care.

The incredible thing also is that along with the Norco I always took multiple antidepressants, mood stabilizers, benzodiazepines, and all sorts of other drugs that ruin the liver as well. I just chalk it all up to God. I think God is basically how most addicts survive to tell their tale.

BTW, I'm going to see my shrink next week and now that I actually have insurance, I will be asking for my first liver panel in over 6 years...I'm kind of scared to see the shape of it now, but I've got to do it. Wish me luck!
JD


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 Post subject: Also...
PostPosted: Thu Jan 07, 2010 11:59 pm 
Also, I'm pretty sure that the liver is the only organ in the body that can regenerate from a very ruined state. I believe the liver can fully regenerate from an only 10% functioning state. Of course, that would have to mean all negative factors cease and supportive care is given.

And another thing, I've read some stuff lately about how they're looking at trying to reexamine the use of Acetaminophen in this country. A lot of people don't realize that when they combine multiple prescription and especially non-prescription drugs, a lot of them can contain acetaminophen. I think that APAP is the leading overdose drug seen in Emergency Rooms in America.

Now that I'm "clean", I like never take acetaminophen. I'm super careful with my body now...but including the Suboxone, I take 6 prescription drugs and 2 over-the-counter drugs. I hope I don't end up regretting it.
JD


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PostPosted: Fri Jan 08, 2010 11:49 am 
Hey jd - hope your liver testing turns out to be all normal! Man, those were scary amounts of APAP you were taking in! I never got near those kind of numbers, but I certainly exceeded the recommended dose!
You're right - exceeding the safe level of APAP is pretty commonplace. It is in so many Rx and over the counter drugs and people don't realize that. Even at the hospital over the past few years we had to start writing alerts on the medication administration record (or the pharmacy would have it highlighted) - "Not to exceed 4G APAP in 24 hrs" Any med with APAP in it had this alert beside it. It was and is such a big problem. I have heard of proposals to diminish or eliminate the amount of APAP in the combo-type drugs. It'll probably take years....like everything else seems to!
My last basic liver and kidney panel blood work was all normal so I feel lucky. But, yeah, I thought about that stuff too, just never enough to make me change anything. Just another testament to the consuming nature of addiction.


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 Post subject: Just wondering...
PostPosted: Fri Jan 08, 2010 10:27 pm 
After thinking about this topic, I started wondering, why is acetaminophen so toxic to the liver? Does anyone know why? The only thing I (think) that I know is that acetaminophen is derived from coal tar in some way...and it used to be called paracetamol. I don't know, maybe I'm way off.
JD

(This edit is me answering my own question)

Here is a little interesting info on acetaminophen (aka paracetamol) and the liver from Wikipedia:

"Excessive use of paracetamol can damage multiple organs, especially the liver and kidney. In both organs, toxicity from paracetamol is not from the drug itself but from one of its metabolites, N-acetyl-p-benzoquinoneimine (NAPQI). In the liver, the cytochrome P450 enzymes CYP2E1 and CYP3A4 are primarily responsible for the conversion of paracetamol to NAPQI. In the kidney, cyclooxygenases are the principal route by which paracetamol is converted to NAPQI. Paracetamol overdose leads to the accumulation of NAPQI, which undergoes conjugation with glutathione. Conjugation depletes glutathione, a natural antioxidant. This in combination with direct cellular injury by NAPQI, leads to cell damage and death."

"Paracetamol hepatotoxicity is, by far, the most common cause of acute liver failure in both the United States and the United Kingdom. Paracetamol overdose results in more calls to poison control centers in the US than overdose of any other pharmacological substance. Signs and symptoms of paracetamol toxicity may initially be absent or vague. Untreated, overdose can lead to liver failure and death within days. Treatment is aimed at removing the paracetamol from the body and replacing glutathione. Activated charcoal can be used to decrease absorption of paracetamol if the patient presents for treatment soon after the overdose. While the antidote, acetylcysteine, (also called N-acetylcysteine or NAC) acts as a precursor for glutathione helping the body regenerate enough to prevent damage to the liver, a liver transplant is often required if damage to the liver becomes severe."

"In June 2009 an FDA advisory committee recommended that new restrictions should be placed on paracetamol to help protect people from the potential toxic effects."

What used to scare me so bad was knowing that I could be walking around with a destroyed liver and not even know it!! And then I would be swallowing another handful of pills...but I think what might have saved me sometimes is that when my body was really on the brink, I would absolutely begin to vomit and my body would not accept any more pills sometimes for 24 hours or so, withdrawal be damned. Ugh, how did we all get throught it???


Last edited by jdhammond1982 on Sun Jan 10, 2010 1:12 am, edited 2 times in total.

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PostPosted: Sat Jan 09, 2010 1:13 pm 
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Hey Donh -

I was too scared to go past 4g a day of tylenol... funny ey?... load up on whatever else I could find - perc, oxy, fent - but hey - don't give me something with tylenol!

I am a wonder -- DUH.. what we can justify.

I stand amazed at the people that survive more acetaminophen than 4g a day. I had a friend that took a one time shot - years before all the warnings - and he almost died (it was his attempt). I had no idea then tylenol could wipeout your liver.


Anyway GREAT QUESTION !


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PostPosted: Sat Jan 09, 2010 1:45 pm 
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I was always careful about the amount of apap I was ingesting. If I had to, I'd filter it out with water, but for most of my opiate abuse I was a pretty controlled user. I went off the deep end later with oc and dilaudid, but that didn't have any apap in it.

I do try to take care of my liver now though. When I was tapering and withdrawing from Suboxone I drank a lot of kombucha and I swear that it was one of the best things I did for myself. I really noticed when I didn't have any to drink.

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PostPosted: Sat Jan 09, 2010 5:37 pm 
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My initial drug of choice for years was a good old Lortab and I happened to accomplish obtaining four 120 count scripts per month, I had every family member I knew going to the same doctor (who was known in my town to overwrite pain pills) so that equals 480 pills a month (and I would find myself still running out). That was at the beginning of my addiction before I started abusing stronger opiates. I went for 4 yrs just on lortabs and when I finally checked into a rehab they did a liver function test. They found that at the time I had some liver damage and it was enlarged. I stopped taking anything with apap in it after I heard that news...crazy how my thinking was back then, so I justified taking morphine and heroin as long as it didn't have the tylenol in it....INSANE when i look back. This was my experience and I wanted to share it with you guys.


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 Post subject: Disturbing fact...
PostPosted: Sun Jan 10, 2010 12:49 am 
Hey donh, sorry if I'm posting way too many replies, but I'm really into this topic!!! I was actually thinking of starting a thread along this line. So anyway, I was researching the Drug Scheduling Act (not it's real name) that was put into affect in 1970, and they actually made it so manufacturers had to produce all hydrocodone in this country and most oxycodone to be combined with a non-narcotic analgesic, for the purpose of ": 1) To provide increased analgesia via drug synergy, and 2) To limit the intake of hydrocodone/oxycodone by causing unpleasant and often unsafe side effects at higher-than-prescribed doses."

What kind of public policy is that!!? Just let the addicts weed themselves out through DEATH? I wonder how many addicts are six feet under because of that very malicious decision. What I think about is all of the elderly and chronically ill people who have been diagnosed with liver problems after years of legitimate use of these combo-type drugs.

Speaking of the liver and kidneys, there is recently recognized phenomenon that is particularly disturbing. Researchers have been finding in otherwise healthy adults that taking just average doses of aspirin or acetaminophen - defined as 300 grams a year (1 g per day on average) - was linked to a condition known as small, indented and calcified kidneys (SICK).

I know I take a lot of prescription drugs, but from now on I'm going to make sure and get liver function tests at least every six months.
I think this is the most interesting topic I've been to on this forum!!
JD


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PostPosted: Sun Jan 10, 2010 1:35 am 
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I am glad to see that there is some interest to this topic. I too was going to start a topic of this subject a few weeks back but never did. I meant to be more 'vocal' in the past few days, but I am in severe pain and trying to deal with it without calling pain dr for meds. I can barely walk, if you want to call it 'walking'.

I too heard that the APAP was in fact added to other narcotic meds to keep 'abuse down' and for 'added pain relief from combo of meds'. I don't remember if I read the above quotes but it was damn similar if not them quotes. Great job!

Is that true that a liver with only 10% function can regenerate (come back, fix it self, what ever its called) to an almost normal healthy liver?? How about kidneys, are they affected as well as the liver from the APAP, or only in gross overtaking of APAP. Also, does ibuprofen have similar effects as APAP does on our bodies? And, if one does have liver damage from APAP, what else besides avoiding APAP should one do to help 'fix' their liver/bodies??

I wish I had some better info/insight to post but my mind is too distracted. I can only use laptop for limited time cause I cannot take the pain. From now on I will most likely be using my crackberry to use the forum since it might be easier for me. I hope that there will be many more great posts to this thread. Thanks, and untill next time...

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PostPosted: Mon Jan 18, 2010 5:37 pm 
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I didn't read all the posts in this thread, and don't know if the issue of tolerance to the acetaminophen was discussed.
This issue has always scared me to the core, and there have been many instantces that I have exceeded the 4 gram limit for Tylenol per 24 hour period, but not by that much luckily since my DOC has always been oxycontin, heroin, and methadone during my full agonist days of using.

I wanted to mention that are bodies and liver adjust remarkably quick to acetaminophen usage, this would make sense since most people would be dead if this wasn't true. I have gotten blood work to test my liver function a few times to see if there was damage, and my tests always came back normal. I ran to the pathologist to get tested after using around 6 grams of acetaminophen on two separate occasions during the course of one week. This period of time was actually a relapse for me as well, and at this time I didn't have a tolerance to acetaminophen at all, since I wasn't using for months. The tests still came back normal but I did feel sick before I went to the doctor. I felt a dull ache by my sternum, and not so much my liver at the time. I don't know if the pain was in my head since I knew beforehand that I was taking too much tylenol, but the ache scared me enough to get blood work done.

I don't think long term damage occurs unless the excess acetaminophen use occurs for long periods of time. I do know that some one's liver can fail if that person has no tolerance to acetaminophen and exceeds the 4 gram limit in a 24 hour period. For us, we started with small amounts of acetaminophen, and as our addiction to hydrocodone or oxycodone increased so did our acetaminophen use. This didn't happen over night, so our livers adjusted to the amazingly high levels of acetaminophen. I don't know for sure, but I think the liver can regenerate from certain levels of damage, as long as it isn't too extreme. Does any one know if the liver can heal at all? I remember asking my doc years ago, and he told me that the liver cannot heal at all, but I may of misunderstood him.


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PostPosted: Wed Apr 14, 2010 10:29 pm 
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Ahh, I am one of those who took around 30 vicodin a day for a while. I was, however, very mindful to the fact that I was destroying my liver with the tylenol, and went out of my way to get vicoprofen. Basically hydrocodone and ibprofen, which does not damage the liver, but is hard on the kidneys. There were also some odd dosages I came across like 7.5mg hydrocodone/250mg acetaminophen. So that's probably why.

You brought up a great question in this post, because that issue with the liver is usually the first wake up call for painkiller abusers. I have experienced mild liver failure, and let me tell you, it was the worst nausea in my life, the worst pain in my life, I cannot even describe it. You cannot imagine how horrible death by liver failure is. If that doesn't wake users up, I don't know what will.

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