Transcript: A Dose of Caution | Sep 22, 2015

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a grey suit, pale blue shirt, and striped red tie. Behind him, a wall screen reads “The Agenda, with Steve Paikin.”

Steve says IT MAY BE THE MOST COMMONLY USED
PAIN KILLER IN CANADA, BUT AN
AVERAGE 68 DEATHS PER YEAR
IN THIS COUNTRY ARE CAUSED BY
ACETAMINOPHEN.
JOINING US NOW FOR MORE ON WHAT
WE NEED TO KNOW, HERE'S JENNIFER
YANG, HEALTH REPORTER WITH
TORONTO STAR. NICE TO HAVE YOU
HERE.

Jennifer says NICE TO BE HERE.

Steve says FIRST TIME IN STUDIO.

Jennifer says IT IS.

Steve says ACETAMINOPHEN ESSENTIALLY IS
WHAT?

Jennifer says TYLENOL. THAT'S WHAT MOST
PEOPLE ASSOCIATE IT WITH.

Steve says ANY OTHER BRAND NAMES THAT WE SHOULD BE AWARE OF.

The caption reads “Jennifer Yang. Toronto Star.”

Jennifer is in her thirties has long black hair and wears a grey sweater vest over a white blouse.

She says WELL PEOPLE DON'T REALIZE IS
THAT ACETAMINOPHEN IS IN MORE
THAN 480 PRODUCTS SOLD IN
CANADA.
SO THERE IN LIES THE PROBLEM.

Steve says BECAUSE?

The caption changes to “A Dose of Caution. Acetaminophen 411.”

Jennifer says BECAUSE PEOPLE WILL BASICALLY TAKE TOO MUCH ACETAMINOPHEN
WITHOUT REALIZING IT AND THIS IS
EASIER DONE THAN YOU WOULD
THINK. FOR INSTANCE SAY
YOU HAVE COLD AND YOU’RE TAKING EXTRA
STRENGTH TYLENOL AND TAKE UP TO
MAX THEY SUGGEST YOU DO IN A
DAY, WHICH IS EIGHT
AND IF AT THE END OF THE DAY YOU DRINK A NEOCITRAN YOU
HAVE ALREADY GONE OVER DAILY LIMIT.

Steve says BECAUSE THERE IS ACETAMINOPHEN IN THAT.

Jennifer says BECAUSE THERE IS ACETAMINOPHEN IN NEOCITRAN.

Steve says PEOPLE DON’T KNOW THAT.

Jennifer says EXACTLY. SO THEN YOU TAKE NYQUIL
TOO TO HELP YOU SLEEP, AND THEN YOU HAVE REALLY GONE OVER THE LIMIT AND SICK FOR A WEEK, AND YOU DO THIS
DAY BY DAY CAN GET YOURSELF INTO SOME SERIOUS TROUBLE.

Steve says AND YOU CAN'T FIGURE OUT WHY YOU'RE
GETTING SICKER. WHEN YOU’RE TAKING ALL THIS GOOD MEDICINE.

Julie says EXACTLY.

Steve says DO YOU NEED PRESCRIPTION TO GET ACETAMINOPHEN?

Jennifer says YOU DON'T AND IN FACT THERE IS ALSO
ACETAMINOPHEN COMBINED WITH
CODEINE CALLED TYLENOL ONE OR THE GENERIC VERSIONS OF THIS DRUG WHICH YOU ALSO
DON'T NEED A PRESCRIPTION TO BUY THIS IN CANADA.

Steve says HOW IS IT POSSIBLE THAT 68
PEOPLE YEAR ARE DYING FROM THIS?

Jennifer says WELL SOME OF THOSE ARE INTENTIONAL DEATHS FOR SURE.
TYLENOL AND ACETAMINOPHEN ARE SOMETHING PEOPLE REACH FOR WHEN
THEY ARE SUICIDAL OR
INTENTIONALLY WANTING TO OVERDOSE,
BUT CORONERS HAVE FOUND THAT
NEARLY HALF OF THESE DEATHS
ARE UNINTENTIONAL. SO THERE ARE PEOPLE WHO ARE ACCIDENTALLY
WHAT WE CALL DOUBLE DIPPING- BY COMBINING LOTS OF PRODUCTS WITHOUT REALIZING THEY ALL CONTAIN ACETAMINOPHEN AND THEY’RE BY
BLOWING THE LIMIT
OR, THEY ARE PEOPLE WHO ARE
MORE SUSCEPTIBLE TO
OVERDOSE AND THIS IS SOMETHING THAT ISN’T WIDELY KNOWN EITHER THAT PEOPLE WHO ARE ALCOHOLIC,
HAVE LIVER PROBLEMS, WHO MIGHT BE MAL NOURISHED ARE MORE SUSCEPTIBLE TO OVERDOSING ON ACETAMINOPHEN.

Steve says SO IF YOU OVERDOES ON ACETAMINOPHEN YOU ARE- IS IT LIVER DAMAGE PEOPLE DIE OFF.

Jennifer says THE LIVER IS THE ORGAN THAT REALLY GETS HIT
HARD AND THERE IS ACTUALLY AN ANTIDOTE
AND IF YOU TAKE THE ANTIDOTE QUICKLY AFTER
YOU OVERDOSE YOU HAVE A PRETTY GOOD SHOT
AT SURVIVING BUT THE INTERESTING
THING IS PEOPLE WHO ACCIDENTALLY
OVERDOSE ON ACETAMINOPHEN TEND
TO HAVE POOR SURVIVAL RATES THAN
PEOPLE WHO TAKE TOO MUCH I ACETAMINOPHEN IN
SUICIDE ATTEMPT AND THATS BECAUSE THEY
DON'T REALIZE THEY'RE DOING IT
AND IT GOES ON TOO LONG AND THEY MISS THE
WINDOW WHERE THEY CAN TAKE THE ANTIDOTE AND
POTENTIALLY BE SAVED.

Steve says NOW I DON’T WANT TO GET MACABRE ABOUT THIS BUT I’M ASSUMING YOU HAVE TO
TAKE AN AWFUL LOT OF THIS STUFF IF YOU
WANTED TO KILL YOURSELF IS THAT
RIGHT?

Jennifer says I THINK SO.
BUT TO OVERDOSE IT REALLY ISN'T THAT
DIFFICULT LIKE THE EXAMPLE I GAVE EARLIER,
ANYBODY WHO IS NOT VERY AWARE
COULD EASILY OVERDOSE --

Steve says THAT ACCIDENTAL BUT IF YOU
COMBINED IT THE WAY YOU
SUGGESTED THAT WOULD BE
UNINTENTIONAL AND ACCIDENTAL, BUT IF YOU JUST
WANTED TO KILL YOURSELF WITH A
ACETAMINOPHEN, WE ARE TALKING ABOUT A WHOLE
BOTTLE I PRESUME.

Jennifer says YOU WOULD PROBABLY HAVE TO TAKE A LOT,
BUT THE OTHER THING THAT
INTERESTING THAT ACETAMINOPHEN
IS THAT THE MARGIN OF SAFETY IS
RELATIVELY NARROW AND THE
DIFFERENCE BETWEEN THE SAFE
AMOUNT AND WHAT MIGHT BE HARMFUL
IS RELATIVELY THIN SO PEOPLE
HAVE BEEN SHOWN TO OVERDOSE ON
ACETAMINOPHEN BY JUST GOING ACOUPLE
OF PILLS OVER THE DAILY
RECOMMENDATIONS LIMIT.

Steve says JENNIFER, IF THIS IS AS CLEARLY
CONCERNING AS IT IS, HOW COME WE
DON'T KNOW ABOUT IT?

Jennifer says IT'S KIND OF INTERESTING, AND
YOU KNOW I THINK BECAUSE
ACETAMINOPHEN AND TYLENOL HAVE BEEN AROUND FOR SO, SO
LONG IT’S A REALLY OLD DRUG AND THERE ARE
SOME DRUG AND SAFETY EXPERTS WHO THINK THAT IF
IT WERE INTRODUCED TODAY IT WOULD PROBABLY BE A
PRESCRIPTION PAINKILLER AND BUT
I THINK JUST BECAUSE IT IS SO
COMMON AND THAT’S WORTH NOTING MORE
THAN FOUR BILLION DOSES IN CANADA ARE TAKEN
EVERY YEAR AND THE VAST MAJORITY OF
THOSE ARE TAKEN SAFELY, AND IT
HAS REPUTATION FOR SAFETY SO I THINK
PEOPLE HAVE BEEN LULLED INTO STATE
OF COMPLACENCY BUT IT IS
INTERESTING- I MEAN, THIS NEW REPORT
THAT WE WROTE ABOUT IN THE STAR RECENTLY
FOUND AVERAGE OF 68 CANADIANS
DYING EVER YEAR FROM
ACETAMINOPHEN IF YOU CAN
IMAGINE A NEW DRUG COMING ONTO THE
MARKET AND IN YEAR END, FOUND 68
PEOPLE HAD DIED FROM IT WHETHER INTENTIONALLY OR HALF OF THEM UNINTENTIONALLY I THINK THAT WOULD CAUSE A BIT OF AN
UPROAR SO IT’S REALLY INTERESTING THE
WAY PEOPLE ARE SORT OF REGARDING
THIS DRUG AND SORT OF UNDERESTIMATING ITS
RISKS.

Steve says YOU SAID BEFORE BUT LETS STATE IT AGAIN: 8 PER DAY, IS
THE LIMIT.

Jennifer says 8 EXTRA STRENGTH.

Steve says EXTRA STRENGTH TYLENOL FOR EXAMPLE.

Jennifer says EXACTLY. SO FOUR GRAMS OF ACETAMINOPHEN IS CURRENTLY THE RECOMMENDED DAILY LIMIT BUT YOU
KNOW, HEALTH CANADA AND
SCIENTISTS STUDYING THIS DRUG ACTUALLY AREN'T TOTALLY
EVEN SURE WHAT DAILY SAFE LIMIT
IS AND THERE IS DISCUSSION
HAPPENING AT HEALTH CANADA RIGHT NOW
WHETHER OR NOT TO LOWER THE DAILY LIMIT IN THE
U.S. THAT DISCUSSION IS HAPPENING AS WELL -- SOME PEOPLE THERE HAVE BEEN CASES WHERE PEOPLE HAVE EXPERIENCED
LIVER TOXICITY OR INJURY AT
DOSES BELOW FOUR GRAMS A DAY
SO IT’S NOT SORTA CUT AND DRY THE
LIMIT.

Steve says ANY IDEA WHEN THEY ARE GOING TO BE READY TO MAKE
CONCRETE RECOMMENDATIONS ON
THAT ONE WAY OR ANOTHER?

Jennifer says WELL, HEALTH CANADA HAS
BEEN LOOKING INTO THIS SINCE 2008
AND IN 2009 THEY CAME UP WITH SOME
STRICTER GUIDELINES ON LABELS
THAT WAS HOPEFULLY GOING TO MAKE THE WAY PEOPLE WERE USING THIS DRUG SAFER AND THEY HAVE COME OUT WITH
ANOTHER REPORT LAST YEAR, AND
THEY ARE NOW SORT OF HOLDING
RECOMMENDATIONS -- CONSULTATIONS
AND TAKING IN CONSULTATIONS FROM
THE PUBLIC TO SEE WHAT FURTHER ACTIONS
NEED TO BE TAKEN AND LOT OF IT HAS TO
DO WITH CHANGES ON THE LABEL BUT CERTAINLY DRUG AND SAFETY EXPERTS ARE RECOMMENDING THEY GO EVEN
FURTHER AND HEALTH CANADA’S OWN
EXPERTS WHO ARE APPOINTED TO
SORT OF LOOK INTO THIS ISSUE ARE
RECOMMENDING SUBSTANTIAL CHANGES
INCLUDING DECREASING DAILY LIMIT DECREASING
THE DOSE PER PILL AND EVEN
TAKING EXTRA STRENGTH AND PUTTING IT INTO
PRESCRIPTION AND REMOVING
ACETAMINOPHEN FROM CODEINE
PRODUCTS- SO TYLENOL THREE FOR INSTANCE AND TAKING ACETAMINOPHEN OUT OF
THAT AND THIS HAS BEEN
RECOMMENDED TO HEALTH CANADA AND
WE DON'T REALLY KNOW YET IF THEY WILL TAKE THESE RECOMMENDATIONS-
AND THEY'RE TALKING ABOUT IT AS WE SPEAK.

Steve says GOTCHA. LET’S COMPARE THIS TO ANOTHER PAINKILLER THAT IS ALSO FAIRLY COMMON OUT THERE CODEINE.

Jennifer says RIGHT.

Steve says HOW ARE THEY SIMILAR AND HOW ARE THEY
DIFFERENT?

The caption changes to “A Dose of Caution. Questioning Codeine.”

Jennifer says WELL CODEINE IS AN OPIATE ITS
ADDICTIVE AS WELL AND IT HAS
BEEN COMBINED WITH ACETAMINOPHEN
IN THESE PRODUCTS THAT PEOPLE COMMONLY KNOW AS TYLENOL ONE, TYLENOL TOW, TYLENOL THREE, TYLENOL FOUR
AND THE ARGUMENT IS THAT IN COMBINATION THEY WILL WORK BETTER AS A PAINKILLER. TYLENOL ONE ONLY HAS
8 MILLIGRAMS OF CODEINE ITS BARELY
AND YOU CAN BUY IT
WITHOUT A PRESCRIPTION ANYONE
CAN WALK UP TO A PHARMACY AND ASK THE PHARMACIST FOR SOME OF THIS DRUG AND THEY
WILL MOST LIKELY SELL IT TO THEM AND
THEY ARE SUPPOSED TO ASK SOME QUESTIONS AND DO
SOME VETTING BUT IN PRACTICE THIS
ISN'T REALLY HAPPENING SO THIS DRUG IS
OUT THERE AND PEOPLE ARE USING
IT AND THERE IS NO PAPER TRAIL, WE DON'T
KNOW HOW MANY CANADIANS ARE TAKING THIS DRUG.

Steve says ITS ADDICTIVE.

Jennifer says AND IT’S ADDICTIVE.

Steve says TYLENOL ONE.

Jennifer says BECAUSE THERE IS CODEINE IN IT.

Steve says EVEN WITH THAT LITTLE AMOUNT OF CODEINE?

Jennifer says OVERTIME YOU CAN CERTAINLY
GET ADDICTED AND ESPECIALLY IF YOU ARE TAKING
MANY PILLS AT A TIME, I ALSO WROTE A
STORY ABOUT THIS WHERE PEOPLE ARE PURPOSELY ABUSING
TYLENOL ONE. THEY ARE PHARMACY SHOPPING, SO TO SPEAK, GOING FROM PHARMACY TO PHARMACY TO PHARMACY
AND BUYING THIS DRUG EXTRACTING THE CODEINE AND USING IT TO
GET HIGH AND THE THING THAT REALLY ELEVATES
THE DANGER WITH TYLENOL ONE IS THE FACT THAT IT
IS MIXED WITH ACETAMINOPHEN SO
THEY MAY GET HOOKED ON THE CODEINE BUT THEN THEY ARE GETTING
DAMAGED BY THE ACETAMINOPHEN WHICH
IS HURTING THEIR LIVER AND MAYBE THEY'RE NOT EVEN
AWARE.

Steve says YOU SAY EXTRACTING THE CODEINE.

Jennifer says THERE ARE WAYS TO DO THAT.

Steve says I WAS GOING TO ASK. YOU KNOW HOW TO DO IT?

Jennifer says LIKE ANYTHING THERE ARE ALL THESE
YOUTUBE AND INTERNET TUTORIALS OUT THERE
I’M OBVIOUSLY NOT GOING TO PLUG THEM BUT THIS
PERSON I INTERVIEWED HE DID IT FOR
MORE THAN A DECADE LANDING HIMSELF
IN THE HOSPITAL LOST
RELATIONSHIPS HE’S NOW ON METHODONE. IN FACT
THE STORY I WROTE EARLIER THIS
YEAR I THINK IT WAS IN FEBRUARY, WE
LOOKED INTO THE STATS AND IN THE
PREVIOUS THREE YEARS, FIVE
HUNDRED PEOPLE HAVE SIGNED UP FOR
METHADONE PROGRAMS TO TRY AND KICK THE NON-PRESCRIPTION CODEINE HABIT, SO THAT’S TYLENOL ONE IN ITS GENERIC VERSION.

Steve says IN THE INTERIM TIME IN WHICH YOUR
STORY HAS APPEARED I WONDER IF YOU HAVE YOU HEARD
FROM ANY OF THE PHARMA COMPANIES AND HOW THEY HAVE
REACTED TO PARTICULARLY THE REPORT
YOU PUT OUT THERE SAYING 68 PEOPLE A
YEAR DIE FROM ACETAMINOPHEN.

Jennifer says WELL, THE COMMON CRITICISMS THAT WE HEAR
FROM PEOPLE WHEN WE PUT OUT THESE STORIES IS THAT
ONE, SO MANY PEOPLE TAKE THIS
DRUG SAFELY AND THAT HAS TO BE
ACKNOWLEDGED IS TRUE IT IS VERY
SAFE WHEN TAKEN RESPONSIBLY, BUT
I DON'T THINK WE SHOULD IGNORE
IT SINCE SO MANY PEOPLE ARE TAKING IT

SAFELY BECAUSE AT THE END OF THE DAY AN AVERAGE OF 68 CANADIANS A YEAR ARE DYING FROM THIS DRUG WHETHER BY TAKING IT INTENTIONALLY OR NOT. ANOTHER CRITICISM IS THERE IS A FEAR THAT BY SCARING
PEOPLE OFF ACETAMINOPHEN WHICH
IS VERY, VERY SAFE WHEN YOU TAKE
IT RESPONSIBLY, PEOPLE WILL BE
PUSHED TOWARDS OTHER PAINKILLERS
SOME OF WHICH HAVE ADVERSE
EVENTS LIKE IBUPROFEN AND ASPIRIN WE KNOW MIGHT CAUSE
STOMACH BLEEDING EVEN WITHIN THE RECOMMENDED DOSE SO SOME DOCTORS REALLY
PREFER TYLENOL OVER ADVIL
AND THEY HAVE CONCERNS FROM THAT SORT
OF POINT OF VIEW IS THAT THERE IS
RISK, OF PUSHING PEOPLE AWAY
FROM TYLENOL BUT YOU KNOW THE UNDERLYING
PROBLEM HERE REALLY IS THERE AREN'T
VERY GOOD PAINKILLER OPTION FOR
PEOPLE WHO SUFFER FROM PAIN AND
CHRONIC PAIN AND THAT’S A LOT OF
CANADIANS AND WHAT THEY HAVE GOT OUT THERE
ARE ACETAMINOPHEN, IBUPROFEN AND ADVIL AND THE
HARDER STUFF THAT CAN BE
ADDICTIVE AND WHICH AS WE KNOW LEADS TO ALL SORTS OF PROBLEMS
SO THEY REALLY NEED MORE OPTIONS AND I THINK THAT’S THE SORT OF MESSAGE TO TAKE ON AT THE END OF THE DAY.

Steve says ANYONE WORKING ON THOSE MORE OPTIONS.

Jennifer says OH YEA PEOPLE ARE CERTAINLY WORKING ON IT BUT
IT IS DIFFICULT.

Steve says AND CAN I PRESUME THAT IF ONE
OF RESULTS OF ALL OF THIS IS
THAT THE RECOMMENDED
ALLOWANCE OR DOSAGE HAVE
ACETAMINOPHEN IS LOWERED, AND
THEREFORE PEOPLE USE LESS OF IT
THE DRUG COMPANIES AREN’T GOING TO BE HAPPY ABOUT THAT I PRESUME. IS THAT RIGHT? THEY WILL SELL LESS?

Jennifer says WELL I THINK SO. TYLENOL IS CERTAINLY A BLOCKBUSTER BRAND FOR MCNEIL WHICH IS THE DIVISION OF JOHNSON
AND JOHNSON AND EXTRA STRENGTH TYLENOL
WHICH IS I MENTIONED HEALTH CANADA’S OWN EXPERTS
WANT TO MAKE
PRESCRIPTION, MAKES UP FOR THE
MAJORITY OF TYLENOL SALES APPARENTLY AND IT
IS WHAT WE HAVE HEARD FROM SOME
SOURCES AND SO CERTAINLY IT IS
HURTING THEIR BOTTOM LINE AND FROM
WHAT WE UNDERSTAND,
PHARMACEUTICAL COMPANIES AND
ASSOCIATIONS YOU KNOW ARE NOT HAPPY ABOUT
SOME OF THE RECOMMENDATIONS- RECOMMENDATION ARE CERTAINLY PUSHING BACK ON THEM AS WELL.

Steve says FINAL QUESTION, AN OBVIOUS FINAL QUESTION WHEN YOU HAVE
HEADACHE WHAT DO YOU DO.

Jennifer says I TAKE TYLENOL I REALLY DO BUT I'M VERY
CAREFUL NOW ABOUT HOW MUCH I TAKE I DEFINITELY
USED TO BE ONE OF THOSE PEOPLE
WHO TAKE TWO, THREE AND MAYBE AN HOUR
LATER I WOULD TAKE ANOTHER TYLENOL ONE AND THEN MAYBE
I WOULD GO OUT FOR BEERS THAT NIGHT AND NOW
I UNDERSTAND THAT THIS IS REALLY
UNSAFE BEHAVIOUR AND I'M VERY
MINDFUL OF IT ALL FRIENDS AROUND ME AND MY COLLEAGUES TOO HAVE BECOME EXTRA CAREFUL WITH THE STUFF
BECAUSE YOU KNOW YOU KIND OF SEE IT EVERYWHERE
IT’S IN THE DRUGSTORE NEXT TO CANDY
PEOPLE HAVE REALLY SORT OF LOST SIGHT OF THE FACT
THAT THIS IS A DRUG AND IT CAN BE A POISON AND YOU HAVE TO
TAKE IT REALLY RESPONSIBLY.

Steve says SMARTER AWARENESS AND MORE
RESPONSIBLE BEHAVIOUR WILL BE A
POSITIVE DEVELOPMENT FROM ALL OF
THE WORK YOU HAVE DONE.

Jennifer says HOPEFULLY AND REALLY, IT
SHOULD BE EMPHASIZED THAT YEAH,
HALF OF THE WORK IS ON US TO BE MORE
AWARE, TO BE EDUCATED, TO READ THE LABELS AND NOT TREAT EVERY PROBLEM AS IF THERE
IS PILL FOR IT TO SOLVE WITH.

The caption changes to “A Dose of Caution. Produced by Hilary Clark @hilarygclark.”

Steve says GOTCHA.
JENNIFER YANG, HEALTH REPORTER, TORONTO STAR THANKS FOR
VISITING US AT TVO TONIGHT.

Jennifer says THANKS FOR HAVING ME.

Watch: A Dose of Caution