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I should mention for readers outside the US that in some countries (notably the UK), tylenol is known as paracetomol.
Codeine is an opiate and has effects common to opiates. One of the main effects in lower doses is that it is a painkiller. It also acts upon the central nervous system, making you feel relaxed and happy. It slows down peristalsis, which can lead to constipation. It can cause unconsciousness by its actions on the CNS. And it can depress the breathing reflex. If you take enough of it, not only does it cause unconsciousness, it also depresses the breathing reflex to the point at which your brain is not sufficiently oxygenated, leading to deeper unconsciousness and an even weaker breathing reflex, which is the start of a vicious spiral.
So take enough of it and you progress through a relaxed, joyous feeling, through unconsciousness and thence to a painless death. Painless because it is a painkiller and because you're unconscious.
The problem arises when you use a tylenol/codeine mix and you don't take enough of it for the codeine to give you that merciful death. Then you wake up the next day. And probably a good night's sleep, together with the surprise at finding yourself alive (and perhaps combined with a belief that there was divine intervention and that you're marked out for special attention by Gawd) means that you no longer feel suicidal. You may be glad you failed. And continue with your normal life. But behind the scenes the tylenol overdose is taking its toll.
Tylenol depletes an enzyme needed by the liver. The maximum dose the packet tells you that you can take is enough to use up that enzyme faster than it can be replaced. But the packet tells you to take that amount for no more than three days. If you take the maximum allowed amount for a week or two, or exceed that maximum for a shorter period then you use up all of that enzyme. And without that enzyme, the liver dies. But it takes one or two days (in some cases as long as three) for the rest of the body to realize it. And then the pain starts. And it's a really, really, bad pain.
In the first day, perhaps two if you're lucky, after the overdose you can go to the doctor and he can treat you with a supplement of the depleted enzyme. You may suffer some liver damage but you'll probably live. But most people don't do that: they think that because they're still alive the day afterwards either they didn't take enough to do the job or they've been miraculously saved. So they go about their lives, happily thinking that somehow they were spared death and thinking that life looks so much better. And then the pain starts. And at that point it's too late: the liver is kaput, no amount of the missing enzyme will fix it. At that point you have a few days to live, and those days will be spent in intense agony.
So he might have taken this stuff, but only if he were damned certain it was enough for the codeine to take him out.
Note to drinkers: tylenol, even in the recommended dose, exacerbates the damage done to the liver by alcohol; simultaneous use of alcohol greatly reduces what constitutes a safe dose of tylenol. People taking the recommended dose of tylenol washed down with a glass of wine have ended up with liver damage.
As an aside... The enzyme that tylenol depletes can be added to tylenol tablets fairly cheaply. If that were done, accidental and deliberate deaths from tylenol would be far rarer than they are today (it's not totally safe even with that enzyme, but the lethal dose then becomes much larger). Any country that has tried to introduce legislation to do so has had big pharma resist to the point that the legislation was dropped, because although the enzyme is cheap, it's not free: tylenol is a low-cost, low-margin drug and adding the enzyme would put up the cost somewhat.
As another aside... Customers ought to have the choice—cheap tylenol that is dangerous or slightly more expensive tylenol that is (by comparison) safe. In the conservative's beloved "market economics" one would expect that one drug company would corner a niche market for "safe" tylenol, but it hasn't happened.
As yet another aside... This is a classic case of "Prisoner's Dilemma." Any one company marketing "safe" tylenol would probably find it uneconomic. The marketing costs, etc., and the fact that shoppers (especially these days) are cost-concious means it would make a loss. Even if all but one company switched exclusively to "safe" tylenol, the one company that "defected" and marketed "fucking dangerous but dirt-cheap" tylenol would sweep the board. Only if they were all forced to market only "safe" tylenol would the situation be stable.
In a similar situation General Electric begged Dim Son to introduce "green" legislation because they wanted to switch to green goods. Not because they're genuinely concerned about the environment but because there is a hell of a market. If you're selling fridges (or whatever) you're essentially servicing a replacement market (people have fridges which eventually wear out). If you could market energy-efficient fridges you'd have a far larger replacement market because people would want to replace their fridges before they wear out. But energy-efficient fridges are more expensive, and people are broke. So that only works if all fridge manufactures switch to energy-efficient models. If GE went it alone they'd have the energy-efficient market to themselves but it would be smaller than their current market. If every manufacturer were forced to switch by legislation then GE would retain their same market share (all other things being equal). But the market would (temporarily) expand a little because people who could afford it would replace their fridges sooner. It's not a major increase by any means, and it wouldn't last for long, but every little helps. So GE, amongst others, begged Bush for green legislation. Which he turned down, because he's a fucktard.
So the big question is, why didn't any of the pharma companies make a similar request wrt tylenol? It wouldn't pay any one of them to go it alone, but if they were all forced into it they wouldn't lose out—they could charge more to cover their costs (and would actually charge a good deal more than that, claiming their costs were higher). Unlike GE and fridges, there would be almost nobody throwing away their tylenol to replace it with "safe" tylenol, they'd just wait until they'd used the old stuff. So there's no slight market boost. Which means there's nothing in it for the pharma companies except knowing that they were selling a safer product.
If the pharma companies were at all ethical, they'd be saying "We'd love to sell 'safe' tylenol, but if we go it alone we're fucked. Please pass legislation forcing us all to do it because then we could revel in the nice, warm, fuzzy feeling of doing good in the world." Why don't they do that? Because they sell the painkillers somebody dying from an overdose of tylenol needs to make his or her last few days on this earth slightly less agonizing.
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