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“It’s both maddening and tragic because many of these cases are entirely avoidable,” says Dr. Yoshida, a hepatologist, gastroenterologist and one of seven specialists in the liver transplant team at the Vancouver General Hospital.

He also chairs the medical advisory committee of the Canadian Liver Foundation (CLF).

According to Dr. Yoshida, the problem has continued to fester in Canada for years, if not decades. “I am really angry about this,” he said. “It seems to be constant and it is not getting better. It affects young people, parents, grandparents—everybody.”

Acetaminophen is found in more than 700 different over-the-counter and prescription medicines in Canada. It is considered safe and effective when daily use from all sources does not exceed 4,000 mg for adults and children over 12.

But according to the Institute for Safe Medicine Practices in Canada (ISMPC), acetaminophen is the leading cause of liver failure in Canada.

Though statistics are not kept on the issue, the ISMPC estimates that 4,500 Canadians are hospitalized each year for acetaminophen overdoses. Roughly 6% of patients experience liver injuries that may be irreversible.

The overdose issue infrequently comes under the public spotlight, like it did in December following the hospitalization of Inuk activist Delilah Saunders. Media attention in Saunders’ case, however, focussed mostly on the liver transplant protocol and whether or not she qualified because of her addiction to alcohol. (Alcohol enhances the creation of toxic metabolites that damage liver cells when acetaminophen metabolises in the liver.)

Health Canada recently conducted a safety review of acetaminophen and is set to bring in new labelling requirements this year.

There is no reason in hell why 500 milligram units should be available…It’s like having easy access to a handgun

According to Dr. Yoshida, who saw a first draft of the recommendations through his work with CLF, the planned changes fail to address what he says is the primary source of the overdose problem: the manufacture and sale of 500-mg capsules of Extra Strength Acetaminophen in Canada.

“There is no reason in hell why 500 milligram units should be available,” said Dr. Yoshida. “People mistakenly believe that they are getting a stronger drug when all they are getting is more acetaminophen.”

He noted that people who are in psychological distress and want to harm themselves need only reach for a bottle of 500-mg units of Acetaminophen, which are now sold in 500-capsule bottles by major Canadian retailers.

“It’s like having easy access to a handgun,” said Dr. Yoshida.

Worse, he adds, are unintentional overdoses, which he said he believes account for the majority of hospitalizations for acute liver failure from acetaminophen that occur in Canada each year, though the ISMPC puts the number at only 20%.

Dr. Yoshida says accidental overdoses are due to a number of factors, including the ubiquitous presence of acetaminophen in over-the-counter cold and pain relief medications, consumer ignorance and temerity.

He also blames Health Canada for failing to protect the public by blocking the sale of 500 mg units of Acetaminophen, and for increasing the maximum recommended daily dose from three grams to the current four—something Extra Strength Tylenol maker Johnson & Johnson did on a voluntary basis in the U.S.

Other Canadian scientific heavyweights have also spoken out against the 500-mg units.

“The less acetaminophen the population uses the better, and the more a regulator helps people understand the potential harms and limited benefits, the better,” Dr. David Juurlink, head of the division of clinical pharmacology and toxicology, department of medicine at the University of Toronto told the National Post in early January.

Dr. Juurlink added that in his opinion, acetaminophen would not be approved for over-the-counter sales because it provides limited pain relief and can be toxic at levels just above recommended doses.

He also said there is “emerging concern” about the use and effect of acetaminophen use among pregnant women.

CANADIANHEALTHCARENETWORK.CA