Educating Airmen on medication misuse, abuse may prevent future deaths

  • Published
  • By Capt. Brus Vidal
  • 22nd Air Refueling Wing
MCCONNELL AIR FORCE BASE, Kan. (AFPN) --  While the Air Force continues to focus on suicide prevention and awareness, one specific issue Airmen should understand is proper medication use and suicide attempts. 

Drug overdose and self-poisoning are two of the most common methods used in suicide attempts, said Lt. Col. (Dr.) Donald Christensen, 22nd Aeromedical-Dental Squadron commander. Acetaminophen, commonly known as Tylenol, is now the most frequently used drug in attempted suicides. Often, acetaminophen is the sole component that is ingested in a suicide attempt, but sometimes other medications may also be involved as a combination overdose. 

According to officials, acetaminophen is a very safe and effective drug when properly taken. However, when used improperly, it can be deadly. Intentional overdose of this medication accounts for 100,000 calls to poison control centers, 56,000 emergency room visits, 26,000 hospitalizations, and 450 deaths annually in the United States, according to the Centers for Disease Control and Prevention. 

Doctor Christensen said these alarming facts are in part due to a number of fallacies or misconceptions about Tylenol and its use. 

“Tylenol, like any other medication, is not a benign drug,” Doctor Christensen said. “Because it’s cheap, over-the-counter, and has well-known status, people have the idea that ‘If I take a large enough dose, I may get sick, but I’m not going to die;’ That’s the fallacy … and there lies the faulty logic."
 
Taking more than the prescribed dose of Tylenol is dangerous because it attacks the human liver and, if the dosage is large enough, it can and will kill a person, Doctor  Christensen said. 

“Tylenol itself, when taken into the body naturally gets metabolized to a chemical byproduct that is very toxic to the liver," he said.

“However, our bodies are put together in a marvelous way, whereby certain liver enzymes will take that toxic component and convert it into a non-toxic chemical component that the human body can effectively deal with,” Doctor Christensen said. 

“The resultant liver damage from a Tylenol overdose is initiated when the amount of drug ingested exceeds the enzyme’s ability to convert the bad (toxic) metabolite to a good (non-toxic) chemical. When this situation occurs, the bad (toxic) metabolite stays around and eats away at your liver.” 

Many suicide attempts are performed as a means to reach out for help, and those who chose this medication and method do so thinking that Tylenol can’t really kill them, he said.

Treatment for a Tylenol overdose includes observation and possibly other medication.
After emergency evaluation and treatment, (which may include, “pumping your stomach”) all individuals who significantly overdose on Tylenol are placed in intensive care for observation and follow-up. Early laboratory testing will determine the amount of Tylenol in the blood. Such testing will tell if liver damage and subsequent liver failure is likely to occur. This all depends on the severity of the overdose. If blood testing indicates a high probability of liver damage and the patient's condition confirms such probability, Doctor Christensen said there is a medication that is used to potentially reverse the overdose effects. 

However, that medication, Acetylcysteine (Mucomyst), is not 100 percent effective in halting any or all ensuing liver damage. This treatment medication is administered orally as a drink and a person must ingest 17 doses over a 24-36 hour period. He said taking this treatment medication is not a pleasant experience. 

Addition, if an adult consumes a lethal amount of Tylenol, it generally takes three or four days for death to occur. “It’s not an instant death at all,” Doctor Christensen said. 

“As health-care providers, our main goal is to save the liver. If the ingested amount of Tylenol is too great for the liver to handle, it will begin to fail and we desperately try to overcome that failure with the Mucomyst medication,” the doctor said. 

“All scenarios and individuals are different, but sometimes once liver damage begins it can rapidly continue to full blown liver failure and death will soon ensue," he said. "When the liver is in complete failure, the only treatment is a liver transplant, which generally doesn’t happen. Once the liver fails, it fails.”

Because a Tylenol-overdose-induced death is not instant or extreme, the vast majority of these suicide attempts go unreported or unnoticed in mainstream America. 

“We hear on the news about the sensational deaths, or suicides of famous people, or when weapons are used,” Doctor Christensen said. 

In fact, according to the National Institute of Mental Health there are an estimated eight to 25 attempted suicides for each completed/successful suicide death. While suicide by firearms account for nearly half of all suicides, the use of Tylenol overdose accounts for 61 percent of suicide attempts and 9 percent of all suicide completions. 

“Tylenol is a phenomenally great drug, and I want to stress that. It’s very effective when used in the proper context. But, like any other drug, it’s got its dangers," Doctor Christensen said.

“Suicide is a hot issue in the military and suicide attempts can happen to anyone, at nearly any age,” Doctor Christensen said. “Obviously, it’s a terrible thing to deal with and there are many questions that arise when someone either attempts a suicide or is successful in their demise. Therefore, our hope is to educate our airman and those associated with our airman on the 'not so obvious' dangers of a commonly-used medication. Also, we need to take notice of our associates and peers in better recognizing someone who may be approaching a 'crying out for help' phase of their life. 

“We in the military have many avenues to seek help and treatment -- the key is to take notice of someone who might be heading down that path,” the colonel said.