Painkillers are some of the most readily available and ingested medicine in the modern world. Nowadays, where we have a huge range of painkillers available to us in the form of over-the-counter medicine, it is hard to imagine a world without them. However, before the 1800s, there was no means to relieve someone’s pain, which is the reason why operations would often result in the death of patients from the shock. Scientists and researchers in the United States and across Europe were trying to develop painkillers but to no avail. Finally, in the year 1804, a German pharmacist, Friedrich Sertürner isolated the first-known painkiller, i.e., Morphine; however, it took almost five decades for Morphine to be used as a painkiller via hypodermic syringe. To this day, Morphine is utilized in emergencies to relieve someone’s pain, especially, after an accident; however, Paracetamol is the most popular over-the-counter painkiller.
What is Paracetamol?
Also known as Acetaminophen, it is an over-the-counter medication used to treat aches, headaches, and mild fever. Interestingly, physicians don’t exactly know how it actually works, but some speculate that it slows the production of prostaglandins, which triggers the pain during a fever. Although Paracetamol is widely used to treat the mentioned symptoms, it only lowers body temperature in the case of fever, and physicians often prescribe ibuprofen to patients with persistent fever. Paracetamol was discovered in 1886 by Arnold Cahn and Paul Hepp; however, it was not used until 1950 in the United States. Arnold Cahn and Paul Hepp tried to bring it to the medical world under the name Antifebrin in 1886 but their attempts were failed because of the toxic side effects that included Cyanosis, a condition where the number of oxygen molecules bonding with red blood cells significantly drops, resulting in the skin turning purple. Following that, it was synthesized, and a German pharmacologist, Joseph Von Mering tried Paracetamol on humans in 1887, and after thorough research, he published a study that stated Paracetamol forms hemoglobin that isn’t able to carry oxygen. This study was accepted for over half a century, and finally, in 1947, two American biochemists, David Lester and Leon Greenberg tested and confirmed that Paracetamol was safe for use, and in the following year, three biochemists, Bernard Brodie, Julius Axelrod, and Frederick Flinn confirmed the tests on Paracetamol. Finally, in 1950, Paracetamol was sold under the name of Triagesic, and it was sold under prescription with a combination of caffeine and aspirin to provide relief from the pain without inducing sleep. Once again, the sale of Paracetamol was halted, but this obstacle was short, as it was brought back in 1953 by The Sterling-Winthrop Company, and it was given a new name, Panadol. Shortly afterward, McNeil Laboratories started selling Paracetamol in 1955 under the name Children’s Tylenol Elixir, and today, Tylenol is the most popular painkiller in North America. By the 1980s, all patents were expired; pharmaceutical companies started selling Paracetamol under different names, and it became widespread across the world. Paracetamol is available largely in the form of tablets and capsules; however, it is also available as a syrup. Presently, it is sold on its own, or in combination with other substances, these are co-codamol (paracetamol and codeine), co-dydramol (paracetamol and dihydrocodeine), and Tramacet (paracetamol and tramadol).
List of Countries where Paracetamol is Banned
The United States (California)
It may be surprising; however, Paracetamol or Acetaminophen is actually banned in the state of California. The studies and discussions over this medicine have been ongoing since 2011, and Paracetamol has been banned and unbanned on several occasions. Presently, it is banned in California; however, seeing the Covid-19 pandemic it might become available once again under prescription.
Reason for the Ban
While the experts in California were trying to take down Tylenol (Paracetamol) since the 1990s by stating it was carcinogenic, International Agency for Research on Cancer and The United States Food and Drug Administration denied these claims and stated that labeling Tylenol as carcinogenic would be misleading. In 2011, a panel of scientists appointed by the governor placed Tylenol as a high-priority substance for testing and research. According to the chairman of the Carcinogen Identification Committee, simply labeling it as carcinogenic is extremely difficult because of how many patients rely on it on a daily basis. From that point, Tylenol was banned and became extremely restrictive. However, it was re-introduced to the market after a few months. This on and off sales of Tylenol has been consistent in California. The Consumer Healthcare Products Association, an organization that represents over-the-counter medicine conducted its own study and found no evidence of Paracetamol causing cancer. This tug-of-war between these organizations is constant, but the government of Califonia is seriously considering placing Tylenol under the carcinogenic list. Plus, Tylenol Extra Strength, which has 500mg of Paracetamol had been recalled numerous times throughout the country.
California considering listing common pain killer acetaminophen as a carcinogen https://t.co/6zrvkEofjJ
— CTV News (@CTVNews) January 21, 2020
Although Paracetamol has been consumed in this country for over two decades, certain Paracetamol combinations have been banned in India since 2016. Interestingly, nearly 25% of the entire world’s Paracetamols are consumed by India, which makes it the third-largest consumer of this drug after the United States and China. Moreover, India is also the country where excessive doses of Paracetamol had been sold more than any other nation.
Reason for the Ban
Similar to Tylenol Extra Strength, there are numerous tablets in India that contain over 500mg of Paracetamol like Vicks Action 500, Dolo 650, T-98 to name a few. Among all of these only Vicks Action 500 has been banned because of the combination drug policy that was implemented in 2016. According to this law, medicines that don’t react well when combined with other substances must be banned. Despite the ban, Paracetamol is the primary drug that is prescribed to people who get vaccinated for Covid-19. Sadly, no studies have been conducted on the interaction between Covid-19 vaccines and Paracetamol, it is a trial-and-error situation. Although this ban is in place, most of the medicines that are sold with alarming amounts of Paracetamol are not bounded by this law, therefore, they are easily available. In 2011, Lincoln Pharma launched a long-lasting medicine called PA 12 that contained a ridiculous amount of Paracetamol, 1,000mg to be exact. According to Lincoln Pharma, their medicine was designed to only release 300mg of Paracetamol in one shot, and the remaining 700mg is released slowly over the course of 12 hours. PA 12 being an over-the-counter medicine has people ingesting more than one tablet in a day, quickly increasing the maximum dosage of Paracetamol in 24 hours. There have been cases of liver damage with just two tablets but there is no such law on the maximum Paracetamol per tablet. Also, amidst of Covid-19 pandemic, the Indian government has placed a ban on exporting Paracetamol tablets.
No more 'Vicks Action 500 Extra' as P&G stops sale after govt ban https://t.co/VpKVldfKEV pic.twitter.com/TQLoT5pVpe
— Business Standard (@bsindia) March 15, 2016
In 2021, when the entire world was fighting Covid-19, New Zealand emerged as the first nation completely free of Covid-19. The number one drug that was used to provide relief to Covid-19 patients has been restricted in New Zealand; however, the restrictions in this country on Paracetamol are not because of side effects or abuse.
Reason for the Ban
Amidst the Covid-19 pandemic, New Zealand is facing a shortage of Paracetamol medicines. Oakley Mental Health Research Foundation funded a study in 2020, in which 201 houses were surveyed by the University of Otago, and it was founded that almost all the houses had a readily available stock of Paracetamol, up to 360gm that could’ve been utilized by hospitals. Therefore, the government has restricted the sale of Paracetamol to one pack (10 Tablets) per person, and also, it is only available via prescription. Plus, the medicines that contain 500mg of Paracetamol are even more limited, the exact numbers are not revealed by the authorities; however, it can be as little as 5 tablets per person. These restrictions were placed in March 2021, and while it was deemed temporary, it is still in action. Also, the export of this drug has been halted for the time being. Additionally, a recent study was carried out in February 2022 by the University of Auckland, which shows the possible link between the usage of Paracetamol during pregnancy and depression in young children. Physicians are now suggesting women take small doses of Paracetamol during pregnancy. According to some experts, this study may even result in a ban of Paracetamol altogether.
Similar to New Zealand, the Philippines is also facing a shortage of Paracetamol; however, in the Philippines, the shortage is for other reasons, and only a slight margin of it is because of Covid-19.
Reason for the Ban
According to a doctor at Philippine General Hospital, there is a significant rise in the demand for Paracetamol in recent years. She stated that people are buying this medicine as a trend. Moreover, she concluded that Paracetamol only treats the discomfort and pain that is usually experienced due to fever, but it doesn’t cure the fever itself. Plus, it doesn’t help the fact that since Covid-19 arrived in the Philippines there has been a constant shortage of Paracetemol, seeing this, the government has placed a restriction on Paracetamol, along with Phenylephrine Hydrochloride, Chlorpheniramine Maleate, and Carbocisteine. As for now, only 60 tablets are allowed per household only under prescription.
Throughout the world, numerous studies are emerging that state that Paracetamol might actually be doing more harm than good. Firstly, researchers from the University of Sydney conducted research and tested Paracetamol on 44 different conditions. They concluded that this drug doesn’t work on the tested conditions, and even if it did, it was so minuscule that its simple rest could give the same results, so its effects are nothing but placebo; however, the overdose of Paracetamol can lead to liver toxicity and other problems. Another study conducted by the researchers of the University of Sydney stated that prolonged usage of Paracetamol can lead to high blood pressure and cardiovascular diseases.
Long-term paracetamol use could increase the risk of heart disease and strokes in people with high blood pressure, according to BHF-funded research https://t.co/hIGYKKzBvZ
— BHF (@TheBHF) February 8, 2022