Can IV Tylenol Help Curb The Opioid Crisis?

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Can IV Tylenol Help Curb The Opioid Crisis?

By Beth Leipholtz 06/21/18

Health experts are debating the efficacy of IV acetaminophen as a non-opioid pain management tool.

Image: 
surgeon adjusting iv drip in operation theater.

An approach to cutting back on opioid use isn’t proving as affordable or as helpful as thought, according to the Washington Post.  

In an effort to cut down on opioid use, some hospitals are turning to intravenous forms of medications like Tylenol. Boston Medical Center was one such entity, adding IV Tylenol as a method of pain management.

However, David Twitchell, Boston Medical Center’s chief pharmacy officer, says the price quickly became concerning. 

According to the Post, Mallinckrodt Pharmaceuticals increased the price of IV Tylenol and the medical center was projected to spend $750,000 on acetaminophen, which is the active ingredient in Tylenol, in 2015.

The Post notes that a normal tablet dose of acetaminophen costs only cents, but Ofirmev, the IV version, is $40 per 1,000 milligrams.

"It was going to cost us, without the intervention that happened, more than any other drug on our formulary. Think of the most expensive cancer drug,” Twitchell told the Post. “To me, that didn’t seem justified.”

Though some medical centers are attempting to turn away from opioids and instead utilizing options such as IV Tylenol, a recent study found that this approach may not be any more effective than taking the medication in tablet form. Some studies, on the other hand, claim there is a benefit to the IV medication. 

Another study published in the July issue of Anesthesiology examined seven years of data for bowel surgeries across 602 hospitals and determined that when it came to decreasing opioid use, IV acetaminophen seemed no more effective than taking a tablet form of the same medication. 

“It just seems very often, physicians have magical thinking about a new preparation of an old drug,” Andrew Leibowitz, system chair of the department of anesthesiology, perioperative and pain medicine at the Icahn School of Medicine at Mount Sinai and co-author of the study, told the Post. “Doctors do seem, in general when a patient is in the hospital, to favor IV medications as a knee-jerk reflex, even when equally effective oral medications are available.”

According to Mallinckrodt, the study was “significantly flawed” and argued that half the patients in the study had not even received a full dose of the medication.

IV Tylenol isn’t the only generic painkiller to be offered in IV form, the Post states. The Post also says that more types of IV painkillers are expected in the future. 

Erin Krebs, a staff physician at the Minneapolis VA Health Care System, led a study published in JAMA that determined that opioids were no more effective than non-opioids when it came to managing chronic back pain or hip and knee pain.

She tells the Post that while it’s good that physicians are reexamining prescribing opioids, they should be careful not to buy into other new medications too early.

"I think part of the reason we got into such a mess with opioids was really a lack of training and understanding of pain management," Krebs told the Post. "It’s a symptom of how little research we've done on the appropriate management of these really common conditions. These are some of the most common human ailments, and they have not received enough research attention, research funding or education."

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