Drug warriors add acetaminophen to opioid pain medication in order to cause nausea/malaise when abused, but acetaminophen also causes liver damage which makes it easier to overdose on the stuff. But drug warriors don't care because it's all counted as opioid overdose so they can point to that and say "See? Opioids are dangerous and need to be banned!".
Actually, it's the opiates
that cause nausea, NOT acetaminophen! Many, if not most, first time users of large doses of opiates will experience nausea or even vomiting.
Acetaminophen doesn't "cause" liver damage at therapeutic doses in most people. Too much
acetaminophen, i.e. "overdose", does cause liver damage. Acetaminophen + alcohol makes this more likely.
Pure opium isn't actually all that dangerous physically, just the shit that's added in order to punish people who use it.
This is true up to a point - pure opium (or opiates) at therapeutic doses is not very damaging (although overdoses can be fatal). In the case of FDA-approved medications NO, stuff is NOT added to opiate formulations to "punish" anyone.
Keep in mind that opiates mimic naturally occurring substances in the body called endorphins. They are very
similar, and the same mechanism the body uses to break down/process the natural chemicals work equally well on the opiates.
Is it true that acetaminophen is added to Vicodin/etc primarily in order to make the side effects of over-use worse?
No, complete bullshit. Opiates and acetaminophen relieve pain by different mechanisms and by combining the two greater pain relief can be achieved by lower doses of each than if they were used singly.
My husband is currently undergoing treatment for cancer. His two main pain medications are pure morphine sulphate (extended release) and something called "norco", which is an opiate (hydrocodone) and acetaminophen. He consistently reports greater relief of acute pain with the combination, and will choose the combination over a higher dose of just the morphine. Mixing opiates and other pain relievers (like acetaminophen, ibuprofen, aspirin, etc.) is done to provide another option for pain relief that works better than just opiates at least some of the time. It's not done to punish people.
Do opioids cause liver damage?
Slightly longer answer: because of the variability of human biology there probably are people for whom opiates cause or exacerbate liver problems, but liver problems in an opiate user are almost invariably combined with a combination pill (like norco) combining opiates with acetaminophen, and the damage is caused by the acetaminophen.
However, liver damage can alter how fast the body processes any drug, which can lead to significant problems regarding dosages and duration of effects. This can complicate medical treatment, and can lead to a greater chance of overdose because the drug isn't cleared as fast from a person's system as it normally would, leading to the drug building up in the system.
What long term damage does pure opioid(opiate? Opium? I don't know what the singular of that word is) do physically?
Constipation. And by that I mean slowing the digestive tract to the point that in extreme cases surgery may be required to remove impacted feces that have essentially solidified into a wad of cement. That's a rather extreme case, but it has happened. More typically is just nasty, nasty constipation where the person only shits once every week or two, with bloating, pain, etc.
Brain damage brought on by episodes of hypoxia due to high doses/over doses interfering with sufficient respiration.
Also, "opioid" is a category of drugs, like "antibiotic" or "NSAID". "Opiate" is generally the singular - "I am taken an opiate for this third degree burn I got saving kids from a flaming school bus". "Opiates" is plural: "Cancer pain sucks, they have me on two different opiates to deal with it."
Could liver damage make fatal opioid overdose easier?
As a general rule, liver damage makes any
fatal drug overdose easier.
Could liver damage make fatal acetaminophen overdose easier?
Absolutely. No questions. Yes it does.
Do current statistics account for acetaminophen overdose separately from opioid overdose?
Acetaminophen overdoses cause liver damage and in the US is the currently leading cause of sudden liver failure and liver transplants. Opiate overdose involves suppression of the respiratory system, leading to what is essentially suffocation (in some cases, opiate overdose can leading to vomiting, aspiration, and choking, where the victim essentially drowns in their own vomit). The two mechanisms of death are easily distinguished on autopsy even without performing a toxicology report.
Would autopsies even mark deaths from the acetaminophen in Vicodin separately from deaths caused by the actual opioid?