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August 2022, Volume 72, Issue 8

Letter to the Editor

The Dark side of acetaminophen

Faryal Tariq  ( Gujranwala Medical College, Gujranwala, Pakistan. )



Madam, Risk-taking behaviour is defined as health concerning behaviours like unsafe sex, substance abuse and various sexual behaviours that result in increased mortality and morbidity.1 Risk-taking behaviour is highly prevalent among adolescents, especially males and factors like low socio-economic status, lack of support and insufficient paternal supervision results in high risk-taking behaviour.2 Maintaining physical intimacy and generation of a financial income are two main reasons for risky sexual behaviour in young homeless people of Pakistan.3 However, recently in 2020, Keaveney et al. found a strong link between acetaminophen and risk- taking behaviour by conducting a three double-blind placebo-controlled study among healthy young adults. The study revealed that acetaminophen works as an analgesic by inhibiting psychological processes such as affect heuristic, decision-making, and blunting affective reactivity. The first trial showed significant risk-taking behaviour on BART (Balloon Analog Risk Task) with a therapeutic dosage of acetaminophen having t (140) of -2.29 and P-value of 0.023. In contrast, studies1 and2 for risk perception showed significant T-test results.4 Overall, throughout all studies (n=545) acetaminophen increased risk-taking behaviour.

These findings raise quite a concern, especially in Pakistan due to its widespread use. According to a study in 2013, 82% of the population of Islamabad with a headache, self-medicated with acetaminophen.5 After carrying out a detailed literature search on PubMed and PakMediNet, very limited studies identified potential causes for risk-taking behaviour in Pakistan. One study conducted in 2016 in Naara Jail Hyderabad found that increased tea consumption with excess sleep had an inverse relationship with criminal behaviour, while high blood pressure and substance abuse had a direct relationship.6

The high use of acetaminophen in the general population and exponential increase in risk-taking behaviours in Pakistan like smoking, substance abuse, sexual violence and criminal law violation raises many questions on what should be the next big step?

This discovery calls for more studies on analysing the connection between acetaminophen and risk-taking. The policy of over the counter availability of acetaminophen in Pakistan should be revised. Patients should be counselled about over-dosing and its effect on the behaviour whenever prescribed. While prescribing it in Jail and psychic wards special caution should be taken to prevent risk-taking. Awareness about acetaminophen's behavioural impact should be propagated through media campaigns in the general public of Pakistan.


Disclaimer: None to declare.


Conflict of Interest: None to declare.


Funding Sources: None to declare.




1.      Smout A, Newton NC, Slade T, O'Donoghue B, Chapman C. The relationship between early risk-taking behavior and mental health problems among a nationally representative sample of Australian youth. J Affect Disord. 2020; 272:239-48.

2.      De Jager M, Naudé L. Antecedents of risk-taking behaviour among South African adolescents. J Psychol Afr. 2018; 28:382-8.

3.      Noor MN, Holt M, Qureshi A, de Wit J, Bryant J. Sexual risk?taking among homeless young people in Pakistan. Health Soc Care Community. 2021; 29:1550-8.

4.      Keaveney A, Peters E, Way B. Effects of acetaminophen on risk taking. Soc Cogn Affect Neurosci. 2020; 15:725-32.

5.      Ghumman SS, Nadeem M, Nawaz AJ, Azeem MU, Khan ZH, Mazhar SM. Self-management of headache: a cross-sectional survey in the General Public of Islamabad. J Pak Med Assoc. 2013; 63:1210-4.

6.      Soomro NA, Naseem C, Amur SA, Muhammad M, Maniya P, Khuhro Q. Factors associated with delinquent behaviour of inmates at Naara jail Hyderabad, Pakistan. Rawal Med J. 2016; 41:441-5.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: