Back when I was in the Third grade, I got a really bad burn on my shoulder…long story for another day. I remember though, that my mom popped open a Tylenol capsule and poured the white powder over the raw pink skin that was exposed, before bandaging me up and sending me off to school. Yes, this was in the early 1990’s when people were more resilient and didn’t run to the emergency room, seemingly as often, but I digress. Has anyone else ever wondered why two piece hard capsules have virtually disappeared ? Now we have pills that look like capsules but, can no-longer be pulled apart and easily emptied of their content. What ever happened to those hard capsule pills that dominated the over-the-counter pain-killer market.

Apparently, there were several tampering’s of over-the-counter pain and cold remedies, that resulted in the deaths of several people, in several states, within the U.S. during the late 1980’s and early 1990’s. In 1986, Extra-strength Tylenol capsules were laced with cyanide in Peekskill, New York, resulting in the death of one woman. The same year, Excedrin and Anacin capsules were also tampered with. In Washington state, 1991, Sudafed-12 Hour capsules also had their content replaced with cyanide. The adulteration of which lead to a series of illnesses, two deaths, and a recall of the cold medication.

Commonly found in rat poisons and fumigants, Cyanide blocks cellular respiration, by interrupting the electron-transfer chain in the mitochrondria; the system that is necessary for energy production. The form of cyanide that is toxic upon ingestion is the alkali salt form. Sodium or potassium cyanide can produce death within minutes to hours upon ingestion of even small amounts. Cyanide has a bitter burning tastes; which one wouldn’t recognize while its encapsulated in a pill. However, after poisoning, ones breath takes on a bitter almond odor. Symptoms include: salivation, nausea (but not vomiting), confusion, lower jaw stiffness, convulsions, cardiac arrhythmias, and respiratory failure.

As a result of the Tylenol tampering, Johnson & Johnson willfully discontinued the manufacture and sale of all its over-the-counter capsulated medications. The company’s chairman cited “we fee the company can no longer guarantee the safety of capsules to a degree consistent with Johnson & Johnson’s standards of responsibility to its consumers.” This was because the capsule form of pills at that time were such that they could be easily pulled apart and put back together, which meant that anyone could open a capsule and alter the contents of the drug inside.

The solution was the replacement of the capsules with gel coated caplets introduced in the 1980’s. Caplets are smoothly coated (usually gelatin) tablets that look like capsules, but are solid and cannot be “opened”. Not all companies immediately decided to discontinue the use of capsules in exchange for caplets or tablets. The FDA did not ban them either, but did implement guidelines that required additional safeguards and improvements in design. In 1994, they proposed that the pills be sealed at the point where the two pieces join and that two tamper-resistant features accompany the packaging. Such precautions included, seals bearing company logos on blister-foil wrap, neck-bands on bottles, and breakable caps.

The practice of dosing medication in capsule form dates back to Ancient Egypt. The “modern” gelatin capsule was first patented in the 1800’s, but did not become popular until the 1931 invention of a machine that made their production easier. Capsules are filled with powders, pellets, granules, or even tablets and liquids. Caplets were introduced in the 1980‘s. The benefits of capsules and caplets over tablets are ease of swallowing and ability to traverse the esophagus and dissolve in the necessary gastrointestinal compartments (the stomach or intestine).Prescription pills and pills used in drug trials are still formulated in traditional two-piece capsule forms, as are some vitamins (caution should be taken with vitamins as they are not regulated). Today, caplets are more popular, but sealed two-piece hard capsules still exist, along with gel capsules, which provide containment of oils and medications dissolved in oils.

Always make sure to check that the boxes and bottles your over-the-counter drugs come in are properly sealed and that the pills themselves do not look tampered with. Opened boxes, broken blister-wrap, missing parts, or otherwise suspicious looking or smelling pills, should be avoided. It might be wise to familiarize yourself with the color, size and labeling of pills you commonly purchase.