Overdose figures prompt calls to reduce paracetamol pack size

Paracetamol poisoning is well and truly on the rise.
 
According to new research published in the Medical Journal of Australia, there were 95,668 hospital admissions between 2007–08 and 2016–17 with paracetamol-poisoning diagnoses – the leading cause of overdose in Australia.
 
The number of cases of toxic liver disease due to those overdoses ballooned by 108%, while the annual number of intentional overdoses increased by 77%.
 
Almost 72% of the overdose patients were female and the proportion of cases attributed to self‐harm was about 56%.
 
These figures led the study’s authors to call for an investigation into potential restrictions for the medication, including reducing pack sizes and changing the way paracetamol is sold.
 
Dr Christine Walker, a member of the RACGP Expert Committee – Quality Care (REC–QC), described the research results as surprising,  showing paracetamol poisonings and overdose are potentially flying under the radar in Australia.
 
However, she is not convinced restricting access to paracetamol in isolation would be the most effective measure.
 
‘There needs to be a big public health campaign to have people understand exactly what the issues are … [as] despite the growth in intentional overdose, there still appears to be an awful lot that was unintentional,’ she told newsGP.
 
‘Whether you release public health messages in tandem with restrictions, or whether it precedes it, I’m not sure … [but] with any kind of public health campaign, you’d want to talk about other ways to deal with pain, that taking a tablet is not always the best way.’
 
Dr Walker also said there is value in GPs potentially asking patients how often they’re taking non-prescription painkillers such as paracetamol, but more research needs to be done in order to better determine the reasons why people are overdosing.
 
‘It’s a public health issue that goes way beyond GPs. I would assume most GPs would not be involved in prescribing paracetamol [and that] most of it is bought over the counter,’ she said.
 
‘The increase in children … is extraordinary and people really need to know more about why it’s happening.’
 
Children aged 10–14 recorded the most marked increase in absolute cases of paracetamol overdose at 133%, while adolescent cases increased by 61%.
 
The study’s authors, led by the University of Sydney’s Dr Rose Cairns, pointed out there are no restrictions on the amount of paracetamol that can be purchased in Australia, while most European countries, for example, do not permit non‐pharmacy sales.
 
‘Paracetamol is the drug most frequently taken in overdose in Australia … whereas many European countries have reduced the incidence of paracetamol‐related harm by restricting pack sizes,’ the study states.
 
‘Public health measures that restrict the availability of paracetamol, such as reducing non‐prescription pack sizes, are needed to stem the increasing number of paracetamol overdoses.’
 
The most recent reduction in paracetamol pack sizes in Australia came in September 2013, when the most widely available sizes decreased from 25 x 500 mg tablets to 20 x 500 mg, with no change in pharmacy pack sizes. However, the researchers suggest this had ‘little impact’ on overdose size and numbers and that ‘more restrictive changes’ may be appropriate.
 
But while the authors advocate smaller pack sizes, they also produced statistics that indicate it does not always have the desired effect.
 
‘In the wake of increasing numbers of overdoses, liver transplantations and deaths, and evidence that paracetamol overdose is often impulsive (taking medications already in the home), paracetamol pack sizes have been restricted in the UK since 1998 to 8 g for non‐pharmacy sales and to 16 g for pharmacy sales (formerly: 50 g),’ the study states.
 
‘The number of large paracetamol‐related overdoses, liver unit admissions, and suicide deaths in England and Wales subsequently declined. However, these changes were not seen in Scotland, and the effectiveness of the measure has been questioned.’

overdose paracetamol poisoning