Increased availability of paracetamol in Sweden and incidence of paracetamol poisoning: using laboratory data to increase validity of a population‐based registry study

Gedeborg, Rolf; Svennblad, Bodil; Holm, Lena W.; Sjögren, Hans; Bardage, Carola; Personne, Mark; Sjöberg, Gunilla; Feltelius, Nils; Zethelius, Björn

doi:10.1002/pds.4166

Cited by 32 publications

(30 citation statements)

References 40 publications

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“…Reports of an increased number of self‐inflicted poisonings led to a decision as early as 2015 by the Swedish Medical Products Agency to prohibit paracetamol tablets to be sold outside pharmacies from November that year . It was later confirmed that the increased availability of paracetamol in Sweden from 2009 is associated with a 40% increase in the incidence of paracetamol poisoning . A similar positive relationship has also previously been reported between availability and consumption of products such as alcohol and sugar‐sweetened beverages .…”

Section: Discussionsupporting

confidence: 65%

Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study

Hedenrud

Sundell

Martinsson

et al. 2018

International Journal of Pharmacy Practice

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Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.

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Section: Discussionsupporting

confidence: 65%

Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study

Hedenrud

Sundell

Martinsson

et al. 2018

International Journal of Pharmacy Practice

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“…Hence, the potential danger of easy access to these medications should be carefully evaluated. Similar arguments have been put forward in some previous controversial reports focusing on the association of drug availability and incidence of poisoning …”

Section: Introductionsupporting

confidence: 72%

Availability of drug at convenient stores is not associated with an increased incidence of their poisoning

Jung

Kim

Hwang

et al. 2019

Pharmacoepidemiology and Drug

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Purpose In late 2012, South Korea revised the Pharmaceutical Affairs Act to make selected medications including acetaminophen, ibuprofen, and cold medications available in nonpharmacy outlets, including the 24‐hour convenient stores (CVS). The objective of this study was to identify whether the characteristics and trend of self‐poisonings associated with these medications were altered after the legislative change. Methods A retrospective study was performed using national data from the Emergency Department (ED)‐based Injury In‐depth Surveillance database. The patients diagnosed with poisoning were sorted from 2011 to 2016 and included in the study. As the Act was implemented from 2013, the demographic characteristics and clinical outcomes were compared before and after January 2013. A piecewise regression analysis was performed to determine the association between the monthly use of acetaminophen, medication for cold, and nonsteroidal anti‐inflammatory drugs (NSAIDs) and the incidence of total poisonings before and after the January 2013. Results Among 1 536 277 patients included in the database, 17 523 patients diagnosed with poisoning were enrolled. After the legislative change, the etiology of poisoning did not change, although the frequency of hospitalization from ED was significantly increased. The monthly trend for poisoning due to acetaminophen, cold medications, and NSAIDs showed no significant slope change between before and after the legislative change. The proportional use of acetaminophen and cold medications was significantly decreased, while that of NSAIDs was unchanged before and after the legislative change. Conclusions The change in the Pharmaceutical Affairs Act was not associated with any change in the monthly frequency of medication‐related poisoning.

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“…The so‐called pharmacist‐led medication appears as an important “chain link” to be encouraged and developed when considering the high level on confidence of people in pharmacists. For instance, in Sweden, where 42 products have been switched to OTC status since 2003, and where drugs like paracetamol have been available through nonpharmacy outlets since 2009 (Gedeborg et al, ), a consumer survey including 8,000 adults showed that pharmacy remains the most preferred OTC drug retailer (Westerlund et al, ). As key pivotal stakeholders in the decision‐making process (Bell et al, ; Chang et al, ; Gilmartin‐Thomas et al, ; Jonas, ), pharmacists are supposed to guide the consumer in making an appropriate choice and to identify inaccurate self‐diagnosis requiring a medical advice, so playing an important role as a point of access for providing OTC drug advice or physician referral when needed (Bell et al, ; Chang et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…The so-called pharmacist-led medication appears as an important "chain link" to be encouraged and developed when considering the high level on confidence of people in pharmacists. For instance, in Sweden, where 42 products have been switched to OTC status since 2003, and where drugs like paracetamol have been available through nonpharmacy outlets since 2009 (Gedeborg et al, 2017), a consumer survey including 8,000 adults showed that pharmacy remains the most preferred OTC drug retailer (Westerlund et al, 2017).…”

Section: Pharmacists Interventions In Analgesic Otc: Rationale Objmentioning

confidence: 99%

Self‐medication in pain management: The state of the art of pharmacists’ role for optimal Over‐The‐Counter analgesic use

Perrot

Cittée²,

Louis

et al. 2019

European Journal of Pain

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Background and Objective Self‐medication is associated with an important utilization of Over‐The‐Counter (OTC) analgesics. The medical outcome resulting from therapeutic options bypassing the physician prescription is a major issue. In that context, pharmacists are expected to play a crucial role. The main objective of this review was to analyse the state‐of‐the art of pharmacists' role in pain management self‐medication. Databases and Data Treatment An expert multidisciplinary group dedicated to self‐medication in pain was established. Selection of publications was performed from PubMedand EMBASE databases which was based on the use of “pain” and/or “self‐medication” and/or “self‐care” and/or “analgesics” and/or “painkillers” keywords, restricted to the past 10 years. Results A total of 480 papers were identified, 49 of which papers were considered relevant and finally kept for final discussion, on OTC pain management and pharmacist's role. Literature analysis demonstrates that OTC analgesics are generally safe when appropriately used. Risks associated with misuse or inappropriateness depend on patients’ vulnerability (elderly, pregnancy) or behaviour. Social cognitive theory‐based intervention and multimedia applications improve self‐medication but do not replace health care professional advice Pharmacists’ interventions may improve the benefits and safety of OTC analgesic medication, with a better management of pain. Conclusions Considering the heterogeneity of patients’ knowledge and behaviour reported worldwide, inappropriate use of OTC pain medication should not be underestimated. Community pharmacists are ideally placed to guide self‐medication or recommend a medical advice when needed. Embedding pharmacists in primary care pain management is essential and pharmacist‐led medication coupled with an appropriate training of pharmacy staffs should be encouraged. Significance Analgesics are widely used without prescription, all over the world. They represent the largest market of OTC drugs, with an overall benefit/risk ratio favourable when appropriately used. Because of potential individual risks associated to the ailment or to the patient's behaviour, pharmacists’ interventions have proven to optimize analgesic self‐medication, provided that pharmacy staffs are both available and more specifically trained. In the future, in pain management, especially self‐medication, pharmacists should play an increasing role and should be included in educational programmes and pain management guidelines.

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Increased availability of paracetamol in Sweden and incidence of paracetamol poisoning: using laboratory data to increase validity of a population‐based registry study

Cited by 32 publications

References 40 publications

Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study

Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study

Availability of drug at convenient stores is not associated with an increased incidence of their poisoning

Self‐medication in pain management: The state of the art of pharmacists’ role for optimal Over‐The‐Counter analgesic use

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