Suicide‐related over‐the‐counter analgesic exposures reported to United States poison control centers, 2000‐2018

Abstract

Purpose To investigate suicide‐related over‐the‐counter (OTC) analgesic medication exposures among individuals ≥6 years old reported to United States (US) poison control centers. Methods Data from the National Poison Data System for the years 2000‐2018 were retrospectively analyzed. Results From 2000 to 2018, US poison control centers recorded 549 807 suicide‐related cases involving OTC analgesics, including 327 781 cases (59.6%) admitted to the hospital and 1745 deaths (0.3%). Most cases involved a single substance (67.5%) and occurred among females (72.7%) and individuals 6‐19 years old (49.7%). Overall, the rate of exposures increased significantly by 33.5% from 2000 to 2018, primarily driven by the increasing exposure rate among 6‐ to 19‐year‐old females. From 2000 to 2018, exposure rates for acetaminophen and ibuprofen increased, while that for acetylsalicylic acid decreased. Additionally, the proportion of cases resulting in a serious medical outcome or healthcare facility admission increased for all types of OTC analgesics. Acetaminophen and acetylsalicylic acid accounted for 48.0% and 18.5% of cases, respectively, and 64.5% and 32.6% of deaths, respectively. Both acetaminophen and acetylsalicylic acid had greater odds of healthcare facility admission (ORs 2.56 and 2.63, respectively) and serious medical outcomes (ORs 2.54 and 4.90, respectively) compared with ibuprofen. Conclusions The rate of suicide‐related OTC analgesic cases is increasing. Acetaminophen and acetylsalicylic acid cases are associated with greater morbidity and mortality. Prevention efforts should include implementing unit‐dose packaging requirements and restrictions on package sizes and purchase quantities for acetaminophen and acetylsalicylic acid products to reduce access to large quantities of these analgesics.

Neurobiological Basis of Increased Risk for Suicidal Behaviour

“…The effect is particularly evident in patients with elevated inflammation markers such as CRP [56]. Otherwise, it is also worth remembering that over the counter (OTC) NSAIDs are responsible for about 50% of suicidal attempts [58].…”

Benzodiazepine exposures among women of reproductive age in the US, 2004–2018

“…A study of adolescent suicidal ingestions reported to the NPDS found that most ingestions involved over-the-counter medications, perhaps reflecting more limited access to prescription medications. 60–62 However, our findings indicate that benzodiazepines are accessible to at least some adolescents with suicidal intent, although the source of the drugs cannot be determined.…”

Kidney Injury Following Ibuprofen and Acetaminophen: A Real-World Analysis of Post-Marketing Surveillance Data

“…Meanwhile, considering that the suicide rate of OTC analgesics increased significantly by 33.5% from 2000 to 2018 ( Hopkins et al, 2020 ), we eliminated all reports that used suicidal attempt as the purpose of medication ( Figure 1 ). We believed it was the suicidal population that the indication of the report meant that people who were suicidal or whose daily dose exceeded 12 g ( Tallarida, 1982 ; Pourarian et al, 2015 ; Fox et al, 2012 ).…”