Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?

Abstract

It has been suggested that making the means of suicide less accessible to patients may result in reductions in method specific suicide rates and in overall suicides.89 In this paper we examine trends in paracetamol poisoning in countries where the availability of paracetamol differs -England and Wales and in France. In England and Wales paracetamol is freely available in unlimited quantities from chemists and up to 12 g may be purchased from supermarkets. In France paracetamol may only be purchased from pharmacies and the contents of each pack of paracetamol is legally limited to 8 g. Our aims were to investigate whether trends in the availability of paracetamol affect the frequency of both non-fatal overdoses and suicides in which paracetamol is used, and to determine if differences in the availability of paracetamol in England and Wales and France affect morbidity and mortality from paracetamol overdose. Methods

Acetaminophen‐induced acute liver failure

“…Legislative changes in the United Kingdom leading to restrictions in the sales of acetaminophen have reduced the number of patients dying from or needing transplantation because of acetaminophen hepatotoxicity. 33,[41][42][43][44][45][46] Because most cases in the United Kingdom are considered to be suicidal, they differ in that sense from unintentional cases. Nevertheless, efforts to limit OTC package size and to restrict the prescription of narcotic-acetaminophen combinations (or to separate the narcotic from the acetaminophen) may be necessary to reduce the incidence of this increasingly recognized but preventable cause of ALF in the United States.…”

Etiologies of acute liver failure: Location, location, location!

“…4 France, a country that has some restrictions on paracetamol sales, sees comparatively fewer cases, though numbers may have increased in conjunction with an overall increase in sales. 5 Australia has reported that over 30% of cases seen at major transplant centers are due to this product as well. 6 The experience from Spain stands out as unique among characterized Western populations.…”

“…Both France and the United Kingdom have found that limited package size and restriction of amounts purchased has correlated with fewer paracetamol-related deaths. 5,9 An Irish study found that 30% of nonfatal overdoses in that country involved paracetamol, and that survivors reported relative ease of access as a principal reason for choosing that compound. 10 Paracetamol overdoses are reportedly common in Sweden as well, 11 and the list goes on.…”

Paracetamol Toxicity: A Review

“…[1] Paracetamol overdose is a common means of self-poisoning worldwide due its wide availability and accessibility. [2] It is widely available as a single-component medication and also as a component of a plethora of combination over-the-counter and prescription medications. Despite its safety when used properly, Paracetamol poisoning is one of the more common overdoses reported to poison centers.…”