Fall in paracetamol deaths 'linked to pack limits'

Paracetamol tablets Further reducing the limit on paracetamol tablets in each pack could be needed, the study says

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Deaths from paracetamol overdoses fell by 43% in England and Wales in the 11 years after the law on pack sizes was changed, according to a study.

But the number of people taking paracetamol overdoses had not declined, says the Oxford University study published in the BMJ.

In 1998, the government restricted pack sizes in the UK to 32 tablets in pharmacies and 16 in other shops.

Researchers say the figures should not lead to "complacency".

Paracetamol overdoses are a common method of suicide and a frequent cause of liver damage.

Previous studies suggested the decision to restrict the size of packs of paracetamol sold over the counter showed initial benefits in both these areas, but there was no data on the long-term impact.

Using figures from the Office for National Statistics, the Oxford researchers looked at deaths involving paracetamol in people aged 10 years and over between 1993 and 2009.

Start Quote

More needs to be done to reduce the toll of deaths from this cause”

End Quote Prof Keith Hawton Oxford University

They found there were 765 fewer deaths after the legislation was introduced in 1998 than would have been predicted based on trends dating back to 1993.

This equated to an average of 17 fewer deaths every three months after 1998.

The study also found that patients registered for a liver transplant because of a paracetamol overdose had reduced by 61% following the legislation. This was equivalent to 482 fewer registrations over 11 years.

More to do

Prof Keith Hawton, lead researcher from the University of Oxford Centre for Suicide Research, said lives had been saved since the change in the law.

"While some of this effect could have been due to improved hospital management of paracetamol overdoses, we believe that this has in large part been due to the introduction of the legislation.

"We are extremely pleased that this measure has had such benefits, but think that more needs to be done to reduce the toll of deaths from this cause."

graph from the BMJ report

Despite the reduction in deaths from paracetamol, the study found there had been no decline in overdose cases after 1998.

The study added that additional measures would be needed to reduce the death toll, such as further lowering the limit on tablets in packs, reducing the paracetamol content of the tablets and enforcing the legislation more effectively.


Catherine Johnstone, chief executive of Samaritans said: "When a person is in suicidal crisis, they will often think of a method that is easily available to them.

"It is during this time, we need to make sure that there are no barriers to seeking help aiming to widen the gap between thought and action in the hope that the crisis period will pass before a suicide attempt is made.

"This is the basic reasoning behind the reduction in the numbers of paracetamol pills sold in a pack and it's encouraging to see that legislation can have an effect on reducing suicides.

"The very act of calling an organisation like Samaritans can be sufficient to get a person through a difficult period and the experience of having another human being listen to your problems, in absolute confidence, can give someone the strength to see other choices."

Ged Flynn - from the suicide prevention charity, Papyrus - said the findings support the point that people are less likely to end their lives, if access to harmful things is made harder.

"An example would be, from our point of view, reducing access to information online, which is dangerous to young, vulnerable people."

Crisis point

Paul Farmer, from mental health charity Mind, said that despite the significant impact of paracetamol packaging, there was a bigger issue at stake. The latest statistics showed an overall increase in the number of people taking their own lives since the start of the recession.

"Now more than ever there is urgent need for support, to prevent people with mental health problems ever reaching crisis point.

"We need to see suicide training for GPs, better access to a range of therapies and, crucially, inadequacies in crisis care services must be addressed. People must be able to get the help they need when they need it the most."

A Medicines and Healthcare Products Regulatory Authority spokesperson said: "We welcome the findings of the study and the positive changes that resulted from the pack size restrictions implemented in 1998.

"The MHRA continuously monitors the safety of all marketed medicines and takes action as necessary. For paracetamol, this has included updating warnings to ensure they are well understood and improving the way paracetamol is given to children.

"The benefits associated with using paracetamol far outweigh the risk of serious side effects and we will closely review all options to manage the risks and benefits of medicines."


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  • rate this

    Comment number 17.

    Has any distinction been made between accidental and deliberate (i.e. suicide attempts) overdoses?

    If accidental deaths are being prevented fine, but I see no reason to inconvenience legitimate users of painkillers to protect people who have chosen to end their lives.

  • rate this

    Comment number 16.

    I'm sure I recently spotted 3 x 16 packs advertised for £1 in a major retailer.

  • rate this

    Comment number 15.

    If you want to kill yourself I am sure you could go to the extra effort of going round a few shops to buy up more packs of the stuff. For the rest of us 16 is just a really annoyingly low amount. It means you have to buy it more often and there are never any in when you need them.

  • rate this

    Comment number 14.

    This is a short term solution to a long term (the suicide) issue. Banning larger packs of paracetamol makes it harder to "hoard" for the winter, when you have all the family on sniffly noses and banging headaches. To be honest, people are just going to find another way to end it peacefully.

  • rate this

    Comment number 13.

    My wife gets near constant headaches, but cannot take anything stronger than Paracetamol due to other stronger things being either dangerous long term, or addictive.
    On a bad week that means we both have to go to the shop and queue up seperatly, then do it again several times.
    If you want them you can get them.
    If you want to kill yourself, I suspect people have found other, easier, ways.

  • rate this

    Comment number 12.

    This report is clearly misinterpreting the figures. They show a declining trend, not simply a step change following legislation. This suggests the influence of other factors such as growing recognition that paracetamol overdose is a poor option for suicide. Also the effect is boosted by using a short period for the pre-legislation trend. A poor study which should not result in legislation.

  • rate this

    Comment number 11.

    I think I'd rather hang myself than die of a paracetamol overdose.

    You don't just drift off into some kind of coma like you'd imagine, you wake up the next morning just feeling ill. It's two or three days later until the liver failure gets you and even then it's a long, drawn out process.

    Maybe a public information campaign highlighting just how horrifying and lengthy the process is would help?

  • rate this

    Comment number 10.

    Give it another year the government will be putting an extra 30p on a packet to save 100 more lifes every year.

  • rate this

    Comment number 9.

    the government restricted pack sizes in the UK to 32 tablets in pharmacies and 16 in other shops.????????????

    so what it is still possible to buy paracetamol tablets from every shop in town.. in supermarkets you could buy them several times a day the government has done nothing

  • rate this

    Comment number 8.

    I've never understood the point of this legislation. If somebody was that determined to commit suicide, I can't imagine they'd allow the limit at one shop to thwart their effort - what stops them going to another shop and another one after that? The cynic in me says the limit is in place just so that one shop alone can't be held responsible if somebody tops him/herself.

  • rate this

    Comment number 7.

    Do they really believe cutting how many packs can cut overdoses? Do they think a disturbed person can't go through the tills several times to buy enough to do themselves harm? My daughter took a paracetamol overdose before anyone thinks I am belittling the problem. Improved methods of treating paracetamol overdoses must lead to a reduction in mortality rates and hospitals should be praised

  • rate this

    Comment number 6.

    Not sure having less in a packet, makes you less likely to over dose. If you just get more boxes it be the same.

  • rate this

    Comment number 5.

    "But the number of people taking paracetamol overdoses had not declined" So ignorance, stupidity and/or a desire to harm yourself are the real problems, not pack sizes. I find it somewhat annoying and patronising that I can only buy a maximum of two of these silly baby packets at a time.

  • rate this

    Comment number 4.

    These smaller quantities in blister packs are surely easier for young children open.
    Can you still get paracetamol tablets in click lock bottles?

  • rate this

    Comment number 3.

    How then does Canada manage? My boyfriend regularly brings me tubs of 400 capsules when he visits from there.

  • rate this

    Comment number 2.

    If it's had an impact then that's great but as far as I'm aware suicide rates in general haven't decreased (and in some parts of the country they have even increased). So it feels like people are perhaps just using other methods/different drugs rather than the paracetamol changes really reducing suicides. More needs to be done to tackle depression, mental health and suicide in this country.

  • rate this

    Comment number 1.

    The law does not stop you doing a 'paracetamol crawl' - going to every shop that sells paracetamol in your town to buy two packs.

    Done this several times when me and both of my parents are all full of cold.


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