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 377.

    I tried to commit suicide with cannabis. After realising it was impossible, I tried mushrooms and LSD since they are Class A drugs and are clearly deadly. All the trouble I went to to obtain these substances, when I could have simply gone to Tesco and bought a bottle of glen's and some paracetamol for less than the price of a half quarter of weed.

  • rate this

    Comment number 376.

    349. Sarah
    Rubbish, I can go to the supermarket and buy two packets, I can then go to Boots and buy 2 more, then another supermarket and another and a different chemists...
    You don't even need to do that. You just run them through the self-checkout till at the supermarket in multiple transactions (or go to different manned tills)

  • rate this

    Comment number 375.

    Proper hard factual EDUCATION about paracetamol use/ abuse wouldn't be a bad idea because the vast numbers of people who accidentally or out of ignorance of the facts do overdose every year is astounding!!! I've told quite a few people myself about the dangers of what they're doing by taking too many paracetamols within a time frame, many think they're relatively 'harmless' & they're NOT!

  • rate this

    Comment number 374.

    Perhaps, an this is just a thought, we should have a national purchasing register, that limits as in this case Paracetamol purchases to only 1 or 2 packs a month without prescription, they do this Australia not with Paracetamol but with sudiphedrine as it is a key component in the Street drug “ICE” so you have to produce ID, it is enterd into a computer and your purchases are restricted

  • rate this

    Comment number 373.

    I was quite vocal in criticising the "nanny state" when this legislation came out. Like many others with similar views I have been proved to be wrong and am happy to admit it.
    Just one thought however, have the pharmaceutical companies not benefited because of the higher cost of smaller packs ?

  • rate this

    Comment number 372.

    Paracetamol unintentional overdoses are a problem too- taking 2 tablets (1g) 6x daily not 4x (as recommended) for 2 weeks for e.g. toothache can cause liver damage in a more insidious but equally dangerous way as taking 30 tablets at once. Pack size won't solve this, education and warnings are required both for regular users not intending to harm themselves and those that do.

  • Comment number 371.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 370.

    #367 SAB

    You'd need to look into the number of suicide attempts by paracetamol overdose and compare it to number of suicide attempts using bleach. Also accidental overdose of paracetamol compared to accidental misuse of bleach. You'll have to do your research and therein will lie the answer to your question I don't doubt. :)

  • rate this

    Comment number 369.

    I see no appreciation here that suicide is considered justifiable in many parts of the world. Just because the state here is not in favour of it does not mean that the pro suicide view should be censored. So BBC take note. If there are comments here implying that suicide is not necessarily always wrong you should publish them.

  • rate this

    Comment number 368.

    People may not realise how numerous but ineffective paracetamol ODs are. There are less than 1000 deaths a year in the whole country (estimated from the figures above) but1000+ODs a year in my small DGH, consider that figure in each hospital across the UK the proportion dying is very small. This is thanks to 1-small pack size and 2-serious suiciders generally chosing methods other than paracetamol

  • rate this

    Comment number 367.

    "Well of course it's not possible to protect everyone from every possible danger every second of every day. Only a fool would try."


    So what puts paracetamol in a different category to bleach in this context?

  • rate this

    Comment number 366.

    #362 SAB

    Well of course it's not possible to protect everyone from every possible danger every second of every day. Only a fool would try. That's not really an argument to do nothing about anything though.

  • rate this

    Comment number 365.

    Educating people is what would be more effective, people are uneducated and narrow minded over mental health illness. Surly the more we learn to beable to talk about such issues and the less afraid people are of talking about them the more people will understand and beable to help such cases. Reducing packet sizes will never be a solution to the problem.

  • rate this

    Comment number 364.

    You may not realise quite how numerous paracetamol ODs are, or how ineffective in most cases. From the numbers above we can estimate the total deaths/UK a year at

  • rate this

    Comment number 363.

    People who are genuinely likely to try suicide are desperately sad about something, fix that & you take away the desire to die. That's as simple as it gets! For those just attention seeking, put them through a process of education of what a failed attempts can do to you, if everyone was fully aware what paracetamol overdose can do to you I'm sure most contemplating that method would reconsider it!

  • rate this

    Comment number 362.


    Because the abuse of things other than paracetamol are just as deadly

  • rate this

    Comment number 361.

    Where do these idiots get their figures from? After reading this article I thought I'd check it out,and found that a visit to three supermarkets and two chemists gave me 80 paracetamol tablets in fact in one well known chemist I could have bought 32 with no questions asked. I thought when we got rid of B-Liar, McClown et al the nanny state would disappear. If people want tablets they'll get them.

  • rate this

    Comment number 360.

    240 Sjelekval
    If you're feeling in despair or suicidal, it could make all the difference to talk to someone who is trained to help you deal with the problems that you may be experiencing.

    Please try to speak to some who can help, such as your GP or the Samaritans.

    08457 90 90 90
    Textphone: 08457 90 91 92
    Text: 07725 90 90 90

  • rate this

    Comment number 359.

    Until a few days ago I was working on a medical admissions unit. We got a lot of paracetamol ODs usually booze fuelled, post arguments with boy/girlfriend, usually in people who had done it multiple times before, usually in people who in the end wanted attention not death. Reduced pack sizes have saved lives that idiots acting on impulse never intended to lose.

  • rate this

    Comment number 358.

    #357 SAB

    Why do you ask?


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