Abstract
BackgroundIn order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). Our aim was to determine whether this resulted in smaller overdoses of paracetamol in Ireland compared with the UK.MethodsWe used data on general hospital presentations for non-fatal self-harm for 2002 - 2007 from the Multicentre Study of Self-harm in England (six hospitals), and from the National Registry of Deliberate Self-harm in Ireland. We compared sizes of overdoses of paracetamol in the two settings.ResultsThere were clear peaks in numbers of non-fatal overdoses, associated with maximum pack sizes of paracetamol in pharmacy and non-pharmacy outlets in both England and Ireland. Significantly more pack equivalents (based on maximum non-pharmacy pack sizes) were used in overdoses in Ireland (mean 2.63, 95% CI 2.57-2.69) compared with England (2.07, 95% CI 2.03-2.10). The overall size of overdoses did not differ significantly between England (median 22, interquartile range (IQR) 15-32) and Ireland (median 24, IQR 12-36).ConclusionsThe difference in paracetamol pack size legislation between England and Ireland does not appear to have resulted in a major difference in sizes of overdoses. This is because more pack equivalents are taken in overdoses in Ireland, possibly reflecting differing enforcement of sales advice. Differences in access to clinical services may also be relevant.
Highlights
In order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies and non-pharmacy outlets, and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets)
* Correspondence: keith.hawton@psych.ox.ac.uk 1Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK Full list of author information is available at the end of the article In Ireland, similar legislation was introduced in October 2001 [6] but pack sizes were restricted to considerably lower maximum amounts than in the UK, namely a maximum pack size of 24 tablets in pharmacies and 12 tablets in non-pharmacy outlets, with just a single pack to be supplied in any one transaction
We investigated the number of tablets of paracetamol consumed in overdoses which resulted in presentation between 2002 and 2007 to six general hospitals in three centres in England, and all general hospitals in Ireland, for persons aged 10 years or more
Summary
In order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). The UK legislation appears to have had beneficial effects, at least in England and Wales, in terms of reduced sizes of overdoses and numbers of deaths and liver transplantations [1,7], some commentators have disputed this [8,9,10]. In Ireland, on the basis of calls to the National Poisons Centre, the change in pack sizes of paracetamol appeared to have resulted in smaller overdoses (i.e. reduced number of tablets) in the first two years after the legislation [12]. Data on deaths involving paracetamol in Ireland have not been published
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