Abstract
BackgroundIntentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance.ObjectiveThis cross-sectional study aimed to determine how much paracetamol is present and therefore accessible in urban New Zealand households, and sources from where it has been obtained. This information is not currently available through any other means, but could inform New Zealand drug policy on access to paracetamol.MethodsRandom cluster-sampling of households was performed in major urban areas of two cities in New Zealand, and the paracetamol-containing products, quantities, and sources were recorded. Population estimates of proportions of various types of paracetamol products were calculated.ResultsA total of 174 of the 201 study households (86.6%) had at least one paracetamol product. Study households had mostly prescription products (78.2% of total mass), and a median of 24.0 g paracetamol present per household (inter-quartile range 6.0–54.0 g). Prescribed paracetamol was the main source of large stock. Based on the study findings, 53% of New Zealand households had 30 g or more paracetamol present, and 36% had 30 g or more of prescribed paracetamol, specifically.ConclusionsThis study highlights the importance of assessing whether and how much paracetamol is truly needed when prescribing and dispensing it. Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it. Prescribers and pharmacists need to be aware of the risks of such accumulation and assess the therapeutic needs of their patients. Public initiatives should be rolled out at regular intervals to encourage people to return unused or expired medicines to pharmacies for safe disposal.
Highlights
Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it
Intentional self-poisoning (ISP) where too much of a medication or other substance is taken by a person for the purpose of self-harm is a common type of injury treated in Emergency Departments in New Zealand, with paracetamol commonly involved [1]
Hospital admissions due to poisoning occur at an annual rate of 115.4/ 100,000 in New Zealand, and again 65% of such presentations are due to ISP [12], with an annual rate of 70.86 hospital presentations per 100,000 population for suspected ISP [1]
Summary
Intentional self-poisoning (ISP) where too much of a medication or other substance is taken by a person for the purpose of self-harm is a common type of injury treated in Emergency Departments in New Zealand, with paracetamol (acetaminophen) commonly involved [1]. World Health Organization international data on suicide deaths show that New Zealand has roughly comparable rates to e.g. Australia, France, the United States, Czech Republic, and Ireland [13]. Young people, those living in deprived neighborhoods, and indigenous Maori have the highest rates of suicide [13]. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance.
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