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Smaller packs halve paracetamol deaths

More work needed to reduce high death toll in England and Wales

Louise Prime

Friday, 08 February 2013

The number of accidental deaths and suicides related to paracetamol overdose has roughly halved in the 11 years since legislation restricted pack sizes. But experts say in a study published today on bmj.com that there are still well over 100 deaths involving paracetamol every year in England and Wales, and suggest further measure might be needed to save more lives.

The number of paracetamol tablets allowed in a pack was restricted by UK legislation in September 1998, to a maximum of 32 in packs sold through pharmacy sales and 16 in non-pharmacy sales. Researchers, including Professor Keith Hawton from the University of Oxford Centre for Suicide Research, have assessed the impact of the legislation on paracetamol-related deaths and liver injury, in adults and children 10 or more years old.

They used data from the Office for National Statistics for drug poisoning deaths involving paracetamol in England and Wales for 1993-2009; and data from UK Transplant (now NHS Blood and Transplant) for registrations for paracetamol-induced liver transplantation in England and Wales for 1995-2009.

The total number of deaths in England and Wales involving paracetamol fell by 43% in the 11 years after legislation restricted pack sizes. There was also a significant reduction in the number of suicide or open verdict deaths involving paracetamol.

When one of the research team, Professor Navneet Kapur, was asked on BBC Radio 4’s Today programme this morning if other factors could have been responsible for the decline in suicides by paracetamol, he said: “Improved medical management [of overdose] might have had a small role.”

The number of registrations for liver transplantation for paracetamol-induced hepatotoxicity fell by 61%, although the number of actual transplants did not fall.

However, there are still 121 deaths caused by paracetamol every year, on average, and the authors say further preventive measures should be sought. They suggest that these could include lowering maximum pack sizes even further, stronger enforcement of legislation, and  possibly reducing the dose of paracetamol in each tablet from 500mg to 325mg – though they acknowledge that “it would need to be shown that such a further reduction would have no major effect on efficacy of pain relief”.

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