The size of paracetamol packets sold in supermarkets could be reduced and limits introduced on the number of boxes that can be bought, in a bid to reduce injury and death from intentional overdoses.
The recommendations are contained in an independent expert report published by Australia’s drugs regulator, the Therapeutic Goods Administration. The report found rates of intentional paracetamol overdose were highest among adolescents and young adults, and more common among women and girls.
Survival rates following a paracetamol overdose are excellent, but only when medical treatment is sought within six hours, the report found. Otherwise, there is a serious risk of liver injury and sometimes death.
The report found the treatment of an overdose was more challenging after ingestion of modified release paracetamol compared with immediate release paracetamol. Modified-release tablets contain a higher dose which is released into the body slowly over a number of hours.
The report, therefore, recommends making modified-release paracetamol – currently available over the counter – prescription-only. Modified-release paracetamol has been completely banned for general sale in Europe due to the risk of liver injury and death.
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“In Australia, unlimited numbers of packs of paracetamol can be purchased without a prescription at pharmacies or supermarkets, with 96 or 100 tablet packs and 20 tablet packs, respectively, being the most commonly purchased through these channels,” the report stated.
Paracetamol overdose contributes to between 40 and 50 deaths in Australia each year. About half were due to liver failure; the remaining were likely cases where paracetamol was ingested but other substances ingested contributed largely or entirely to the death.
While hospitalisation and death rates have not increased in recent years, the report said: “There is a concerning increase of misuse in the community.”
“Deliberate self-poisoning accounted for the majority of poisoning [hospital] admissions in those aged over 10 years,” it said.
“The increases were most marked in those aged between 10 and 24, and for females, who accounted for two-thirds of admissions. Paracetamol poisoning … particularly intentional poisonings, were 2 to 3-fold more common in females than males, with a notable increase in events involving adolescent females in 2019-2021. Intentional poisonings are now almost twice as common as non-intentional poisonings.”
Young people who self-poisoned with paracetamol often had no prior history of self-harm, and the availability of paracetamol at home and the ease of buying it from pharmacies or supermarkets contributed to its use in self-harm by young people, the report found.
Impulsive and planned paracetamol overdose occur at similar rates with impulsive acts often using paracetamol already present in the home. The authors recommended increasing awareness about the safe storage of medicines and reducing stockpiling of unwanted medicines.
They also recommended restricting the purchase of paracetamol without a prescription to adults aged 18 years and older.
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Dr Rose Cairns, a senior research fellow with the University of Sydney’s school of pharmacy, said: “The increase in self-poisoning and self-harm amongst young people, especially young women, is being seen in lots of countries at the moment.”
“This report didn’t look into why this is increasing, but found anything that can reduce stockpiling and the number of tablets available in people’s homes is going to reduce harm,” she said.
In Australia, self-harm rates are high for young women with mental illnesses including depression, anxiety, post-traumatic stress disorder and eating disorders, a Women’s Health Victoria report found.
There have long been calls for the harms of paracetamol to be addressed, with people believing the wide availability of paracetamol means it is safe.
They may take more than recommended in an attempt to resolve pain, or mix paracetamol with other products without knowing that other medicines also contain paracetamol – or substances harmful when mixed with paracetamol.
A University of Sydney study published in the Medical Journal of Australia in 2019 called for measures that restrict the availability of paracetamol, given it was the drug most frequently taken in overdose in Australia.
The recommendations are open for feedback until October and will then be considered at the November meeting of the Advisory Committee on Medicines Scheduling.
Crisis support services can be reached 24 hours a day: Lifeline 13 11 14; Suicide Call Back Service 1300 659 467; Kids Helpline 1800 55 1800; MensLine Australia 1300 78 99 78; Beyond Blue 1300 22 4636
