What can be done to reduce mortality from paracetamol overdoses? A patient interview study

• Published in: QJM : An International Journal of Medicine Vol. 105; no. 1; pp. 41 - 51
• Main Authors: Simkin, S., Hawton, K., Kapur, N., Gunnell, D.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2012
• Subjects: Acetaminophen - poisoning; Acetaminophen - supply & distribution; Adolescent; Adult; Aged; Analgesics, Non-Narcotic - poisoning; Analgesics, Non-Narcotic - supply & distribution; Biological and medical sciences; Choice Behavior; Drug Labeling; Drug Overdose - prevention & control; Drug Overdose - psychology; Epidemiology; Female; General aspects; Guidelines as Topic; Health Knowledge, Attitudes, Practice; Humans; Male; Medical sciences; Middle Aged; Motivation; Practice Guidelines as Topic; Public health. Hygiene; Public health. Hygiene-occupational medicine; Suicide, Attempted - statistics & numerical data; Young Adult; Human; Medicine; Paracetamol; Analgesic; Antimigrainous agent; Mortality; Overdosing; Antipyretic; Patient; Overdose; Epidemiology; Interview
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcr135

Background: Paracetamol (acetaminophen) is the most common self-poisoning agent in the UK and a leading cause of fatal hepatotoxicity. Following legislation in 1998 to limit pack sizes, beneficial effects on paracetamol-related mortality and morbidity were reported in England. However, there are still over 100 deaths a year and evidence of breaches of sales guidelines. Aim: To investigate characteristics of people taking larger paracetamol overdoses and compliance with sales guidelines, to inform possible further initiatives to reduce paracetamol fatalities. Design and methods: Interview study of 60 general hospital patients who took overdoses of over 16 paracetamol tablets (8 g). Results: Half of all paracetamol overdoses involved over 16 tablets. Patients were predominantly young (three-quarters aged 16-40 years) and female (58.3%); over half (53.3%) had taken a previous paracetamol overdose. Three-quarters said they wanted to die. Half took the overdose within an hour of first thinking of it, half (53.3%) took tablets already in the home and 58.3% bought tablets specifically for the overdose. Ten people tried to buy more than 32 tablets in one transaction; four succeeded. Most knew that a paracetamol overdose could cause death or permanent damage (88.3%) and harm the liver (80.0%) but 70.0% thought they would lose consciousness. Warnings on packs had little deterrent effect. Media and internet influences were identified. Patients chose paracetamol because it was cheap and easily available. Conclusions: Further measures to reduce breaches of sales guidelines and the dangers of paracetamol overdose are required. Media and internet site producers should follow guidelines on reporting suicide.