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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.

Original publication

DOI

10.1093/qjmed/hcr135

Type

Journal article

Journal

QJM

Publication Date

01/2012

Volume

105

Pages

41 - 51

Keywords

Acetaminophen, Adolescent, Adult, Aged, Analgesics, Non-Narcotic, Choice Behavior, Drug Labeling, Drug Overdose, Female, Guidelines as Topic, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Motivation, Practice Guidelines as Topic, Suicide, Attempted, Young Adult