Paracetamol risk awareness needed

THE tragic 2017 death of a University of Otago student has raised wider concerns about our attitude to the common painkiller paracetamol and awareness of its dangers.

While coroner David Robinson found the 20yearold had not intended to take her own life, he recommended tighter sales restrictions on paracetamol which can be bought without control at supermarkets.

Since his September finding, Countdown supermarkets have voluntarily restricted sales of the drug to one packet per customer per visit.

News reports suggest unintentional overdoses from the painkiller have been increasing in many countries.

It seems people in pain may take more than the recommended dose because they think it will be more effective, not realising that this can cause liver damage because the body cannot process the drug safely.

The National Poisons Centre in Dunedin says paracetamol is the most common single substance involved in cases of intentional selfpoisoning and the substance it receives most inquiries about.

Reports to the centre of instances where people had taken 30g or more of the drug seem to be on the increase, with four cases in the last five months of 2016 but 54 cases this year by October 12.

Centre director Adam Pomerleau points out that the centre only captures those instances where people (patients or health providers) choose to contact it. Substances and amounts are reported by callers, but the centre is unable to independently verify the information. Nor does the centre record where the paracetamol came from — prescription, pharmacy, or supermarket sale.

He sees intentional selfpoisoning as a significant public health problem which is often an impulsive act by those harming themselves.

He suggested a reasonable hypothesis was that limiting availability of paracetamol could limit opportunities for impulsive intentional selfpoisoning.

Some believe restricting the amount of paracetamol which can be sold will help both intentional and unintentional overdosing. Making the medication something which is only available through a pharmacy or by prescription (and reducing the number of pills available on prescription) are other options.

Late last month Medsafe’s Medicines Classification Committee gave preliminary consideration to the coroner’s call for tighter restrictions, but what the next steps might be are unclear as there is not yet a formal proposal for change.

Regardless of whether there is a move for future restrictions, there is a need for better education of consumers.

We wonder if many of us have become blase about paracetamol use, not fully appreciating the seriousness of taking more than the eight 500mg tablets in 24 hours. After all, for years the main message drummed into us by marketers is that it is safe and gentle on the stomach.

There is information on packs about not exceeding the stated dose and on the information sheet inside packs bought over the counter. However, the medicine is so ubiquitous and trusted we would be surprised if many people pore over all the information available.

A move to more obvious labelling alerting people to the risk of taking too much and that this might lead to liver failure and death without prompt treatment would seem sensible. Whether people with conditions requiring ongoing prescriptions of paracetamol receive much information on the risks of overdose will be hit and miss, depending on the rigour applied to this by the health professionals involved.

Since the amount of paracetamol many typically have in their medicine cabinets has also been cited as an issue, we wonder how many consumers know they should be returning excess and expired medications to pharmacies for proper disposal, rather than storing them or flushing them down the toilet.

Perhaps those marketing the drug could take the initiative on such education.