Call for smaller painkiller packs to reduce suicides

Doctors have called for a further reduction in painkiller pack sizes after research was published showing previous reductions had slashed suicide rates by a fifth.

The research, published in the British Medical Journal today, shows that suicidal deaths from paracetamol and aspirin fell by 22 percentage points in the year after pack sizes were reduced in September 1998. The reduction in suicides continued over the next two years.

Non-fatal overdoses were also reduced: by 20% for paracetamol and 39% for aspirin in three years. As a result, liver transplants and admissions to hospitals for paracetamol poisoning saw a 30% fall in the four years after the laws came into force.

But over the same period, overdoses from ibuprofen, which was not covered by the legislation, increased by 27% - although the number of deaths stayed the same.

Sue Simkin, senior researcher at the Centre for Suicide Research at Oxford University, said: "Legislation restricting pack sizes of analgesics in the United Kingdom has been beneficial. A further reduction in pack sizes could prevent more deaths.

"Other countries that have addressed this problem, such as France and Ireland, have had greater reductions in pack sizes than the United Kingdom."

She said the risk of liver poisoning from a paracetamol overdose substantially increases with the taking of more than 30 tablets for a person weighing 60kg.

"A further small reduction in pack sizes of paracetamol and salicylates would be unlikely to inconvenience users, and could have further beneficial effects in preventing deaths from self poisoning," she added.

The research showed that between 1996 and 1998, there were 364 deaths as a result of paracetamol or aspirin overdose. This had fallen to 274 in the years 1999 to 2001.

Deaths by aspirin saw a 46% fall, while paracetamol-induced deaths fell less sharply, by 29%. However, paracetamol overdoses are far more common.

The legislation, which came into effect in 1998, reduced the previously unrestricted sale limit for pharmacies to 32 tablets, and for other retail outlets from 24 to 16 tablets. They must be sold in blister packs, not bottles.

The aim was to reduce household stocks of analgesic drugs. Although there is nothing to stop someone buying two packs of painkillers, doctors say people usually attempt to commit suicide on impulse and use whatever they can find in the home.

Suicide rates overall fell during the period (a 12% fall for men and a seven-point fall for women), but these reductions were outstripped by the reductions in fatal painkiller overdoses.

Separate research published in today's Economist shows that suicides and unexplained deaths fell to a rate of 84 per million last year, a rate bettered in Europe only by Greece, Italy and Portugal.

One of the most dramatic falls is among women aged 45 to 75: their suicide rate now stands at a third of the level in the sixties. Suicides among males aged 15 to 34 are down by 31 percentage points from their peak in 1998.