In new harm-reduction measures from next month, packs of paracetamol sold in Australia will contain fewer tablets, both in pharmacies and other outlets.
The Therapeutic Goods Administration (TGA) is also encouraging retailers like supermarkets to restrict sales to a single pack at a time.
Paracetamol is the most common cause of liver poisoning in Australia, and the updated regulations are intended to reduce harm to young people.
The country’s medical association says rates of paracetamol poisoning in girls and young women are two to three times higher than for boys and young men, reports the body’s journal, InSight.
Dr Rose Cairns, a poisons and pharmacology lecturer at the University of Sydney and director of research at the NSW Poisons Information Centre, said her research showed a marked increase in child and adolescent female self-poisonings over the past six years.
“Paracetamol is not only the leading cause of acute liver injury in Australia, but also in many other countries,” she said. It’s the drug most frequently taken in overdoses, and by young people.
The rates of self-harm by poisoning increased sharply during the Covid-19 pandemic restrictions but persisted when restrictions eased, Cairns added.
“This increase is particularly apparent in young people, teenagers, especially young women. Statistics have more than doubled in the past decade in that demographic.”
Her 2024 study looking at rates of self-harm in young people showed higher rates of poisoning for girls and young women – at 64% of self-poisonings documented.
During the pandemic, the increase in intentional poisonings in young people was just under 30%. Although for young men the increase was 11%, the rate for young women was more pronounced at 37%.
“It’s a lot more. For self-harm generally, young women outnumber young men three to one. With paracetamol, it might be an even bigger difference,” said Cairns.
A 2019 report co-authored by Cairns stated that while the gold standard treatment for paracetamol overdose is acetylcysteine, “adverse outcomes in patients with massive paracetamol overdoses, despite early administration of acetylcysteine, have recently been reported”.
Associate Professor Angela Chiew, a Staff Specialist in Clinical Toxicology & Emergency at the Medicine Prince of Wales Hospital and Clinical Toxicologist, NSW Poisons Information Centre, said the changes in pack sizes are important.
“The toxic dose of paracetamol is 10g or 200mg/kg – whichever is less – so in most adults, 10g is a toxic dose that if taken over 24 hours can cause liver injury, potentially liver failure, the need for liver transplant, and death if not treated with the antidote (NAC) in a certain time. Hence the decrease in the amount readily available from 20 tablets (10g) to 16 (8g) as a means of harm minimisation,” said Chiew.
A persistent problem
Cairns had also co-authored an expert report in 2022, commissioned by the TGA, regarding intentional paracetamol poisoning, especially among young people.
“When that TGA report was written, there was a tripling in paracetamol overdoses in teenage girls, in the decade before Covid. It was massive,” she said.
“The numbers were already rising pre-pandemic, then we saw this big spike with the pandemic, and things have settled somewhat since then but at a higher baseline than the pre-pandemic levels.”
Availability
Paracetamol will still be available over the counter, but she said the new restrictions aimed to address self-harm, while avoiding lack of access.
“The difference is that pack sizes available outside pharmacies have been reduced in size from 20 tablets to 16 tablets.
“In pharmacies, the pack size will shrink from 100 tablets to 50.”
The changes will not affect liquid paracetamol, used for children, or modified release (MR) paracetamol, which had already been moved behind the pharmacist’s counter a few years ago.
“Paracetamol will also be in blister packs now, as that’s been shown to reduce the number of tablets people take. The data show most self-poisoning is impulsive, and the time taken to pop out a tablet reduces the amount taken,” she said.
“It’s something that won’t restrict access to people but might prevent harm.”
UK restricted paracetamol in 1998.
Cairns said similar restrictions on paracetamol had been in place in other countries for decades.
“Many countries in Europe don’t even allow non-pharmacy sales of paracetamol. The UK made similar restrictions to what we’re about to do, in 1998.”
Study details
Self-poisoning in young Australians: The impact of Covid-19 and recent trends following easing of restrictions
Nicholas Buckley, Firouzeh Noghrehchi, Rose Cairns et al.
Published in Australian and New Zealand Journal of Psychiatry on 18 November 2024
Abstract
Introduction
Self-poisoning is the most common form of hospitalised self-harm in young people and has been increasing over the past decade. The pandemic was associated with further increases in self-harm in adolescents. There are limited data on changes after pandemic restrictions ended. This study aimed to describe recent trends in self-poisoning in young people.
Setting
Australia 2018–2023.
Methods
A retrospective analysis of self-poisoning calls to Australia’s poisons information centres. Intentional poisoning exposures in people aged 5–19 years were included in the main analysis. We also examined intentional poisonings in people aged 20 and over for comparison. We used interrupted time-series analysis to estimate the impact of Covid-19 (March 2020) and ‘re-opening’ (December 2021), when many restrictions were lifted in Australia. We compared effects in the jurisdictions with most disruptions and lockdowns with other jurisdictions.
Results
There were 201,755 self-poisonings documented, 64% female, with 19,946 children (aged 5–14, 9.9%) and 44,388 adolescents (aged 15–19, 22.0%). There was a steep increase in the rate of poisoning in female children and adolescents – with the annual increase being 1.361 (95% confidence interval = [1.074, 1.735]) and 1.154 (95% confidence interval = [1.049, 1.283]) times faster than pre-pandemic trends in these two groups between March 2020 and December 2021. Following relaxation of restrictions, there was a sudden drop and then slow decline in self-poisonings (despite rising Covid-19 infection rates). There was an overall 29.6% increase in intentional poisonings in young people over the study period. This is markedly more pronounced among young females (37.0%) vs males (11.2%). There were substantial jurisdictional variations, with larger increases in Victoria, Tasmania and the Australian Capital Territory.
Conclusion
There has been a marked increase in child and adolescent female self-poisonings over the past six years, with increases strongly associated with Covid-19 pandemic restrictions but persisting after their removal.
Expert Report 2022 (Open access)
InSight article – Paracetamol restrictions updated as self-harm levels remain high (Open access)
See more from MedicalBrief archives:
Paracetamol: Precautions necessary during pregnancy — Consensus Statement
Acetaminophen over-dose risk rises in the flu season
Suicide risk rises after surviving self-poisoning
Dental painkillers may put young people at risk of opioid addiction