Editor—New regulations to limit the availability of aspirin and paracetamol came into effect on 16 September.1 The number of tablets or capsules per pack has been limited to 16 in supermarkets and 32 in pharmacies, although multiple packs can be bought. Pharmacists can provide up to 100 tablets at their discretion for patients with chronic conditions, but greater amounts now require a prescription. Supermarkets may also sell 100 tablets, albeit in packs of 16.
The health of the nation target was a 15% reduction in overall suicide rates by 2000.2 These packaging regulations aspire to reduce the incidence of deliberate and accidental overdose, but we believe that their effect will be limited. No single intervention was found to reduce suicide.3 The authors commented that measures to reduce the quantity of medicines available over the counter should be evaluated but suggested that only interventions of proved effectiveness should be introduced.3 Currently there is no such evidence available to justify these major changes.
Thirty two paracetamol tablets is sufficient to commit suicide, and this amount is available in one container from pharmacies and in two from supermarkets. An adult requires only 12 g to achieve a toxic dose.4 On one day we purchased eight packs of paracetamol from four different supermarkets, obtaining 128 tablets within half an hour without any difficulty or questioning. Clearly the regulations prevent no obstacle to the acquisition of lethal doses.
Since the implementation of the new regulations the cost of paracetamol over the counter has roughly doubled. This extra cost is partly due to the new packaging and has been passed on directly to consumers. The same considerations apply to aspirin, including the low dose preparation (75 mg). Patients entitled to free prescriptions may be more likely to approach their general practitioner to obtain these drugs because of this price increase. This will generate more work for general practitioners.
We are all encouraged to practice evidence based medicine, with rational prescribing being one result of such an approach. The same principles should apply to policy making. The health of the nation strategy is full of good intentions,5 but more effective policies are needed for suicide to be reduced. These changes represent laudable aspirations but are a paternalistic folly. We believe that they are unlikely to succeed and will only inconvenience the vast majority of people, who use these drugs appropriately and responsibly, and add to the workload of general practitioners and pharmacists.
Acknowledgments
Conflict of interest: None.
References
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