Co-proxamol and suicide

Editor—In 1998 an audit of suicides in Doncaster identified the alarming rate of co-proxamol overdose as a method of suicide: of the 44 suicides with prescribed drugs between 1995 and 1998, 18 were with co-proxamol (41%).¹ That this is much higher than the national figure of 18% quoted by Hawton et al² may be because the rates of prescribing of co-proxamol in Doncaster (around 11 million tablets a year) were 65% higher than the national average.

Hawton et al recommend restricting co-proxamol on the evidence that restricting availability of a specific means of suicide can reduce deaths. Doncaster Health Authority reached the same conclusion in 1998 and undertook to reduce the amount of co-proxamol in circulation by asking general practitioners to be more cautious in prescribing the drug. Doncaster Royal Infirmary also removed co-proxamol from its formulary.

The table shows how, four years on, the policy of reducing prescribing has been successfully implemented: around 60% fewer tablets are currently prescribed than in the period up to 1998 and the prescribing rate is now lower than the national average.

Table 1.

Effectiveness of reducing prescriptions of co-proxamol in Doncaster

	1996	1997	1998	1999	2000	2001	2002
No of co-proxamol tablets per prescribing unit*:
Doncaster	27.9	28.0	26.7	17.6	13.1	11.7	10.7
England and Wales	16.9	16.7	16.4	15.9	15.1	14.5	13.8
No of suicides†:
With co-proxamol	5	3	7	5	2	3	0
All other methods	25	29	36	22	31	26	14

^*Based on data from the Prescription Pricing Authority for preceding eight months for 1996 and on first six months only for 2002.

^†Office for National Statistics public health mortality file; data for 2002 not final.

The numbers of suicides among Doncaster residents, also shown in the table, are too small for us to show any relation between the amount of co-proxamol prescribed and the number of suicides with the drug or the total number of suicides. However, we cannot help but be encouraged by the numbers: only five since the beginning of 2000.

The remarkably low number of suicides in 2002 is not a final figure, but many more are unlikely to emerge, and this clearly cannot be attributed to reductions in co-proxamol prescribing. We can, however, be sure that the quantity of tablets in circulation has been massively reduced and that the evidence, as quoted by Hawton et al, implies that this is likely to reduce deaths.