title: Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?
abstract: OBJECTIVE
  To investigate the relationship between the availability of paracetamol and its use for overdose and suicide.
  
  
  METHODS
  Analysis of routinely collected information on time trends for paracetamol suicides, non-fatal overdoses, and sales.
  
  
  METHODS
  England and Wales and France.
  
  
  RESULTS
  There were strong correlations between trends in paracetamol sales in the UK and trends in non-fatal paracetamol overdose in Oxford between 1976 and 1993 (Spearman's r = 0.86; 95% confidence interval (CI) 0.54, 0.96) and between paracetamol sales and non-fatal overdoses in France between 1974 and 1990 (r = 0.99; 95% CI 0.97, 1.00). Sales figures were also correlated with paracetamol related suicides in both England and Wales, 1983-91 (r = 0.72; 95% CI 0.11, 0.94) and France, 1974-90 (r = 0.79; 95% CI 0.50, 0.92). Similarly strong relationships were observed between trends in non-fatal overdoses and suicide by paracetamol poisoning in England and Wales (r = 0.85; 95% CI 0.61, 0.95) and France (r = 0.79; 95% CI 0.50, 0.92). It is estimated that approximately 32,000 overdoses involving paracetamol occur annually in England and Wales. Fatality rates from paracetamol overdose were four times as high in England and Wales (0.4%, 95% CI 0.38, 0.46) as in France (0.1%, 95% CI 0.06, 0.17).
  
  
  CONCLUSIONS
  Trends towards greater availability of paracetamol are paralleled by increases in its use for both non-fatal overdose and suicide. Paracetamol related morbidity and mortality seem to be less frequent in France where the quantity of paracetamol in a single purchase is limited. Although not conclusive, these data add to a body of evidence which suggests that restrictions in the quantity of paracetamol available as a single purchase in the UK may reduce suicide and liver failure related to paracetamol.
authors.affiliation: Department of Social Medicine, University of Bristol.
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
authors.forename: K
authors.initials: K
authors.lastname: Hawton
authors.forename: V
authors.initials: V
authors.lastname: Murray
authors.forename: R
authors.initials: R
authors.lastname: Garnier
authors.forename: C
authors.initials: C
authors.lastname: Bismuth
authors.forename: J
authors.initials: J
authors.lastname: Fagg
authors.forename: S
authors.initials: S
authors.lastname: Simkin
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D062787:Drug Overdose; D005602:France / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D013405:Suicide / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D000092864:Suicide Prevention
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen