title: Paracetamol recall: a natural experiment influencing analgesic poisoning.
abstract: OBJECTIVE
  To determine whether the occurrence of paracetamol and non-paracetamol analgesic deliberate self-poisoning (DSP) and accidental paediatric poisoning was affected by two periods of recall of paracetamol products.
  
  
  METHODS
  Retrospective, observational audit of proportions of poisonings with tablet and capsule formulations of paracetamol, ibuprofen and aspirin products during two recall periods compared with the number of poisonings during the same periods of the previous three years.
  
  
  METHODS
  A national poisons information centre and a regional toxicology service.
  
  
  METHODS
  Rates of DSP and accidental paediatric poisoning with paracetamol, ibuprofen and aspirin.
  
  
  RESULTS
  During the two recall periods, there was a significant increase in ibuprofen DSP calls to the poisons information centre (RR, 1.86; 95% Cl, 1.41-2.44; P = 0.001). There was no significant change in paracetamol or aspirin DSP calls over the two recall periods. However, there was a non-significant reduction in DSP calls with paracetamol in the first recall period alone (P = 0.057). There was a significant increase in the proportion of aspirin DSP presentations for the toxicology service (RR, 3.33; 95% CI, 0.97-11.4; P = 0.043), but no significant changes in paracetamol and ibuprofen DSP presentations. For accidental paediatric ingestions there was a significant increase in the proportion of ibuprofen calls (RR, 2.35; 95% CI, 1.85-2.98; P = 0.001), but no significant change in paracetamol or aspirin calls.
  
  
  CONCLUSIONS
  Reduced paracetamol availability increased poisoning with alternative analgesics, but had little effect on the incidence of paracetamol poisoning. Restriction of paracetamol-containing products may inadvertently increase poisoning with potentially more toxic agents.
authors.affiliation: NSW Poisons Information Centre, The Children's Hospital, Westmead.
authors.forename: Corrine R
authors.initials: CR
authors.lastname: Balit
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Isbister
authors.forename: Jennifer
authors.initials: J
authors.lastname: Peat
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Dawson
authors.forename: Ian M
authors.initials: IM
authors.lastname: Whyte
mesh_terms: D000082:Acetaminophen / Q000506:poisoning* / Q000600:supply & distribution*; D018712:Analgesics, Non-Narcotic / Q000506:poisoning* / Q000600:supply & distribution*; D001241:Aspirin / Q000506:poisoning; D001315:Australia / Q000453:epidemiology; D002648:Child; D062787:Drug Overdose / Q000453:epidemiology; D004335:Drug and Narcotic Control; D006801:Humans; D007052:Ibuprofen / Q000506:poisoning; D015994:Incidence; D004366:Nonprescription Drugs / Q000506:poisoning / Q000600:supply & distribution; D012189:Retrospective Studies; D013406:Suicide, Attempted
chemical_list: D018712:Analgesics, Non-Narcotic; D004366:Nonprescription Drugs; D000082:Acetaminophen; D001241:Aspirin; D007052:Ibuprofen