title: Acetaminophen availability increases in Canada with no increase in the incidence of reports of inpatient hospitalizations with acetaminophen overdose and acute liver toxicity.
abstract: In September 1999, several Canadian provinces had place-of-sale restrictions lifted that had limited the sale of acetaminophen >325 mg and packages >24 tablets (any strength) to pharmacies only. This allowed the sale of all strengths of immediate-release acetaminophen in all package sizes in nonpharmacy locations. This study's purpose was to explore the effect that lifting restrictions on acetaminophen place of sale may have had on reported hospitalizations in Canada related to acetaminophen overdose toxicity. Using hospital discharge data, provinces with no preexisting restrictions on place of sale were compared with those in which restrictions were lifted in September 1999. Cases of reported APAP overdose included ICD-9/9-CM code 965.4, ICD-9 code E850.2, or ICD-9-CM code E850.4. Cases with reported acute liver toxicity included ICD-9/9-CM codes 570, 572.2, 572.4, V42.7, or procedure code 50.5. There were no significant differences between the 1.5-year periods pre- and post-September 1999 in annual incidence rates per 100,000 persons ages >/=12 years of hospitalizations reported with acetaminophen overdose, either overall or limited to those with death as an outcome, or in hospitalization reports with both acetaminophen overdose and acute liver toxicity, either overall (provinces with no restrictions: pre = 0.70, post = 0.80, P = 0.6328; provinces with restrictions lifted in September 1999: pre = 0.49, post = 0.47, P = 0.8649) or limited to those with death as an outcome (provinces with no restrictions: pre = 0.22, post = 0.12, P = 0.3030; provinces with restrictions lifted in September 1999: pre = 0.13, post = 0.09, P = 0.3589). In conclusion, the decision to lift Canadian place-of-sale restrictions increased acetaminophen availability and did not increase the rate of reported hospitalizations related to acetaminophen overdose toxicity.
authors.affiliation: Research and Development, McNeil Consumer and Specialty Pharmaceuticals, Fort Washington, Pennsylvania 19034, USA. mprior@mccus.jnj.com
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Prior
authors.forename: Kimberly
authors.initials: K
authors.lastname: Cooper
authors.forename: Peter
authors.initials: P
authors.lastname: Cummins
authors.forename: Debra
authors.initials: D
authors.lastname: Bowen
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data*; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D002170:Canada / Q000453:epidemiology; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D062787:Drug Overdose; D004363:Drug Utilization / Q000706:statistics & numerical data; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D006753:Hospital Records; D006801:Humans; D008875:Middle Aged
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen