Legislation restricting paracetamol sales and patterns of self-harm and death from paracetamol-containing preparations in Scotland.
OBJECTIVE
To describe how changes in legislation to restrict paracetamol sales have affected overdose discharges and death associated with the drug in Scotland.


METHODS
A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2004. Patients in Scotland participated who were discharged from hospital with a diagnosis of poisoning; deaths in Scotland from diagnosis of poisoning 1995-2003 were also analysed. Outcome measures were changes in mortality and overdose due to poisoning involving paracetamol. A comparison was made of in-hospital and out-of-hospital mortality in fatalities involving paracetamol.


RESULTS
The majority of paracetamol-associated deaths were due to co-proxamol. Deaths associated with paracetamol alone or with ethanol occurred principally in hospital and were a minority of deaths overall. The proportion of in-hospital deaths attributed to paracetamol increased (post/pre ratio 1.347; 95% confidence interval 1.076, 1.639; P = 0.013). Overall numbers of cases discharged with poisoning fell. The proportion of these involving paracetamol in any form increased significantly in all groups except young men aged 10 to <20 years.


CONCLUSIONS
Legislation has not reduced mortality or proportional use of paracetamol in overdose, both of which appear to have increased in Scotland since pack-size limitations. Other approaches are necessary to reduce the death rate from overdoses involving paracetamol.
Bateman
D N
DN
NPIS Edinburgh (Scottish Poisons Information Bureau), Royal Infirmary of Edinburgh, Edinburgh, UK. nick.bateman@luht.scot.nhs.uk
Gorman
D R
DR
Bain
M
M
Inglis
J H C
JH
House
F R
FR
Murphy
D
D
D000082:Acetaminophen / Q000506:poisoning* / Q000600:supply & distribution; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000506:poisoning* / Q000600:supply & distribution; D002648:Child; D062787:Drug Overdose / Q000401:mortality; D004349:Drug Packaging / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007880:Legislation, Drug / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data* / Q000639:trends; D013406:Suicide, Attempted / Q000706:statistics & numerical data
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen