title: Impact of different pack sizes of paracetamol in the United Kingdom and Ireland on intentional overdoses: a comparative study.
abstract: BACKGROUND
  In order to reduce fatal self-poisoning legislation was introduced in the UK in 1998 to restrict pack sizes of paracetamol sold in pharmacies (maximum 32 tablets) and non-pharmacy outlets (maximum 16 tablets), and in Ireland in 2001, but with smaller maximum pack sizes (24 and 12 tablets). Our aim was to determine whether this resulted in smaller overdoses of paracetamol in Ireland compared with the UK.
  
  
  METHODS
  We used data on general hospital presentations for non-fatal self-harm for 2002-2007 from the Multicentre Study of Self-harm in England (six hospitals), and from the National Registry of Deliberate Self-harm in Ireland. We compared sizes of overdoses of paracetamol in the two settings.
  
  
  RESULTS
  There were clear peaks in numbers of non-fatal overdoses, associated with maximum pack sizes of paracetamol in pharmacy and non-pharmacy outlets in both England and Ireland. Significantly more pack equivalents (based on maximum non-pharmacy pack sizes) were used in overdoses in Ireland (mean 2.63, 95% CI 2.57-2.69) compared with England (2.07, 95% CI 2.03-2.10). The overall size of overdoses did not differ significantly between England (median 22, interquartile range (IQR) 15-32) and Ireland (median 24, IQR 12-36).
  
  
  CONCLUSIONS
  The difference in paracetamol pack size legislation between England and Ireland does not appear to have resulted in a major difference in sizes of overdoses. This is because more pack equivalents are taken in overdoses in Ireland, possibly reflecting differing enforcement of sales advice. Differences in access to clinical services may also be relevant.
authors.affiliation: Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. keith.hawton@psych.ox.ac.uk
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.forename: Helen
authors.initials: H
authors.lastname: Bergen
authors.forename: Sue
authors.initials: S
authors.lastname: Simkin
authors.forename: Ella
authors.initials: E
authors.lastname: Arensman
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
authors.forename: Jayne
authors.initials: J
authors.lastname: Cooper
authors.forename: Keith
authors.initials: K
authors.lastname: Waters
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D002648:Child; D062787:Drug Overdose / Q000517:prevention & control*; D004349:Drug Packaging; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult; D000092864:Suicide Prevention
chemical_list: D000082:Acetaminophen