title: What can be done to reduce mortality from paracetamol overdoses? A patient interview study.
abstract: BACKGROUND
  Paracetamol (acetaminophen) is the most common self-poisoning agent in the UK and a leading cause of fatal hepatotoxicity. Following legislation in 1998 to limit pack sizes, beneficial effects on paracetamol-related mortality and morbidity were reported in England. However, there are still over 100 deaths a year and evidence of breaches of sales guidelines.
  
  
  OBJECTIVE
  To investigate characteristics of people taking larger paracetamol overdoses and compliance with sales guidelines, to inform possible further initiatives to reduce paracetamol fatalities.
  
  
  METHODS
  Interview study of 60 general hospital patients who took overdoses of over 16 paracetamol tablets (8 g).
  
  
  RESULTS
  Half of all paracetamol overdoses involved over 16 tablets. Patients were predominantly young (three-quarters aged 16-40 years) and female (58.3%); over half (53.3%) had taken a previous paracetamol overdose. Three-quarters said they wanted to die. Half took the overdose within an hour of first thinking of it, half (53.3%) took tablets already in the home and 58.3% bought tablets specifically for the overdose. Ten people tried to buy more than 32 tablets in one transaction; four succeeded. Most knew that a paracetamol overdose could cause death or permanent damage (88.3%) and harm the liver (80.0%) but 70.0% thought they would lose consciousness. Warnings on packs had little deterrent effect. Media and internet influences were identified. Patients chose paracetamol because it was cheap and easily available.
  
  
  CONCLUSIONS
  Further measures to reduce breaches of sales guidelines and the dangers of paracetamol overdose are required. Media and internet site producers should follow guidelines on reporting suicide.
authors.affiliation: Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Headington, Oxford, OX3 7JX, UK.
authors.forename: S
authors.initials: S
authors.lastname: Simkin
authors.forename: K
authors.initials: K
authors.lastname: Hawton
authors.forename: N
authors.initials: N
authors.lastname: Kapur
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000082:Acetaminophen / Q000506:poisoning* / Q000600:supply & distribution; D000293:Adolescent; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000506:poisoning* / Q000600:supply & distribution; D002755:Choice Behavior; D004348:Drug Labeling; D062787:Drug Overdose / Q000517:prevention & control / Q000523:psychology; D005260:Female; D017408:Guidelines as Topic; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017410:Practice Guidelines as Topic; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen