Did Smaller Paracetamol Packet Sizes Save Lives?

There is a wide range of services, prescription medications and treatments available over the counter at a local pharmacy, but alongside the types of specialist services only available from a pharmacist, it is also an opportunity to top up on essential first aid kit supplies and medications.

One of these is paracetamol, a very popular pain relief medication sold both on its own and in combination with other compounds to provide stronger targeted relief, help reduce feelings of nausea and sickness, and with decongestants as part of cold and flu remedies.

However, despite its popularity, its sale is very heavily restricted; only 100 tablets can be supplied by pharmacists when there is a justifiable reason to do so, the boxes themselves contain a maximum of 32 tablets, whilst in supermarkets and other non-pharmacies, boxes were limited to 16 tablets each.

This approach is still seen today; supermarkets will often display a “limit two per customer” warning for over-the-counter painkillers, but why was this implemented in the first place, and did it help to save lives?

When Was Paracetamol Restricted?

In September 1998, the Medicines and Healthcare products Regulatory Agency recommended the limitations, which were subsequently adopted by the UK government.

The recommendations, which also included changes to marketing information to include warnings about taking with other paracetamol products and advice to seek urgent medical 

attention if the recommended dose is exceeded.

Why Was It Restricted?

Paracetamol is one of the most commonly taken medications, but one concern that has been raised with larger supplies of it is the potential for overdosing, which can be both an immediate medical emergency and can have long-term effects.

In particular, paracetamol can cause liver and, rarely, kidney damage when overdosed, which can require transplants in some particularly serious cases of paracetamol poisoning.

The logic of the restriction was that if there is less paracetamol available, there is less of a chance of a life-threatening overdose, as people would not stockpile vast amounts of it in favour of keeping one or two packets at home at a time.

Did Paracetamol Help Save Lives?

There was a significant reduction in deaths related to paracetamol, with one study claiming that there was a 43 per cent reduction in deaths, and 61 per cent fewer liver transplant registrations in the 11 years since the regulations were enacted, as compared to before.

Part of this was how it affected intentional overdoses; Catherine Johnstone, former chief executive of the Samaritans, and Ged Flynn of Papyrus both made the point that access is a key part of intentional overdoses, and by limiting the availability of a substance, it can be potentially harmful in high quantities.

The more resistance and the more steps that need to be taken, the less likely it will be carried out and the greater the chance that someone will be able to navigate a crisis period or find help.

Whilst the causes of paracetamol poisoning are complex and are far outside the scope of the medication itself, it is fascinating how a relatively small step managed to save hundreds of lives and help people to avoid serious self-injury.