Paracetamol should be more tightly regulated to prevent suicides

Does Tescos want to encourage its customers to kill themselves? One would have thought not but for some time now some branches have been running a promotion that may well have that effect.

If it piled packets of cigarettes by the checkout it would rightly be vilified; it would also be prosecuted. So instead, it is – perfectly legally – piling up packets of paracetamol in the most prominent position possible, by the check-out queues.

Overdosing is the commonest method of suicide amongst women of all ages, and paracetamol is the drug most commonly used. There are, on average in England and Wales, over 120 deaths each year from paracetamol poisoning, most of which are deliberate.  Many are teenagers.

One of the reasons it is such a popular choice is that it is available at every pharmacy, every supermarket and many smaller shops. It is an exceptionally useful drug that has the capacity to relieve pain and suffering on a huge scale.

But it has an unparalleled capacity to produce suffering too. Just 42p can buy 32 pills: a potentially lethal dose, especially for a young teenager who is able to buy paracetamol perfectly legally.

It might be a cheap way to die, but there its advantages end. Death from paracetamol poisoning is neither quick nor easy. It can take more than a week of agony between the overdose and death.

In the first hours after ingestion nothing much seems to happen. You may feel a little unwell. But if left untreated the symptoms will worsen over the following days. You will probably change your mind. Contrary to popular belief you do not drift into a sleep or coma. Paracetamol is not kind.

You will stay awake throughout the whole process, lying in excruciating pain, as your skin turns yellow and your organs slowly shut down. Eventually only a liver transplant can save you, but of course it usually does not come. Your loved ones stay with you as you die. Your physical pain will be aggravated by the knowledge that you are responsible. You wish you had never picked up those pills. But of course it is too late.

There is nothing glamorous about a paracetamol overdose.

The typical teenage suicide victim may or may not suffer from mental illness. They might be fine one day and overcome with depression the next. Some might find their moods swinging wildly, perhaps perfectly happy in the evening, and then the next morning inexplicably, like Gerard Manley Hopkins they “wake and feel the fell of dark not day.”

But in most cases those who take paracetamol overdoses, do not subsequently end up killing themselves. As Professor Keith Hawton, Director of the Centre for Suicide Research, puts it:

Most survivors of potentially lethal suicide attempts do not appear to have a very high long-term risk of suicide.”

Decisions to take paracetamol are usually irrational. Some may overdose in a genuine attempt to kill themselves, others in a proverbial “cry for help.” Sometimes their attempts are carefully planned, but more often they are impulsive and the paracetamol is bought and taken within an hour of the decision having been made. Either way, the decision to commit suicide is a great deal easier, and may even be directly triggered, if a fatal dose of paracetamol tablets is readily available, especially if they are being energetically promoted at a bargain price.

How much is a fatal dose? It varies: as few as 12 tablets can kill some people. If a teenager takes 32 and does not get treatment he, or more likely she, may well die.

Research published in 1997 by Oxford University’s Department of Psychiatry Centre for Suicide Research suggested that reducing the size and number of packets of paracetamol that sold at one time would be likely to lead to fewer overdoses. This led to regulations that restricted the number of 500 mg pills that could be contained in a packet to 16, and the number of packets that could be sold in a single purchase to two in a pharmacy, and one in other shops.

The effect was dramatic. Following the change in the law in 1998 deaths from paracetamol poisoning fell by over 40%. A similar, but even tougher law was introduced in Ireland, again leading to sharp fall in deaths from overdoses. But it remains one of the biggest causes of death, particularly amongst young women, and in practice paracetamol remains easy to buy in large quantitities.

Of course Tescos, like all other reputable companies trains its staff to comply with the law. Their tills are meant to alert cashiers if an attempt to buy more than a single packet is made. But, being human, sometimes the staff do not comply; and being computers sometimes the tills do not work. 17 year old Prudence Scouse, for example, was allowed to buy 4 packets of 16 paracetamol tablets at her local Tescos store. She took all 64 tablets and died 4 days later.

In any case, when paracetamol packets are allowed to be on unrestricted display – whether or not as a promotion – it is a simple matter to slip a couple of packets into a handbag and by-pass the tills altogether. The threat of a shoplifting prosecution is a minor deterrent to a would-be suicide.

Today is National Self-Harm Awareneness Day so it is particularly unfortunate that Tescos are still running promotions aimed at selling more paracetamol.

The time has now surely come for these promotions to stop.

Even more important, there should be tighter legal restrictions on the sale of this potentially deadly drug.The following modest reforms would save many lives:

  1. The maximum number of tablets sold in a packet should be reduced from 16 to 12.
  2. The display and promotion of paracetamol on open shelves should be banned.
  3. The sale of paracetamol to children under the age of 18 should be allowed only in pharmacies.
Liked it? Take a second to support Matthew on Patreon!

Author: Matthew

I have been a barrister for over 25 years, specialising in crime. You may also have come across some of my articles I have written on legal issues for The Times, Standpoint, Daily Telegraph or Criminal Law & Justice Weekly

11 thoughts on “Paracetamol should be more tightly regulated to prevent suicides”

  1. No they shouldnt. That is just stupid. If someone wants to kill themselves they will do it, making some paracetamol harder to get won’t make any difference other than making it more bother for ordinary people to get them.

    1. That is an obvious response, but it’s wrong. Making suicide even slightly harder actually does prevent suicides, strange though it may seem. In the case of paracetamol making it sold behind the counter, like whisky, would not prevent anyone getting it but it would deter nervous and suicidal teenagers from asking for it.

  2. Why can't all the religious nut balls just shut their mouths for one? Please stop talking about God's will, or what God wants until you can provide some tangible proof for it. Don't we have enough mindless "faith based" nonsense in this country already? It's time to move on to fact based disuossicns. So if you feel bad for people of Hati, send some damn money; prayers don't build houses or feed children.

  3. 120 suicides a year from paracetamol, out of 60+ million people? How about 120 out of the 6,581 suicides in the UK and Republic of Ireland, in 2014? Hmm…I think we need to dress this up a little. How about ‘the poor helpless woman that’s end the end of her rope’? Or ‘ the sad lonely teenager that may (or may not) have mental health issues’? That’s it. Load up the emotional charge, don’t let people consider the facts, discuss the situation with some reason. THINK EMOTIONALLY!

    Older adults are disproportionately likely to die by suicide.
    In the States firearms are the most common method of suicide, followed by hanging (although for women only, poisoning is the second most common).

    Before I went to California I could buy 100 codeine and aspirin in Boots. Now you can’t buy a decent number of any painkiller thanks to the nanny state. I buy naproxen in the grocery store by the 100, it’s prescription only in the UK. If I want to kill myself I can buy seconal and Nembutal online rather than use paracetamol.

  4. i agree, it’s ridiculously ridiculously easy. the limit is 2 packets legally, 4 is a fatal dose. i have 2 supermarkets (1 tescos) in a 5 minute radius of my house. i went to both and bought a total of 4 packets today at 26p each. it literally took me 15 minutes and £1.04. there’s no age limit either- i’m 15, nobody questioned my age or anything. i’m not usually for tightening everything etc but i did find that completely ridiculous

    1. Having an age limit would not make any difference

      No evidence has been shown to suggest that a 15 year old, a 25 year old and a 55 year old are more/less likely than each other to commit suicide by paracetamol.

      The article claims that the decision to OD is made within an hour of doing so. This mean reducing the amount which can be bought in a single packet wont help much because in built up city centers a person could easily buy 5-10 packets from different shops in 40 mins and have 20 mins left to take the tablets.

  5. I remember when paracetamol was promoted over aspirin because it was felt to be a safer drug than aspirin re overdoses. Then someone told me that the damaged caused by paracetamol overdoses short of suicide was far worse with liver damage particularly bad. It seems though you have to take far more aspirin for it become a potentially fatal dose. The question is why teens would take paracetamol as a suicide drug of choice when they could just as easily obtain aspirin or ibuprofen. Is it because it’s the most widely used painkiller or because they think it won’t be fatal or that they can take it and tell and get successful emergency treatment? If someone is really determined they can obviously milk stores for as many pills as possible. I don’t think price raising would help unless it was so prohibitive as to discriminate against people needing genuine pain relief. Maybe they simply don’t know about the effects and a bit of scare-education in schools might assist (though of course these things can sometimes incite). But obviously this would not stop impulsive attempts with other substances. I really don’t think it’s wise or practical to ban teenagers from buying painkillers.Though there might be an age limit of 16, above that – when they may be working and independent – would be harsh and potentially cruel. Teenagers self-harming seems to be a far bigger problem now than it was once. Why?

  6. ERM no!!! It should not be reduced. I’ve had a hard enough time trying to buy paracetamol after a major op without the pharmacist or sales people looking at me like a drug lord over two packets. I can’t even restock a medicine cabinet without having to make 500 trips to the pharmacist because we want to keep babying people.
    I’m sorry but people need to learn there are consequences for their actions, are you going to recommend we stop selling kitchen knives too because they’re used to murder people?
    And no to an age limit either, i can remember the number of times i had to run to the store as a teenager to buy paracetamol because I had pain and there’s been none in the house. I certainly would not have been pleased if I had to make a special journey to the pharmacist instead of the petrol station at the end of the road because a few people want to get stupid with some painkillers.
    Paracetamol kills!! Everyone knows this, I’m sure the people who want to top themselves will just find another way, stop restricting everything.

  7. Suicide is not always an irrational decision.
    Buyers regret is common, however some people (especially older people) use Paraceatmol as a drug of choice for suicide because after a certain period of time death is certain; The ‘rational decision to end their life’ can’t be altered due to human weakness such as fear of the unknown.

    1. Far more often the decision to kill oneself is an impulsive decision, and the chance to reverse it is welcomed. Over 90% of those who were stopped from jumping off the Golden Gate bridge did not thereafter kill themselves.

Leave a Reply

Your email address will not be published. Required fields are marked *