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:
- The maximum number of tablets sold in a packet should be reduced from 16 to 12.
- The display and promotion of paracetamol on open shelves should be banned.
- The sale of paracetamol to children under the age of 18 should be allowed only in pharmacies.