That sums it up.
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I agree. It will be easy enough to accumulate sufficient quantities to effect an overdose. Two packs of 16 tablets are more than enough. Paracetamol, at therapeutic doses, is very safe and effective but highly toxic to the liver when the therapeutic dose is exceeded. If one were suicidal, there are less painful ways to die.
I think more research is needed.
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No pain killers come without risks. As someone who treats people with Chronic Pain, I have treated people who have had to have their stomachâs removed as a result of taking anti inflammatory medications. Personally, a small amount of an anti inflammatory makes my stomach bleed. I am amazed at how easy they are to access. I would like to see them out of Supermarkets.
We need analgesics, but I would prefer to see them dispensed from pharmacies, with a community education campaign about their dangers. As many impulsive overdoses are in the adolescent years, a warning to parents not to have large quantities of pain killers accessible could help. Impulsive overdoses usually are about finding what pills are available and taking them indiscriminately, so I would support smaller packs.
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But then how far do we go with this? Do we require all parents to keep their paracetamol in the âgun safeâ?
Then there are the usual arguments about
- what about households where there are no children?
- what about households where children never visit?
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Indeed. Or to put it another way ⊠where is the cost / benefit analysis?
How many lives will it save?
How many lives will it add hassle and/or inconvenience and/or pain to?
There is a tendency by government to argue: âbut if it only saves one life âŠâ
and you can justify just about any restriction with arguments like that.
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More importantly, it could require the government to be on board.
However cost is not the only factor that drives a decision to buy a larger pack. For those on chronic pain relief, a larger pack is also convenient (even more so for people living some distance from the nearest pharmacy). Aside: you know you are old when your medical calendar is busier than your social calendar. 
But wouldnât putting it on the PBS mean that it would be prescription only? which would mean even more hassle?
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Couldnât agree more. Sadly weâve become a âtreat the symptom not the causeâ society. I suspect itâs because treating causes can be expensive, often requires real change and actual sacrifice, and might interfere with the relentless pursuit of instant gratification through accumulation of baubles and trinkets, which seems to have become an opiate of choice. If governments were to do something like interfere with that it might be unpopular. And that might not get it returned to office.
Governments have proven itâs possible to be returned to office despite doing nothing/being asleep at the wheel while obvious problems build over decades and become unmanageable. This may have arisen due to such relentless outsourcing of sovereign capabilities that governments now donât actually know to do do anything, because the reality of actually doing things is left to industry which has itâs snout buried so deeply in the trough of taxpayer money itâs nearly impossible to extract. Either that or the keys to the Blood Bank were given to DraculaâŠhmmm energy market anyone? If you havenât already, in an idle moment itâd be worth Googling Snowy Hydro 2.0; specifically, the progress of a tunnel boring machine named âFlorenceâ upon which the success of the project somewhat rests, and also the fate of the prime contractor. If you donât laugh youâll cry.
AI has for good reason been referred to as potential threat to humanity. We could heed the warnings now and consider controlling it if we wanted to, but will we? Better for Goverments if they can manage to let things get out of control and then plead that the enormity of the problem i.e. the symptoms makes it nearly impossible to address the cause. Cyber attacks of the kind recently experienced by Optus, NSW Government, Latitude Finance etc were absolutely inevitable and many folks are personally bearing the burden of these acts because governments simply stood idly hand wringing and bleating about how terrible cyber attacks are while âadmiring the problemâ for years because they lacked the political courage to enforce tighter controls on industry. Possibly like burglary, assault, appalling public health care and car theft itâs something theyâll simply want us to become desensitised to so theyâre off the hook for not having treated a cause when they shouldâve.
/rant.
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TGA has announced their final decision today.
" From 1 February 2025, new restrictions on paracetamol will:
- reduce the maximum size of packs available for general sale (e.g. supermarkets and convenience stores) from 20 to 16 tablets or capsules
- reduce the maximum size of packs available in pharmacies without the supervision of a pharmacist (i.e. âPharmacy Onlyâ packs) from 100 to 50 tablets or capsules.
- make other pack sizes of up to 100 tablets or capsules available only under the supervision of a pharmacist (âPharmacist Onlyâ medicines)."
Further details are included in this media release.
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They also need to put a 50 pack on the PBS, for those who need pain relief but not as much as 100 tablets.
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What is on the PBS is decided by a different Division in the Department of Health to that of the TGA.
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Paracetamol is the leading cause of acute liver failure in the Western world and is known to be the medicine most frequently responsible for calls to Poisons Information Centres in Australia. So many countries are trying to mitigate the issue, or at least make more people aware that it is not the benign medicine that itâs often been marketed as (âgentle to the stomachâ - but nasty to the liver).
Many suicidal patients act on impulse, so having smaller packets around the home may reduce the overdosages. Also, many suicidal teens also often think erroneously that they will simply lapse into unconsciousness.
The elderly age group is also more susceptible to the harmful effects of paracetamol, and are more likely to be on slow-release formulations or to make errors in dosing. And it is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis, for which many elderly probably take it.
I think it needs to become S3 and with greater warning visibility on the packets. It opens the chance of pharmacists to at least bring up the topic with consumers, as should any doctors prescribing it.
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Do you have a source for those facts?
- Tanne J. Paracetamol causes most liver failure in UK and US. BMJ 2006;332:628
- Chiew AL F3, Graudins A, Ibister CK, Reith D, Buckley NA. Guidelines for the
management of paracetamol poisoning in Australia and New Zealand. Medical Journal of Australia, 2015
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Thanks. I cannot get much out of either paper on my main concern, which is overall how much harm is being done by paracetamol OD in this country. Knowing that most cases of acute liver failure are due to the drug is not that useful without knowing what that means in morbidity or mortality rates.
However, there are other reports along the same lines so let us say that paracetamol OD is a real concern in this country, that the rate of OD has been growing and the problem needs some action.
Why is it that the first thing authorities reach for is reducing access? Where is the information campaign, the prominent warnings on packets and getting doctors to talk to their patients about it?
Where might we get this information from, the Poisons Information Centre in each State perhaps?
Well no, not in NSW, Vic or QLD at least, there are lots of warnings about mushrooms and dozens of other possible poisons but none that I can find about paracetamol.
NSW Dept of Health has an extensive web site with a section headed Public, this has articles on many aspects of health for people and their families, nothing on poisons or on paracetamol in particular.
The media pages on that site have a great deal on many topics with COVID at the front but getting down to 2 cases of Murray Valley encephalitis (two!) but nothing on paracetamol poisoning. The issue didnât reach the media that I read until the plans to limit access were well under way.
Itâs hard for John Citizen to take this seriously if there is no information. If people do not perceive it as a risk getting action from them is not going to be easy.
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Did you mean to say âAcute Liver Failureâ. Apparently there is a difference between âAcute Liver Failureâ which is what is mentioned by numerous references on the same topic, and numerous other factors/conditions also leading to progressive liver decline and failure? Iâll suggest thatâs one for considered medical opinion.
In context the journals refer to many different causes of liver failure. One cause can be the most common, however its relative significance also needs comparison to the many other causes and contributing factors. It may stand out as more common, and be only one of many other causes of similar statistical importance.
How does one assess the benefits of a particular medication which can be to a great many relative to harm to others? One take is the role of the TGA should be left to the TGA. There are differing opinions, and many consumers will be keenly interested in any change.
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The dangers of paracetamol overdose has been well known for many years.
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Yes, acute mainly relates to short-term overdosages as discussed in that paper, but many older people are taking slow-release paracetamol and are more susceptible to chronic paracetamol hepatoxicity that can be become an acute issue by simply taking another medicine compounded with paracetamol.
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Well yes for those who know there is something to look for but in my experience the common person doesnât go looking. I donât think anyone is suggesting that some risk was not known well to professionals. It has been classed as safe if used as directed for decades.
However, the rate of actual poisoning in the community has been increasing quite quickly. The incidence of using contrary to advice is increasing. Nothing has changed about the drug but something has changed about the community. Are we getting more careless or thoughtless? Is is somehow becoming attractive for those who wish self-harm?
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I am guessing that simply branding paracetamol with a warning would then cause a ripple effect - which other medicines should be similarly branded? Should we have a simple âtraffic lightâ type system? This would take a long time, much more than the relatively simple task of warning labels for tobacco products.
An interesting study on labelling is found in, âDeveloping Consumer-Centered, Nonprescription Drug Labeling: A Study in Acetaminophenâ by King, Amer. Jnl of Prev Med.
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