2023-05-12 08:33:36
To reduce the number of overdoses and deaths, the well-known painkiller will only be available in small format from 2025 in Australia. But how effective is that really?
No matter how innocent a paracetamol may seem, frequent and long-term use is not without consequences. For example, this can be harmful to certain vital organs, such as the liver and kidneys – and in the worst case, you can even die from it. Unfortunately, overdoses, both intentional and accidental, are still too common. Last week, the Australian government organization Therapeutic Goods Administration A final decision has therefore been taken to reduce the size of the boxes of paracetamol. But to what extent does this actually make a difference? We asked Noortje Swart, head of the department of clinical pharmacology and pharmacy at Amsterdam UMC.
Paracetamol
Paracetamol is a well-known pain reliever used to control fever and pain. If you stick to the dosage stated on the package leaflet, paracetamol is effective and safe. But at higher doses it can become dangerous. “Paracetamol is converted into breakdown products in the body by the liver,” says Swart Scientias.nl. “These breakdown products are then rendered inactive by a body’s own substance (glutathione). In the event of an overdose, all available glutathione is used up, resulting in a large amount of active degradation product. This can seriously damage the liver, from which you can even die. If someone drinks alcohol to excess, the liver is extra sensitive to this damage.”
Overdose
Incorrect use of paracetamol is unfortunately common in the Netherlands. “More than 2,700 reports are received by the National Poison Information Center every year,” says Swart. “It is therefore the drug with the highest number of reports.” While paracetamol is in some cases taken intentionally in excess, many people are unaware of the significant risks involved. For example, its use is often underestimated because it is so easily available and in such large quantities. “An overdose can be chronic, for example by taking too much in a row for a long time,” explains Swart. “But it can also be acute, where too much is taken at one time. We distinguish between an accidental overdose (usually the chronic overdose or in children) and the intentional overdose (usually in the form of a suicide attempt).”
The decision
In both cases, the amount available that you can buy in the store or pharmacy is an important determining factor. And that is why Australia has now decided to reduce the size of paracetamol boxes. In supermarkets and convenience stores, instead of 20, there will be only 16 tablets in a box. And at the pharmacy, the numbers will be reduced from 100 to 50. The new restrictions will take effect from 1 February 2025.
The numbers
The aim of this decision is to reduce the number of serious poisonings, liver injuries and deaths. Because in Australia the numbers don’t lie. Every year, about 7,000 people suffer from poisoning, about 200 people suffer liver damage, 225 people are hospitalized and about 50 people die from paracetamol overdose. In addition, deliberate self-poisoning among young girls and women is becoming more common. With the decision, Australia hopes to reduce these figures. But to what extent will this actually lead to the hoped-for result? “No research has been done on this yet, but as long as it is freely available everywhere, I don’t expect it to make much difference,” says Swart.
Intentional overdose
People who deliberately take too much paracetamol can still get enough tablets from 2025. “For people who intentionally overdose, it won’t matter much if the package is smaller, as long as you can buy unlimited packages from all kinds of places,” Swart notes. “Paracetamol is freely available in Australia and the Netherlands, including in supermarkets.”
The Netherlands
Large packs of paracetamol are still available in the Netherlands. “Here there are a maximum of 50 pieces in a box,” says Swart. “That is more than enough for an acute overdose and also costs very little. The maximum pack size has been determined based on the recommended maximum dose for eight days.” The question is whether the Netherlands should take a similar decision to Australia. To reduce the number of intentional overdoses, we probably don’t need to. “For an accidental overdose it might make a difference,” Swart thinks, “because someone who takes a whole pack is more likely to think that he or she is taking a lot.”
From after
The question is also to what extent the lion’s share of the population that adheres to the prescribed dosage is the victim of such a decision. Because a box with a lot of pills is quite handy to prevent you from running out again soon. The fact that this plays a role among people became clear during the corona pandemic, for example, when paracetamol was hardly available in supermarkets at the start of the pandemic. Still, Swart thinks that this will not be too bad. “The drug will remain widely available in Australia, so people will not be affected,” she suspects. “It may just be that it becomes more expensive for people who often use paracetamol, because smaller packages are relatively more expensive.”
With the new decision, Australia hopes to have found a middle ground. On the one hand, paracetamol remains available to treat acute pain, while at the same time raising awareness of the dangers of paracetamol and making the drug safer for everyone. Will they succeed? Time will tell. And on the basis of those results, the Netherlands can then also take a decision and determine to what extent smaller packages can reduce the number of reports received by the National Poisons Information Centre. For now, Swart thinks that it is at least a good step to inform people better, since too many people are still not sufficiently aware of the risks. “Proper information is important, because paracetamol is less safe than many people think,” concludes Swart.
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