December 9, 2022

Limitations of Panadol: Australians ‘fear’ of possible restrictions on the purchase of paracetamol

KEY POINTS
  • Australia’s medicines watchdog is considering a proposal to restrict the sale of paracetamol products like Panadol.
  • Changes only include permission to buy one or two packs of paracetamol at a time
  • The proposals have raised concerns about impacts on women and people living in regional areas in particular
This article contains references to suicide/self-harm.
According to an advocacy group, a proposal to restrict the sale of paracetamol products like Panadol is likely to “frighten” the millions of Australians who depend on these products to live their daily lives.
A Therapeutic Goods Administration (TGA) committee met on Wednesday to consider comments from the public consultation on limiting the sale of some products.

Advocacy group Pain Australia, which made a presentation to the committee, is particularly concerned about four changes:

  • Restriction of paracetamol to a box of 16 tablets;
  • Allow people to buy only one or two packs at a time;
  • Allow only those over 18 to buy tablets without a prescription; and
  • Forcing those who buy slow-release paracetamol like Panadol Osteo to get a prescription for these products.
The changes were developed in response to a 2019 research paper, which found a 93% increase in overdoses among young Australians aged 5 to 19 between 2006 and 2016.
One of the objectives is to reduce the stock of paracetamol at home. A survey by the NSW Poisons Information Center found that only 10% of people who poisoned themselves with paracetamol had recently purchased painkillers.
But Pain Australia chief executive Giulia Jones worries about the unintended consequences of the changes on one in five Australians (aged 25+) which is pain that does not go away after three months.

“These people often have a really hard time getting out of bed every day,” she said. “It’s kind of hard to imagine if you’ve never lived with someone with chronic pain, how much it affects their daily life.”

Authorities are considering introducing limits on the number of paracetamol tablets people can buy. Source: AAP / David Crosling

Who relies on paracetamol?

Paracetamol is used by many Australians with a wide variety of health conditions.
Ms Jones said ‘modified-release’ paracetamol, also known as slow-release paracetamol, could be used by people with arthritis or those who have recently had joint replacements that they are still getting used to.
Others might take standard paracetamol for spinal problems, periods, or pelvic pain, including endometriosis, headaches, and fibromyalgia, which causes musculoskeletal pain.
Ms Jones noted that a submission to the TGA by pain specialists pointed out that paracetamol is one of only three non-painkillers they recommend people use.

“A lot of people can’t use the others because of their stomach or other physical conditions or other medications they’re taking,” she said.

“Paracetamol is the one that has the least adverse effects with other drugs and other physical conditions, so it’s really the safest drug we have.
“You can imagine being a mum with a back problem, trying to keep up with a young family or a dad with fibromyalgia whose life is painful, but they want to keep working, they have to keep going for their family.

“We really don’t want to affect these people’s ability to manage their own pain.”

“Unintended” consequences of paracetamol proposals

Ms Jones said people with chronic pain can safely take six to eight tablets of paracetamol a day. Limiting them to a pack of 16 tablets meant they would only have enough supply to last two days.
“If you limit the number [to two packets] it’s every four days, you have to go back to the supermarket,” she said.

“For a lot of these people, day-to-day life is really tough, so we want them to be able to buy a fortnight’s supply on payday.”

If you limit the number [to two packets] it’s every four days, have to go back to the supermarket

Guilia Jones, CEO of Pain Australia

Forcing people under the age of 18 to get a prescription could also impact young carers who take paracetamol for their parents, or those who suffer from chronic menstruation or pelvic pain.
Ms Jones said requiring people to get a prescription for slow-release paracetamol would also create another barrier to people getting what they need.
She said there was a shortage of GPs at the moment and .

‘I know here in Canberra it’s $80 a GP visit per person, if you can get in, when you can get in. Very few doctors are mass billing these days,’ she said .

Doctor taking notes during video call with patient

Critics say forcing people to see a doctor for a paracetamol prescription could cause unnecessary hardship. Source: Getty / Luis Alvarez/Getty Images

Ms Jones said once people learned how to manage their condition, they no longer needed their doctor’s advice on a monthly basis.

“What they need is to be empowered to self-manage. And we encourage people to self-manage because it puts them in the right mindset for what we call ‘leaning into your pain “rather than backing off,” she said. .
The change would also disproportionately impact those in regional areas. Ms Jones said someone working at a station in a regional area might have to drive several hours to get to the shops.
“You need to be able to buy a fair supply of these things because travel costs money and time that you don’t always have,” she said.

“They also have pharmacies that are not open late. In cities, you can often find a night pharmacy.”

Proposed changes ‘frighten’ Australians

Asked how she thought Australians were reacting to the proposed changes, Ms Jones said: “I think it scares people with chronic pain.”
“The government already told them, ‘you shouldn’t take opioids’ and before that, ‘you shouldn’t take codeine’…and people accepted that, but it was really stressful,” said she declared.
“People who had just taken their doctor’s advice were suddenly treated like something was wrong with them for doing this.
“So there’s already been a lot of stress on this cohort and their view is ‘paracetamol? Are you going to make it more difficult to buy paracetamol? That’s kind of all we have left.”

“So I’m very concerned about this cohort and how they’re reacting. I imagine people are already buying packets of paracetamol to keep at home, which is exactly what we don’t want.”

Australia should consider mental health approach

The 2019 research from the University of Sydney and the NSW Poisons Information Center that sparked the proposals for change, found an alarming rise in the number of overdoses among young people, with women three times as many as men.
He revealed that the substances they used to poison themselves were widely available in the community, including household products and over-the-counter drugs like paracetamol, rather than prescription drugs like antidepressants.

The proposed changes are backed by Suicide Prevention Australia, but he also stressed the need to address any unintended consequences for people with chronic pain.

A woman with back pain looks at a diagram of a spine at a physiotherapist's office

About one in five Australians suffer from chronic pain. Source: AAP

But Ms Jones said while the basis for actions was good, the solution should come from Mental Health Minister Emma McBride, not the TGA.

“Emma is a very capable woman, she was a pharmacist herself before she was a politician. She has all the tools and government support to address issues such as the behaviors of young women if they have concerns about their mental health – do they want relief or are they looking for ways to harm themselves?

“I wouldn’t put this in the hands of the TGA to be honest.”

What happens now?

The TGA’s Advisory Committee on Medication Planning (ACMS) is expected to announce an interim decision on the changes to paracetamol by February, with another round of consultation before any final decision, which is expected to be made in April 2023. change would likely not be implemented until late 2023 or early 2024.
Ms Jones said she hoped the pack limits, size limit and prescription requirement would all be removed.
“Because they affect so many people in detrimental ways, and this group of people living with chronic pain has already had so much to deal with over the past few years – losing access to medical care during lockdowns, scripts were hard to get, they’ve had the sanity strain.
“People living with chronic pain are two to three times more likely to be suicidal than those living without chronic pain in our country. They also have to consider stress and strain. So I really hope that this part of the TGA’s proposal will be dropped.”
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