December 9, 2022

Who takes paracetamol overdoses?

norman swan: There has been a lot of publicity over the past few weeks about changing the size of paracetamol tablet packs, in an effort to reduce self-harm due to overdose. Paracetamol overdoses are very dangerous. But even so, there has been some backlash, saying this is the nanny state in action, and what’s to stop people from shopping if they’re determined to hurt themselves, and people suffering from chronic pain complaining that they will be refused paracetamol.

What didn’t get much coverage was the data behind this policy. And I suspect that when you hear what’s going on, you might change your mind. I heard it last week at the Black Dog Institute’s National Self-Harm Summit, and the speaker was Professor Nick Buckley from the University of Sydney, who notably looked at the experience of New South Wales Poison Centre. Welcome to the CheckupPseudo,

Nicholas Buckley: Thank you for inviting me.

norman swan: Let’s review what you found.

Nicholas Buckley: So for many years, decades, I worked dealing with medical complications of poisoning, the age and gender distribution of people who poison themselves was very static, it was the same kind of pattern of people…

norman swan: What was this model?

Nicholas Buckley: It was a small spike in girls 15, 16, more than boys, and it was quite common in older people as well, but that was the older age group.

norman swan: And there was a seasonal effect, wasn’t there, it was worse in summer than in winter?

Nicholas Buckley: There is a risk of suicide at the end of spring, which may be related to the seasons, but perhaps it is simply related to the fact that people drink more at the end of winter. So there are a lot of possible reasons for this. Anyway, what happened around 2011 is we started to see this big increase, and we just noticed it off the cuff, people were just getting multiple calls about 12 year olds poisoned. And so we’ve seen a doubling in the decade to about 2017 in the number of young people poisoning themselves. Then it leveled off for a few years, and then it increased by about the same amount in the last two years. So overall, we’ve seen the rates of intentional self-poisoning among young people tripling.

norman swan: But it’s not just young people, it’s young girls.

Nicholas Buckley: It is especially young girls, there has been an increase in boys, but boys have never been so frequent. And so you have this huge increase in the number of girls.

norman swan: And what you described last week when I was listening to you speak was this birth cohort effect, which started with the children born in 1997 and then continued.

Nicholas Buckley: Yeah, so a lot has happened in society since, obviously, but yeah, there’s a big increase in people born after that year, and that’s at all ages since that year . So this group poisoned themselves more often when they were 10 and when they were 11 and when they were 12, and so on. And they are still poisoning themselves at higher rates than the group that preceded them.

norman swan: And it’s getting younger, I mean, it started the highest group was 15 and 16, and now it’s younger than that.

Nicholas Buckley: Now that the maximum age range is 14, it is not at all uncommon to see 12 year olds. So, as anyone with teenage children knows, it’s a tough time to be a parent, and it’s a tough time to be a person.

norman swan: Now, other data on self-harm in this age group suggests that it is related to the school year, it is more common during the school year than during the holidays. Were there patterns like that in the data?

Nicholas Buckley: Yes so we have seen that and New South Wales Health has also seen that in a separate analysis of admission rates but in our poisoning calls we see that poisoning rates when we think children are in school, based on school terms, etc., are approximately 50% higher for those school terms. And there is also a weekly peak, so Friday and Saturday are the best days. And then it’s worse on Sunday, Monday, etc.

norman swan: This is largely New South Wales data, how applicable is this data to other states and territories?

Nicholas Buckley: So our regional analysis, we saw the same pattern in Victoria. So we did a combined study with the Victorian Poison Centre, and so we saw that very well, and it applies to ACT and Tasmania, which the New South Wales Poison Center takes. So the New South Wales Poison Center takes half of all poisonings from Australia, so it’s not limited to New South Wales data.

norman swan: So what’s going on here? It’s a fairly sudden effect in children born around 1997. But seems to have happened in 2011. Something happened. I mean, it’s not like all of a sudden parents are giving birth to children who are going to be different teenagers, there’s something environmental that happened here. The most obvious thing to think about, you imagine, is social media.

Nicholas Buckley: Yes, but one thing I didn’t say is that we actually saw… I think we were the first to show this, but it was followed in Canada, the United States, several countries Europeans all see this tripling of self-harm. So I think that’s pointing to something that’s un-Australian, at least relevant to high-income countries, and probably technology-related. But what is in this technology that causes this is unclear. Is it bullying, is it bad content, is it worrisome for the future, is it contagion where people read things that do others do, do they feel terribly insecure because they see all these influencers their age getting hundreds of thousands of dollars and free products? It’s hard to know.

norman swan: And difficult to control. So you’ve gotten past that regulator step by reducing the size of packs, the maximum amount of paracetamol you can buy at one time. Is there any evidence that it will have an effect? For what is the pattern here?

Nicholas Buckley: So obviously fixing paracetamol is not the solution to adolescent auto-intoxication, it’s not a complete solution. What we’re trying to do is reduce the damage that comes from that. And then hopefully other things will be put in place to respond to what’s happening with teenagers in terms of mental well-being and so on. Paracetamol represents 50% of overdoses in this age group, it represents more than that in terms of serious overdoses. And what happens is that kids just go into their closet in their house, that’s the predominant pattern, and grab what’s there.

norman swan: So they don’t go to Coles and Woolies and collect a massive amount of paracetamol.

Nicholas Buckley: They can be on the Internet all the time. But they don’t research it on the internet. They act impulsively and grab what’s in their closet. And we made four suggestions, and three of them were really about trying to reduce the amount of paracetamol that’s sitting around in people’s cupboards because it’s cheap and you can buy it in huge quantities.

norman swan: So how do you respond to the chronic pain lobby by saying, well, we’re being denied our painkillers?

Nicholas Buckley: I would say maybe they should read what the suggestions are because I don’t think anyone will be denied pain medication because of this particular procedure. So I think they have a lot of reasons for wanting to raise the profile of chronic pain in the community, but if you look at the interventions that are offered, they will have minimal impact on anyone. People who need paracetamol regularly in preparation for the modified version will need to get a script every six months. If they don’t see a doctor every six months, maybe they should. Paracetamol is not prohibited. There’s a lot of hysteria, like it’s going to be deleted. It’s much more like telling people to put their seat belts on or doing something simple, not telling them they can’t use the car.

norman swan: Nick, thank you for joining us. We will follow developments with interest.

Nicholas Buckley: Yes thanks.

norman swan: Nick Buckley is Professor of Clinical Pharmacology at the University of Sydney. And it’s the Checkup.