Citation

Cairns R, Noghrehchi F, Buckley NA. Med. J. Aust. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Australian Medical Association, Publisher Australasian Medical Publishing)

DOI

10.5694/mja2.51888

PMID

36941110

Abstract

In Australia, paracetamol is the agent most frequently implicated in drug overdoses, and their frequency is increasing, particularly in young people.1 Paracetamol overdose causes significant morbidity despite treatment, and is the leading cause of acute liver failure in Western countries.2 Modified release (MR) paracetamol overdose is associated with a higher rate of liver injury than immediate release paracetamol.3 The sole therapeutic benefit of MR paracetamol is its more convenient dosage regimen (three rather than four times a day).4

In response to the rising numbers of overdoses, the Therapeutic Goods Administration (TGA) up-scheduled MR paracetamol, from Schedule 2 to Schedule 3, in June 2020.5 A pharmacist must be involved in sales of Schedule 3 medicines, which must be stored behind the pharmacy counter. We evaluated whether re-scheduling was associated with changes in the numbers of overdoses with MR paracetamol, immediate release paracetamol, and other over-the-counter analgesics reported to the New South Wales Poisons Information Centre (NSWPIC) to the end of August 2022. The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2021/ETH00165).

We assessed changes in monthly overdose numbers using interrupted time series analysis. We also examined the impact of coronavirus disease 2019 (COVID-19)-related restrictions, and that of new paracetamol overdose treatment guidelines that could have increased referrals to NSWPIC (published online in December 20193), using changepoint analysis...

Language: en

Keywords

Analgesics; Self-injurious behavior; Pharmacoepidemiology; Policy, drugs and alcohol