The Pharmaceutical Journal
Vol 269 No 7217 p427
28 September 2002

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National Suicide Prevention Strategy for England (more)

Suicide prevention strategy considers safety warnings for OTC packaging

The Government is to consider introducing safety warnings on packs of over-the-counter aspirin and paracetamol to highlight the dangers of overdose as part of its National Suicide Prevention Strategy.

The National Institute for Mental Health in England (NIMHE), which forms part of the National Health Service's Modernisation Agency, will consult with the Medicines Control Agency on how the dangers of paracetamol overdose can be publicised more effectively, possibly through safety warnings on packaging. It will also consider including a helpline number with any warning.

National director for mental health Professor Louis Appleby, who will lead implementation of the strategy, told The Journal: "We are very much in favour of the safety messages. Of course, we will also have to talk to manufacturers about doing that."

A spokesperson for the PAGB commented: "It's really an issue for the MCA, but we will work with them and help them in any way we can. We are not going to argue against stronger safety messages if the MCA believe these are necessary."

The PAGB also welcomes the recognition in the strategy that reductions in pack size for over-the-counter paracetamol and aspirin, made in 1998, have led to a fall in overdose deaths from these medicines: "We think the pack size reduction is about right," he added.

One of the six goals outlined in the new strategy, published this month, is to reduce the availability and lethality of suicide methods. The NIMHE is therefore going to look at promoting safe disposal of unwanted medicines by the public and the recall of unused prescribed antidepressants by clinicians.

But Professor Appleby said it was first necessary to identify the scale of the problem associated with certain drugs through research. He said: "We know there are deaths from these drugs, but we actually don't have the full evidence. One of the first steps will be to spend a short time collecting the evidence on paracetamol and codeine deaths so that we can issue guidance to primary care and pharmacy."

Questions the research also would need to answer, Professor Appleby said, included how much of the drugs were being prescribed for which conditions, whether most of the prescriptions were being issued by primary care, and what proportion of drugs remained unused by patients and were kept around the house. One suggestion is that when patients are changed over from one drug to another, it could be stipulated that they must bring back any unused stocks of the old medicine to the pharmacy before the new medicine is dispensed.

"We will use the research for the basis of some clearer rules, or greater publicity for the need to return medicines," said Professor Appleby. "It's a question of making the public aware and making it higher profile so it becomes part of everyday clinical and pharmacy practice."