SUICIDE AND POISONS

In England and Wales the majority of suicides by poisoning are now attributable to one of five products-paracetamol, dextropropoxyphene, amitriptyline, dothiepin and temazepam. Most of the temazepam deaths occur when it is taken in combination with one or more other products. Co-proxamol (dextropropoxyphene plus paracetamol) and paracetamol account for the majority of suicides by overdosage of analgesics. The ratio of the number of prescriptions dispensed to the number of fatalities varies considerably between antidepressants. The highest ratio is amongst the older tricyclics, it is lowest for the atypical antidepressants including the newer selective serotonin reuptake inhibitors. The variation in the fatality ratios of these compounds is related to differences in their inherent toxicity and compliance. Recognising the pattern of suicides from overdosage of drugs has important implications for prevention. Safety in overdose must be taken into account when prescribing drugs to patients who are at risk for suicide.