Limiting paracetamol pack size: has it worked in the UK?

Introduction. Paracetamol poisoning is a major health problem worldwide. Limitation of pack size is an approach increasingly advocated to reduce rates of suicide and serious self-harm from this agent. The United Kingdom adopted such a policy in 1998, restricting non-pharmacy sales to 8 g and pharmacy to pack sizes of 16 g. Methods. A literature review was conducted and commentary written on the impact of the change in the United Kingdom on a variety of indices of paracetamol overdose. Results. Potential markers of effect identified included paracetamol sales, poisons information data, laboratory results, liver unit referrals, and hospital activity and mortality data. Initial reports suggested effects associated with the legislation, but longer term suicide trend analysis has not confirmed these early findings, which were confounded by population trends in self-harm. Conclusion. Paracetamol pack size limitation as applied in the United Kingdom has not reduced paracetamol-related death. Reasons postulated for this failure include patient avoidance of the legislation's intentions, patient confusion, and ineffectiveness of the regulations as conceived and implemented.