Paracetamol poisoning has become a growing concern in Australia, with a significant rise in hospital admissions linked to overdose cases. While paracetamol is widely used for pain relief, excessive consumption, whether accidental or intentional, can have serious health consequences. This alarming trend has prompted authorities to take action, leading to new regulations aimed at reducing the risks associated with its misuse.
Paracetamol Poisoning on the Rise
While paracetamol is safe when used as directed, excessive intake can lead to severe liver damage and, in extreme cases, death. In Australia, there has been a notable increase in hospital admissions due to paracetamol poisoning, with intentional overdoses being particularly prevalent among adolescents and young adults. Some studies even note that paracetamol overdose resulted in over 225 people being hospitalised over liver injuries. This trend has placed a significant burden on the healthcare system, both in terms of patient care and associated costs.
For instance, a Therapeutic Goods Administration (TGA) study from 2022 found that from 2007 to 2020, there were no less than 8,000 hospital admissions a year from paracetamol poisoning, with 2016-2017 as the worst period at 11,697. And that’s just for accidental overdoses, admissions from self-poisoning incidents peaked at 9,381 that year as well. The annual fatalities for such emergencies numbered between 40 to 50 patients.
A look at the NSW Poisons Information Centre data for paracetamol poisoning events from 2011 to 2021 also warrants much reading for the elderly. For accidental single-ingredient and combination-ingredient poisoning incidents, the most number recorded for adults 20 to 74 years old was at 757 and 201 people at least 75 years old, both in 2020.
For deliberate single-ingredient and combination-ingredient poisoning incidents, 2021 had the highest recorded cases at 1,123 for the 20-74 bracket and 30 for over-75s. When it came to doses taken during the incidents in that year, 849 involved drinking five to ten grams, and the fewest number of occurrences – 57 – involved drinking over 60g.
New Paracetamol Regulations Take Effect in 2025
In response to these concerns shared over consultations in late 2022, the TGA resolved in May 2023 to draft a new set of regulations to limit the size of paracetamol packs being sold, effective from 1 February 2025. The new rules, however, are not applicable to syrup-based paracetamol such as the Panamax 240 Elixir or other children’s medicine, modified-release products, and Schedule IV (Prescription Only) paracetamol. These measures include the following.
Reduced Pack Sizes
The maximum pack size available for sale in businesses aside from a pharmacy, such as supermarkets and convenience stores, will be set at 16 tablets down from 20.
Pharmacists in Queensland and WA will have full authority to supervise the sale of paracetamol products with at least 16 tablets.
For pharmacies located in other Australian states (except the above) and territories, paracetamol packs that can be bought without pharmacist supervision are now limited from 100 tablets to 50 tablets max. Larger “Pharmacy Only” packs, up to 100 tablets, are available only under pharmacist supervision.
Blister/Strip Packages
The TGA mandated that both paracetamol tablets and capsules sold at general sale and as Pharmacy Only are now required to be sold in blister packs. A manufacturer of individually wrapped powdered drinks containing paracetamol, that are usually sold Pharmacy Only, must
must standardise the sachet size to be the same as a tablet or capsule pack.
This packaging change is designed to slow down the consumption process, thereby reducing the likelihood of impulsive overdosing.
Reducing Paracetamol Harm Through Regulation
The primary goal of these regulations is to reduce the incidence of paracetamol-related harm. In limiting the quantity of paracetamol readily accessible, it is anticipated that both accidental and intentional overdoses will decline. This reduction in cases is expected to alleviate the strain on hospital resources, leading to significant cost savings for the healthcare system.
Furthermore, the requirement for pharmacist supervision for larger quantities ensures that consumers receive appropriate guidance on safe usage, storage, and potential risks associated with paracetamol. This professional oversight is crucial in promoting responsible consumption and preventing misuse.
Educating the Public on Safe Paracetamol Use
While regulatory measures are essential, public education on safe paracetamol use is a key harm reduction strategy. Consumers are advised to adhere strictly to dosage instructions and to consult healthcare professionals if pain persists beyond a few days. UNSW Sydney professor Natasa Gisev and doctoral research fellow Ria Hopkins said the reduced size for paracetamol available at a non-pharmacy seller means a single package can be consumed over two days at the dosage of two tablets four times a day (per package instructions), for patients having chronic pain. However, if the pain still persists after the package has been expended, the person must visit their doctor immediately.
Additionally, exploring natural alternatives for pain management can be beneficial. Methods such as physical therapy, acupuncture, and the use of herbal remedies like turmeric and willow bark have been traditionally employed for pain relief. Incorporating these alternatives, under the guidance of healthcare providers, can reduce reliance on pharmaceutical interventions and their associated risks. However, a patient with a noted history of paracetamol consumption for pain relief must heavily consult their doctor before undertaking any alternatives to the medicine.
Conclusion
The recent changes in paracetamol regulations in Australia represent a proactive approach to mitigating the risks associated with its overuse. By implementing stricter controls on pack sizes, packaging, and sales, the TGA aims to promote responsible consumption, reduce the incidence of poisoning, and ultimately save on hospital costs. Coupled with public education and the exploration of natural pain relief alternatives, these measures hold the promise of enhancing public health outcomes and ensuring the safe use of this common medication.
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DISCLAIMER: This article is for informational purposes only and does not reflect official pharmaceutical advice. The Australian Seniors Advantage Group is not affiliated with any pharmaceutical industry body or chemist business. Please consult your GP for tailored solutions on using paracetamol or other medicines.