Published 18 June 2009, doi:10.1136/bmj.b2270
Cite this as: BMJ 2009;338:b2270

Research

Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis

¹ Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX, ² Office for National Statistics, London EC1R 1UW, ³ Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Oxford, OX2 6UD, ⁴ Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL, ⁵ Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Objective To assess the effect of the UK Committee on Safety of Medicines’ announcement in January 2005 of withdrawal of co-proxamol on analgesic prescribing and poisoning mortality.

Design Interrupted time series analysis for 1998-2007.

Setting England and Wales.

Data sources Prescribing data from the prescription statistics department of the Information Centre for Health and Social Care (England) and the Prescribing Services Unit, Health Solutions Wales (Wales). Mortality data from the Office for National Statistics.

Main outcome measures Prescriptions. Deaths from drug poisoning (suicides, open verdicts, accidental poisonings) involving single analgesics.

Results A steep reduction in prescribing of co-proxamol occurred in the post-intervention period 2005-7, such that number of prescriptions fell by an average of 859 (95% confidence interval 653 to 1065) thousand per quarter, equating to an overall decrease of about 59%. Prescribing of some other analgesics (co-codamol, paracetamol, co-dydramol, and codeine) increased significantly during this time. These changes were associated with a major reduction in deaths involving co-proxamol compared with the expected number of deaths (an estimated 295 fewer suicides and 349 fewer deaths including accidental poisonings), but no statistical evidence for an increase in deaths involving either other analgesics or other drugs.

Conclusions Major changes in prescribing after the announcement of the withdrawal of co-proxamol have had a marked beneficial effect on poisoning mortality involving this drug, with little evidence of substitution of suicide method related to increased prescribing of other analgesics.

© Hawton et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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