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UK legislation on analgesic packs: before and after study of long term effect on poisonings

BMJ 2004; 329 doi: (Published 04 November 2004) Cite this as: BMJ 2004;329:1076
  1. Keith Hawton (keith.hawton{at}, professor of psychiatry1,
  2. Sue Simkin, senior researcher1,
  3. Jonathan Deeks, senior medical statistician2,
  4. Jayne Cooper, research fellow3,
  5. Amy Johnston, research assistant3,
  6. Keith Waters, clinical nurse specialist4,
  7. Morag Arundel, transplant fellow5,
  8. William Bernal, consultant in intensive care6,
  9. Bridget Gunson, clinical scientist7,
  10. Mark Hudson, consultant hepatologist8,
  11. Deepak Suri, consultant gastroenterologist9,
  12. Kenneth Simpson10, consultant physician
  1. 1 Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Headington, Oxford OX3 7JX
  2. 2 Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LF
  3. 3 Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL
  4. 4 Mental Health Resource Centre, Derbyshire Royal Infirmary, Derby DE1 2QY
  5. 5 Department of Hepatology, St James's University Hospital, Leeds LS9 7TF
  6. 6 Institute of Liver Studies, King's College Hospital, London SE5 9RS
  7. 7 Liver Laboratories, Queen Elizabeth Hospital, Birmingham B15 2TH
  8. 8 Liver Unit, Freeman Hospital, Newcastle upon Tyne NE7 7ND
  9. 9 Royal Free Hospital, London NW3 2QG
  10. 10 Department of Medicine, University of Edinburgh, Royal Infirmary, Edinburgh EH3 9YW
  1. Correspondence to: K Hawton
  • Accepted 8 September 2004


Objective To evaluate the long term effect of legislation limiting the size of packs of analgesics sold over the counter.

Design Before and after study.

Setting Suicides in England and Wales, data from six liver units in England and Scotland and five general hospitals in England, and UK data on sales of analgesics, between September 1993 and September 2002.

Data sources Office for National Statistics; six liver units in England and Scotland; monitoring systems in general hospitals in Oxford, Manchester, and Derby; and Intercontinental Medical Statistics Health UK.

Main outcome measures Deaths by suicidal overdose with paracetamol, salicylates, or ibuprofen; numbers of patients admitted to liver units, listed for liver transplant, and undergoing transplantations for paracetamol induced hepatotoxicity; non-fatal self poisonings with analgesics and numbers of tablets taken; and sales figures for analgesics.

Results Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths.

Conclusion Legislation restricting pack sizes of analgesics in the United Kingdom has been beneficial. A further reduction in pack sizes could prevent more deaths.


  • Contributors KH, SS, and JD designed the study. KH and SS coordinated the study and wrote the report with JD, with the help of the other investigators. JC, AJ, KW, MA, WB, BG, MH, DS, and KS participated in the planning, data collection, and writing of the report. JD conducted the data analysis. KH is the guarantor.

  • Funding Grant from Southeast Region Research and Development Committee.

  • Competing interests None declared.

  • Ethical approval Not required

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