Content warning: This article contains sensitive information on self-harm, which some readers may find triggering. Any readers particularly affected by this content are advised to link with a supervisor or allied supports available. Additional supports are listed at the end of this article.
Written by:
Dr Caroline Daly, Postdoctoral Researcher, National Suicide Research Foundation and Paracetamol WG Co-ordinator
Dr Michelle O’Driscoll, Postdoctoral Researcher National Suicide Research Foundation and Paracetamol WG Co-ordinator
Prof. Philip Dodd, Consultant Psychiatrist/Clinical Professor, Mental Health Policy & Clinical Specialist at the Department of Health, Mental Health Unit, Clinical Advisor of National Office for Suicide Prevention and Paracetamol WG Co-Chair.
Paracetamol intentional drug overdose
Paracetamol is the drug most frequently taken in intentional and accidental overdose in Ireland. Each year the National Self-Harm Registry Ireland (NSHRI) records approximately 2,300 hospital-presenting intentional drug overdoses with paracetamol, with rates increasing among young people.1,2 For every male overdose with paracetamol there are four female paracetamol IDOs.
Many paracetamol overdoses are clinically serious, and the physical consequences of overdoses occur in parallel with social and psychosocial impacts on individuals and their wider circles.
Restricting access to means
Restricting access to means of self-harm, including paracetamol overdose, is the single most effective prevention measure. Statutory pack size and sales legislation introduced in Ireland since 2001 have led to a decrease in deaths involving paracetamol and a reduction in the toxicity of overdoses.4 However, research has shown that adherence to this legislation is poor.5
Preventing Paracetamol-Related Drug Overdose Working Group (WG)
To address this issue, the Preventing Paracetamol-Related Drug Overdose Working Group (WG) led by the Department of Health was established in 2021 to decipher next steps to prevent intentional paracetamol overdose in Ireland. This works supports the implementation of Connecting for Life, Ireland’s National Strategy to Reduce Suicide (2015-2024), and specifically action 6.1.2, ‘continue improvements in adherence to the legislation limiting access to paracetamol through raising awareness amongst retailers and the public and the use of point of sale systems.’
The group has representation from the Department of Health, the HSE National Office for Suicide Prevention (NOSP), the Health Products Regulatory Authority (HPRA), the National Suicide Research Foundation (NSRF), the Pharmaceutical Society of Ireland (PSI) and support from retail stakeholders. The Group aims to enhance information and support training development for pharmacy and non-pharmacy retail sector staff, collaborate on preventative interventions, and support actions required following market surveillance work.
New information campaign
Following extensive consultation, and a nationwide survey of pharmacy and non-pharmacy retail staff, new educational materials were launched by Minister Mary Butler on behalf of the working group on 17th October 2023 at the Department of Health. These educational materials highlight the purpose of the legislation and how to raise awareness of regulations amongst those who sell paracetamol to the public. This will ultimately contribute to the prevention of paracetamol related intentional drug overdose in Ireland.
As part of this campaign, new information packs are now available to order or download for pharmacy settings. They contain informative posters and postcards suitable for display in staff areas or noticeboards. They also contain shelf-riders/stickers that might be suitable for public-facing or staff-facing display units where paracetamol-containing products are displayed. Additional icons are available in .jpg and .png formats that could be suitable for inclusion on, for example websites, or email signatures.
Get your information packs
Two versions of information packs are available – one for Pharmacy retail settings and staff, and one for non-Pharmacy general retail settings and online (for example convenience stores, supermarkets, service stations).
Follow the QR code or visit https://www.hse.ie/eng/services/list/4/mental-health-services/connecting-for-life/publications/safe-sales-of-paracetamol.html – where the information packs are now available:
• To order for free delivery
• To download.
Further information
Contact the HSE National Office for Suicide Prevention (NOSP) at info@nosp.ie if:
• You would like to adapt any of these materials for other uses (for example incorporating the information with your own branding or pharmacy signage), or
• You have any questions or feedback on these information packs.
The CEO/Registrar of the Pharmaceutical Society of Ireland (PSI), Joanne Kissane said of the campaign. “This information and awareness campaign is an important milestone in the ongoing work of the multi-stakeholder, collaborative Working Group. The PSI are happy to be a part of this work, which is intended to highlight the importance of appropriate paracetamol sales to protect public safety, and support the education of pharmacy and non-pharmacy retail staff on restrictions in place for paracetamol-containing medicines. We all have a role to play in the reduction of the incidence of paracetamol-related intentional drug overdose in Ireland, and so we encourage pharmacies to engage in this information campaign, and utilise the tools available to increase awareness and knowledge among staff and the public.”
For further information in relation to the Working Group and this campaign, please contact Dr Michelle O’Driscoll at michelle.odriscoll@ucc.ie.
Literature
1. Joyce M, Daly C, McTernan N, Griffin E, Nicholson S, Arensman E, Williamson E, Corcoran P. (2020) National Self-Harm Registry Ireland Annual Report 2019. Cork: National Suicide Research Foundation.
2. Daly C, Griffin E, McMahon E, Corcoran P, Webb RT, Ashcroft DM, Arensman E. (2020) Paracetamolrelated intentional drug overdose among young people: a national registry study of characteristics, incidence and trends, 2007-2018. Soc Psychiatry Psychiatr Epidemiol. 56(5):773-81.
3. Gulmez SE, Larrey D, Pageaux GP, Bernuau J, Bissoli F, Horsmans Y, Thorburn D, McCormick PA, Stricker B, Toussi M, Lignot-Maleyran S, Micon S, Hamoud F, Lassalle R, Jové J, Blin P, Moore N. Liver transplant associated with paracetamol overdose: results from the sevencountry SA LT study. Br J Clin Pharmacol. 2015; 80: 599-606
4. Donohoe E, Walsh N, Tracey JA. Pack-size legislation reduces severity of paracetamol overdoses in Ireland. Ir J Med Sci. 2006;175(3):40-2.
5. Ni Mhaolain AM, Davoren M, Kelly BD, Breen E, Casey P. (2009) Paracetamol availability in pharmacy and non-pharmacy outlets in Dublin. Ireland. Ir J Med Sci. 178(1):79–82.
Support information – If you, or someone you know, needs mental health support or a listening ear, reach out to a trusted service. Many are available 24/7 and you can make contact in different ways, for example:
• on the phone – Samaritans – freephone 116 123
• by text message – Text About It – text HELLO to 50808
• online – MyMind – www.mymind.org
• face-to-face – Pieta – freephone 1800 247 247
You can also call the HSE YourMentalHealth Information Line, anytime day or night, for information on mental health, and what other services and supports are available near you. Freephone 1800 111 888 or visit www.yourmentalhealth.ie
