Public Health
Volume 121, Issue 1 , Pages 45-50, January 2007

How has legislation restricting paracetamol pack size affected patterns of deprivation related inequalities in self-harm in Scotland?

  • D.R. Gorman

      Affiliations

    • NHS Lothian, 148 The Pleasance, Edinburgh, EH8 9RS, Scotland, UK
    • Corresponding Author InformationCorresponding author. Tel.: +1315369165; fax: +1315369164.
    • ,
  • M. Bain

      Affiliations

    • NHS Scotland, Information and Statistics Division, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK
    • ,
  • J.H.C. Inglis

      Affiliations

    • NHS Health Scotland, Woodburn House, Canaan Lane, Edinburgh EH10 4SG, UK
    • ,
  • D. Murphy

      Affiliations

    • NHS Scotland, Information and Statistics Division, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, UK
    • ,
  • D.N. Bateman

      Affiliations

    • Scottish Poisons Information Bureau, NPIS Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK

Received 25 March 2005; received in revised form 17 July 2006; accepted 24 August 2006.

Summary 

Objective

To describe how changes in legislation to control sales and thus restrict the general availability of paracetamol have affected deprivation-related inequalities in deliberate self-harm associated with the drug in Scotland.

Design and setting

A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2002.

Participants

Patients in Scotland admitted to hospital with a diagnosis of poisoning and deaths in Scotland due to poisoning 1995–2002.

Outcome measures

Changes in mortality and overdose rates by deprivation quintile, and case fatality rates due to poisoning involving paracetamol.

Results

Rates of overdose involving paracetamol, while much higher in disadvantaged quintiles, fell in each deprivation quintile following the 1998 legislation. They then returned to levels similar, or above those in the mid 1990s. All quintiles were affected to a similar extent with the relationship between them remaining constant over time. Case fatality rates were significantly higher in more disadvantaged quintiles.

Conclusions

Marked inequalities exist in paracetamol related harm in Scotland. The most disadvantaged groups (both male and female) have higher overdose and death rates, as well as higher case fatality rates.

Following the restrictions all social groups saw similar reductions in paracetamol related harm. This effect has been short-lived and rates have returned to pre-legislation levels. Legislation has not permanently affected overall use of paracetamol in overdose in Scotland or reduced the proportion of patients taking paracetamol as a component of the overdose in the longer term.

An important public health policy has failed to achieve its objective and it is not clear why. We need a better understanding of why this measure had only short-term benefits if its full potential is to be achieved.

Keywords: Paracetamol poisoning, Self-harm, Suicide, Deprivation

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PII: S0033-3506(06)00255-1

doi:10.1016/j.puhe.2006.08.014

Public Health
Volume 121, Issue 1 , Pages 45-50, January 2007

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