In September 1998, UK legislation on pack sizes came into effect in a bid to curb the 200 odd deaths attributable to paracetamol poisoning every year in England and Wales. The drug is highly toxic to the liver if taken in excess amounts.
The legislation restricted the size of paracetamol packs available to a maximum of 32 tablets of 500 mg each in pharmacies and to a maximum of 16 tablets in other outlets, such as petrol stations, supermarkets, and corner shops.
The drugs and medical devices watchdog, the Medicines and Healthcare products Regulatory Agency, also recommends that only one packet of paracetamol should be sold at a time.
But evidence from the emergency department of an inner city London teaching hospital and information on purchases from pharmacies and other outlets in south London suggests that these recommendations are being contravened.
The researchers questioned 107 people attending one major hospital emergency department for paracetamol poisoning between November 2001 and March 2003 as to how many tablets they had taken, and from where they had obtained them.
In all, 77 of these patients said they had swallowed more than 16 tablets, with 73 patients able to say where they had bought their tablets.
Almost half (35 patients) had deliberately set out to buy paracetamol for an overdose. Sixteen of these patients had managed to buy more than one pack at a time.
One person had bought more than 32 tablets from a pharmacy, and 15 others had bought more than 16 tablets from other outlets.
In 2004, the authors also visited randomly selected pharmacies and other outlets in South London to see how much of the painkiller they would be allowed to buy.
They attempted to buy 64 tablets in one go by taking packs off the shelves, and if not available on display, by simply asking for four packs.
In four of the eight pharmacies they visited, they were able to buy at least 48 tablets in one go.
They also bought more than 16 tablets in four of the six supermarkets, and in nine out of the 10 newsagents, petrol stations, and corner shops, they visited. In all, they were able to purchase at least 48 tablets in nine of the 16 outlets in one go.
The authors point out that their study is small and covers only one area of London, but on the evidence of their research, the recommendations appear to be being contravened.
[Paracetamol availability and recent changes in paracetamol poisoning: is the 1998 legislation limiting availability of paracetamol being followed? Postgrad Med J 2006; 82: 520-3]