President’s Blog: Before you reach for the paracetamol | AMA (WA)


Woman taking paracetamol

President’s Blog: Before you reach for the paracetamol

Friday September 23, 2022

Dr Mark Duncan-Smith, AMA (WA) President

Well, we’re in the unusual vector between a National Day of Mourning for the death of a monarch and the nominal celebration of her birthday (nominal, as she was born 21 April 1926).

You may have noticed I’ve been asked to comment rather regularly since the announcement of the one-off holiday. My responses have not been out of disrespect to the recently deceased queen but through the prism of the effect on healthcare of the holiday.

The AMA (WA) estimates as many as 500 elective surgeries in public hospitals were delayed because of the day, with almost 30,000 West Australians on the wait list. Private hospitals also cancelled some services.

To take a broader perspective, there are, on average, about 10,000 elective surgeries performed every day in Australia. The AMA estimated about half of the surgeries that take place each day were affected on Thursday.

Here we are on the long weekend (I’m somewhat doubtful many of our frontline medical staff were able to change any plans and cash in on the possibility of a five-day break, if they’re getting a break at all), and due to the planned coincidence of the holiday with the Perth Royal Show, we are of course in school holiday territory (I don’t need to tell medical parents juggling cascading responsibilities).

It’s enough to give you a headache (unless you’ve managed to secure some well-deserved time off, of course). But before you reach for the paracetamol…

On 14 September, the Therapeutic Goods Administration (TGA) published an independent expert report examining the incidence of serious injury and death from intentional paracetamol overdose.

A TGA consultation is open until 14 October on possible options to amend the federal Poisons Standard to restrict sales of paracetamol products, particularly to young people.

The independent expert report found that 50 Australians die, and 225 others are hospitalised every year from planned or impulsive paracetamol overdoses every year.

Unfortunately, rates of paracetamol misuse are highest among adolescents and young adults, particularly among girls and young women.

The problem is that impulsive overdoses often involve paracetamol already present in the home, with 20-tablet packs most commonly bought in supermarkets and convenience stores and 96 to 100-tablet packs most commonly bought in pharmacies.

Customers usually buy the largest pack size available and larger pack sizes are more frequently used in overdose cases.

Dr Nick Yim, a GP and the Vice President of the AMA Queensland, recently spoke to the ABC about the repercussions:

DR YIM: An overdose of paracetamol – Panadol – can be quite serious. The majority of time, if they’re treated in time, the survival rates are excellent, but obviously we need to get that in the window of two to six hours when they have that overdose.

ABC: So, what does it do to your body taking too much paracetamol?

DR YIM: To put it in a simplistic form, without the antidote, the person will go into liver failure and ultimately die. So, obviously it’s not a pleasant death. It’s quite painful, quite distressing, and obviously it’s not treating the root cause of the problem, which is mental health in our society. And there’s been a lot of talk about that over the past many months and years.

ANNIE GAFFNEY: How concerning is this report by the TGA on higher rates of intentional overdoses in young women and girls?

DR YIM: I think with the higher rates of intentional overdose, that’s a reflection of what many of society is going through and obviously the challenges of access to mental health, access to psychologists, psychiatrists, and doctors. And that’s the root cause of the issue. The TGA report definitely is valid and at the AMA, we are very supportive of this consultation. In our society and access to paracetamol, we do need to make a few changes.

TGA recommendations include reducing the size of packs of paracetamol sold in supermarkets and convenience stores, and in pharmacies without the advice of a pharmacist, as well as limiting the number of packs that can be bought at one time to one or two to reduce home stockpiles.

The AMA Federal and the Black Dog Institute support the consultation.

It’s a long weekend, it’s Grand Final Day (next year, Dockers, next year). Let’s do everything responsibly this weekend, but should you reach for the paracetamol for whatever reason, do that responsibly too. And keep an eye especially on the kids. Their lives are worth so much more to us than a potentially impulsive act that could turn fatal.