As someone who lives with chronic pain, I was pretty alarmed to see the TGA is currently considering proposals to limit the availability of paracetamol.
The move follows a report into self harm with paracetamol, requested by David Coleman – the absentee minister who barely set foot in Canberra for most of the last term due to dealing with his daughter’s mental health issues. While his family’s story is tragic, and surely influential on the shaping of the independent expert report (which just looked at self harming, not at the rest of the picture), it is hardly justification for locking up a very safe drug that millions of Australians use daily without issue to manage their pain.
These are the options the TGA is considering to reduce harm from intentional paracetamol overdose:
- Reducing the size of packs of paracetamol sold in supermarkets and convenience stores, and in pharmacies without the advice of a pharmacist
- Limiting the number of packs of paracetamol products that can be purchased in one transaction to 1 or 2 packs to reduce home stockpiles of paracetamol
- Making modified-release paracetamol, which is designed for long-term use rather than for acute pain, available only with a prescription
- Restricting the purchasing of paracetamol without a prescription to individuals aged 18 years and older
- Improving the communication around the potential harms from paracetamol
- Maintaining and expanding follow-up care and support after self-harm
- Increasing awareness about safer storage of medicines and reducing stockpiling of unwanted medicines
Let’s go through them shall we?
1 and 2 are the same thing – reducing supply and hoping that will reduce stores at home. You can already buy small packs. Smaller packs isn’t going to stop someone who intends to self harm from buying more packs. The maximum pack size in supermarkets is already limited to 20 tablets, and has been since 2013.
You restrict the number of packs and they’ll just go to more stores. Or, as I did throughout the entire period of the supermarket pack limits during the earlier stages of Covid-19, buy the maximum at every shop whether I needed it or not, leading to more stock piling rather than less.
The report itself says purchasing patterns don’t contribute to self harming; only 10% reported buying paracetamol on that day. So why they think either pack size or numbers of packs will make any difference is really odd.
Number 3 is probably the dumbest one of the lot. Long acting paracetamol, most commonly Panadol Osteo, is already only available at pharmacies. It is intended for long term use and those in chronic pain, and not that long ago there was a push to get it off the PBS and stop doctors prescribing it because it was costing too much money. Making it prescription only just adds cost and inconvenience to people who are usually elderly, disabled, or living with chronic pain, and adds unnecessary burden to GP workloads.
The report authors compare upscheduling long acting paracetamol to the upscheduling of codeine which reduced the overdosing of codeine and paracetamol products. Yes it did; it also massively inconvenienced people with chronic pain conditions, has caused significant harm and suffering to many people, and put an unreasonable burden on GPs. I can assure you that most people with chronic pain would very much like codeine to go back to s3. The further reform in opioid availability in 2020 made it damn near impossible to get codeine even with a script, with hugely detrimental outcomes for pain patients. Codeine was also killing as many people as heroin, so how about we compare apples with apples?
Number 4 is the one that really makes me angry. Like many women with chronic pain from conditions like endometriosis, migraine, and fibromyalgia, my pain started as a teenager. The absolutely catastrophic impact of not allowing teenagers with chronic pain conditions – of even just girls dealing with periods – from being able to buy paracetamol needs to be screamed at the TGA and anyone else who thinks this is a good idea. Just proposing such a thing drips of old white privileged men who grew up in nice functional households, who literally cannot conceive of the bravery and challenges most of Australia’s kids negotiate daily. You don’t even have to contemplate the nightmare scenarios to come up with examples of why this is dumb: how about a 15 year old girl being raised by a single dad or with a mum who travels for work a lot? You want to tell her she can still go into a supermarket to buy tampons herself, but The Government has decided she can’t buy common, safe, medication to manage the pain?
Again, the report itself says that most of the overdoses were people taking what was at home – they aren’t buying on the day. So why would limiting sales to over 18’s reduce poisonings in 10-17 year olds?
The last three points being considered are just pathetic performance art to make people feel good about themselves while achieving nothing.
Improving the communication around self-harm from paracetamol is just going to make it more popular for kids to do. Try talking to a child psychologist… or any parent. If you want to improve awareness in schools, doctors, whatever, knock yourself out (although I’m not sure why it would be the TGA’s job to do that) but remember the problem is the child who has intentionally chosen to harm themselves, not the thing they found at easy reach to inflict said harm. People intent on harming themselves are generally not picky about the tool – if paracetamol is not available, they’ll find something else.
Maintaining and expanding follow up care and support after self harm would be ideal for any type of self harm, intentional paracetamol overdose shouldn’t get special treatment. Feel free to properly fund mental health care and perhaps remove the GP gateway of mental health care plans anytime you like.
And the final one, increasing awareness around safer storage of medications and reducing stockpiling? That might have a tiny tiny tiny impact if the overdoses were not intentional.
And that’s the crux of this nonsense. It’s really hard to overdose on paracetamol in order to cause yourself harm. Again, from the report itself: the minimum toxic overdose is 10 grams, or a full packet of 20, 500mg pills. However, most people that develop the liver toxicity associated with overdose have taken three times that. No one swallows 60 pills by accident, and there’s no suggestion that it was accidental… all of the self harm discussed in the report is intentional.
Which means that nothing you do to how the vast majority of people buy, store, or use paracetamol will make a lick of difference.
People with chronic pain have been treated woefully in recent years, forced to bear the burden and suffer so that ‘public health’ types can imagine they have achieved something. Our doctors have been harassed and threatened, our pharmacists bullied, and the stigma associated with needing regular pain medication has gone through the roof. Enough already.
If you want to make your own submission to the TGA, you can’t. Like most, the first I heard of it was after the submissions had closed.
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