The effect of recalling paracetamol on hospital admissions for poisoning

To the Editor: We read with interest the study of Kisely et al,1 which showed a decrease in admissions for poisoning with paracetamol, but no coincident increase in use of other agents, as a result of the paracetamol recalls. We had noticed there was an unusually high number of presentations (18) to the Paediatric Emergency Department at the Women’s and Children’s Hospital, Adelaide (WCH), for poisoning with aspirin in 2000, compared with one presentation in 2001 and one in 2002. We wondered if the presentations in 2000 were temporally associated with the paracetamol recalls.

We extracted all WCH presentations with a primary diagnosis of paracetamol poisoning (ICD-9 code 965.4), aspirin poisoning (965.1), nonsteroidal anti-inflammatory drugs (965.6) and poisoning with all other drugs (960–979.9) for the two recall periods (16 March 2000 to 21 May 2000; 6 June 2000 to 23 August 2000)2 and the same periods in 2001 and 2002. It could not be determined whether an over-the-counter preparation of a nonsteroidal anti-inflammatory drug had been taken. The results are shown in the Box.

Although it is not possible to reach any definite conclusion from these observations, we share the concerns of Balit et al2 that limiting the availability of paracetamol could result in an increase in poisonings with potentially more acutely dangerous agents such as aspirin, particularly for adolescents. There needs to be further consideration of the motivation of patients in choosing paracetamol and the source of the drug when taken for intentional self-poisoning before measures are taken to restrict access to paracetamol.