The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67944

Dermot Robert Gorman¹, Marion Bain², James Inglis³, D Nicholas Bateman⁴, and David Murphy². (1) Public Health/Health Policy, Lothian NHS Board, Deaconess House, 148 Pleasance, Edinburgh, United Kingdom, +44 191 536 9000, dermot.gorman@lhb.scot.nhs.uk, (2) NHS Scotland, Information and Statistics Division, Trinity Park House, South Trinity Road, Edinburgh, EH5 3SQ, United Kingdom, (3) Health Information Department, NHS Health Scotland, Thy Priory, Canaan Lane, Edinburgh, EH10 4 SG, United Kingdom, (4) Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, United Kingdom

Overdose is a major cause of acute hospital admission in Scotland responsible for some 21,800 hospital admissions each year with acetaminophen being involved in 30%. Overdoses increased steadily during the 1990s and in 1998 in an effort to limit the ill-effects of acetaminophen poisoning restrictions were put on its sale and packaging. Similar restrictions were rejected by the US Food and Drug Administration (USA has 450 deaths attributed to acetaminophen per year vs. 100 in Scotland).

We studied overdoses during 1997–2001 from the Scottish Morbidity Record System for the Scottish population of 5.1 million. Both acetaminophen and ‘all’ overdoses dropped substantially subsequent to the change in legislation. This has not been sustained with rates returning to 1998 levels in 2000 and exceeding them in 2001.

There is contradictory evidence regarding any differential and larger reduction in severe versus ‘trivial’ overdose with some evidence of a short-term reduction in deaths due to acetaminophen poisoning in 1998 & 1999. The well-recognised higher overdose rates in disadvantaged communities was constantly seen.

Conclusion We report a substantial reduction in acetaminophen overdose in the Scottish population following the restrictions on its sale in 1998. This has not been maintained and levels of acetaminophen overdose are now exceeding rates seen before the intervention. The differences between social groups will be examined in our paper.

One needs to continually monitor the ‘success’ of public health initiatives.

Learning Objectives:

• Participants will learn about:
• The effects of legislation restricting the availability of acetaminophen on national overdose rates
• socio-economic variation in overdose rates and deaths from acetaminophen poisoning

Keywords: Public Health Legislation, Drug Abuse

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.