Over the Counter Drugs in Suicide Attempts

Over the counter (OTC) pain relievers and sleep aids are common medications to relieve pain, fever, inflammation and insomnia. Although safe and effective if taken correctly, if ingested in excess, toxicity, and death may result. Especially concerning is acetaminophen, the most common cause of acute liver failure in the US and implicated in renal damage.  In addition to unintentional overdose, OTC products can be used for intentional self-poisoning, including suicide and suicide attempts (SA).  Recent systematic knowledge on the magnitude of OTC-involved SA in the US is sparse. We examined 2011data from the Drug Awareness Warning System (DAWN), a nationally representative data system of all drug related Emergency Department visits.  OTC drugs were involved in 24% (55,491 SAs) of the over 200,000 drug-related SAs in the US. Approximately one-third of the OTC-involved SAs involved acetaminophen only, and 18% percent involved a combination of 2 OTCs of which the highest combination was acetaminophen and OTC sleeping aids, constituting 65% of SAs among those who used two OTCs.  Case severity, gauged by hospital admission indicated that 56% acetaminophen involved SA’s and multiple OTCs (60%) were admitted. Given the toxicity of acetaminophen in large doses, these self-poisonings pose a burden on the health care system and possible long term adverse effects for the individual.  Public health measures similar to those utilized in other countries such as small count sales and blister packaging merit consideration.