Britt Reuter Morthorst1, Annette Erlangsen2, Manon Chaine3, Frank Eriksson4, Keith Hawton5, Kim Dalhoff6, Merete Nordentoft7. 1. Institute of Clinical Medicine, Faculty of Medical and Health Science, University of Copenhagen, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark; Child & Adolescent Mental Health Services Capital Region of Denmark, Gentofte Hospitalsvej 15, DK - 2900 Hellerup. Electronic address: britt.reuter.morthorst@regionh.dk. 2. Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA; Center for Mental Health Research, College of Health and Medicine, Australian National University, Canberra, Australia. 3. Statens Serum Institut Copenhagen, Denmark. 4. Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark. 5. Centre for Suicide Research, University Department of Psychiatry, Oxford University, Oxford, UK. 6. Department of Clinical Pharmacology and Clinical Toxicology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark. 7. Institute of Clinical Medicine, Faculty of Medical and Health Science, University of Copenhagen, Copenhagen, Denmark; Danish Research Institute for Suicide Prevention, Copenhagen Research Center for Mental Health (CORE), mental Health Center Copenhagen, Copenhagen, Denmark.
Abstract
OBJECTIVE: Self-poisoning with non-opioid analgesics presents a growing challenge to health care providers. We aimed to assess the impact of an 18-year age restriction of OTC sales and a pack size restriction of non-opioid analgesics sold OTC in pharmacies on hospital-treated poisonings and poisoning severity measured using biomarkers. METHODS: We applied a before and after design using interrupted time series analysis. Data on all poisonings recorded as hospital admissions were obtained during 2002-2015 and biochemical parameters from laboratory databases during 2011-2015, both covering the entire Danish population. RESULTS: The age restriction was followed by a 17% level reduction in admissions for non-opioid analgesic poisoning among young people age 10-17 years (RR 0.830; 95% CI 0.697-0.988; p < 0.036). After the pack size restriction, an instant level reduction of 18.5% (RR 0.815; 95% CI 0.729-0.912; p < 0.001) was observed for the entire population. A 27% decrease in the number of poisonings with alanine transaminase levels (ALT) ≥ 210 U/L was observed (RR 0.734; 95% CI 0.579-0.931; p = 0.011) followed by 40% decrease in biomarkers indicative of liver failure (RR 0.597; 95% CI 0.421-0.847; p = 0.004). We also observed similar reductions for other poisonings such as psychotropics. LIMITATIONS: Although declines in poisonings were observed after implementation of means restrictive measures, a causal link cannot be inferred. CONCLUSION: Age and pack size restriction were assiociated with a reduction in the numbers of poisonings. This was also observed for pharmaceutical poisonings in general, which might suggest a non-specific or spill-over effect.
OBJECTIVE: Self-poisoning with non-opioid analgesics presents a growing challenge to health care providers. We aimed to assess the impact of an 18-year age restriction of OTC sales and a pack size restriction of non-opioid analgesics sold OTC in pharmacies on hospital-treated poisonings and poisoning severity measured using biomarkers. METHODS: We applied a before and after design using interrupted time series analysis. Data on all poisonings recorded as hospital admissions were obtained during 2002-2015 and biochemical parameters from laboratory databases during 2011-2015, both covering the entire Danish population. RESULTS: The age restriction was followed by a 17% level reduction in admissions for non-opioid analgesic poisoning among young people age 10-17 years (RR 0.830; 95% CI 0.697-0.988; p < 0.036). After the pack size restriction, an instant level reduction of 18.5% (RR 0.815; 95% CI 0.729-0.912; p < 0.001) was observed for the entire population. A 27% decrease in the number of poisonings with alanine transaminase levels (ALT) ≥ 210 U/L was observed (RR 0.734; 95% CI 0.579-0.931; p = 0.011) followed by 40% decrease in biomarkers indicative of liver failure (RR 0.597; 95% CI 0.421-0.847; p = 0.004). We also observed similar reductions for other poisonings such as psychotropics. LIMITATIONS: Although declines in poisonings were observed after implementation of means restrictive measures, a causal link cannot be inferred. CONCLUSION: Age and pack size restriction were assiociated with a reduction in the numbers of poisonings. This was also observed for pharmaceutical poisonings in general, which might suggest a non-specific or spill-over effect.
Authors: Tammy Jiang; Dávid Nagy; Anthony J Rosellini; Erzsébet Horváth-Puhó; Katherine M Keyes; Timothy L Lash; Sandro Galea; Henrik T Sørensen; Jaimie L Gradus Journal: J Psychiatr Res Date: 2021-08-11 Impact factor: 5.250