So if the box is smaller, do we just buy more boxes?

October 2, 2019

I read with interest in a recent edition of ‘Australian Doctor’ (that’s right, I don’t confine myself to motorcycle mags and artistic anatomy journals!) of the call by ‘authorities’ to restrict paracetamol packages to a maximum of eight tablets on the supermarket shelf or 16 tablets from pharmacy sources.

Hmmm…and why, you ask? Well, the author draws on a recent article in the Medical Journal of Australia which states that deliberate Paracetamol overdoses have risen by 3.8% per year over the period from 2004 to 2017 (95,668 admissions)1. The rationale of their advice, I gather, is to limit availability of paracetamol, in an attempt to address the overdose issue. Anyone else see a flaw in this argument?

It seems this is a follow on to the ‘successful’ reclassification of combination analgesics to prescription only (that is, combinations containing codeine), which came into effect on February 1, 2018. I am yet to see figures demonstrating that this has addressed Australia’s prescription drug dependence problem in relation to narcotics (I’m not even sure if those figures exist/are available, and how reliable they might be). My guess is that this is following in the footsteps of other successful prohibition campaigns; everyone will remember the ethanol experiment in the USA (….pearler that one, eh!?), the abstinence campaign in addressing the AIDS epidemic (another brain fart of an idea!), and the ‘war on drugs’ (need I say more?!).

Human beings are clever little blighters, and if they want to make, what is in retrospect, a misguided choice, they will go ahead and do it, by whichever means are available. To address just the illicit drug industry, the ‘war on drugs’ has hatched a very successful black market economy enriching criminal organisations and depleting the reserves of law enforcement and society as we address the fallout from this ill-conceived idea. By all means, criminalise the illicit suppliers, but decriminalise the user and offer them a safer (and more affordable) alternative through their GP or pharmacy. Give the professionals a chance to spread education and awareness. Look at the example of tobacco; smoking rates have been declining since the 70’s with adult smoking rates almost halved since 1985 in Australia 1. Did prohibition contribute to this? Arguably. Or was it the education campaign addressing the effects of smoking. From where I sit, hard core smokers still access their drug despite accessibility barriers, but I have not met a smoker in my rooms who was unaware of the risks they were taking in pursuing their habit, and this speaks volumes for the resources dedicated to the education of the public.

Now, I managed to go off course, but, fear not, I am about to resume the initial rant.

Rather than inconvenience the vast majority of individuals who responsibly use simple analgesics by adopting restricted packaging, let’s look at why this harmful usage is happening. Do mentally well people take paracetamol overdoses? Is a suicide attempt the normal province of the composed and serene? Nooooo. So perhaps mental illness is driving this pattern of response. So are we seeing a corresponding drive to direct funding into public education and mental health resources? …that resounding silence is the answer to that one.

How adequate are our mental health resources? May I share a recent experience?

I made a call to the CAT Team (Crisis Assessment and Treatment Team) in the past month (or thereabouts) in reference to an urgent referral for a client at risk. GP’s get a priority line, which meant I could hit the appropriate number, leave a call back number, and an inner-northwest primary mental health team triage worker (try to say that in one breath) would call me back to discuss the referral…the NEXT DAY! I kid you not.

Similarly, in the month prior, a call to the YAT (Youth Access Team) regarding a seriously mentally unwell young person, eventually lead to an exasperated mother contacting me some days later frustrated at the inaction as her son deteriorated. I advised her to take him to an emergency department where he was assessed, and eventually admitted to a mental health facility for urgent treatment.

By this, I do not imply that those working in our community-based mental health services are not competent. On the contrary, I feel they do an exemplary job on a shoestring budget, and that is the point I am trying to make.

Public mental health services are chronically underfunded, and successive administrations, when faced with the enormous health burden of mental health need in our community, have consistently endeavoured to find low budget approaches to address this…such as restrictive packaging of commonly abused medications! I hope I have made the point that, clearly, without resources in other areas for a more comprehensive approach to the problem, this is likely to be just another annoying prohibition easily worked around by those bent on mischief, and frustrating (exasperating) to the majority.

So, by sounding off, do I imply that I have the answer to our escalating mental health woes? Nope. But I’m even more certain that the old fall-back of prohibition has been woefully inadequate in the past (oh, I left out another humdinger from the past…the “just say no” campaign in addressing teenage pregnancy in Texas, proposed by Governor Rick Perry3 – Texas now has the third highest teenage pregnancy rate in the whole USA! Well thought out Rick! Don’t educate your children about sex…just tell them to forget about it and engage in other more wholesome pursuits, just like you, eh!?4)

All this deep thinking has given me a headache…is there any paracetamol left in that box, dear?

Dr Alan Underwood