the origins of myths about paracetamol safety

Paracetamol is the most widely used medicine in the UK, taken therapeutically by over 30 million people each year. However, a small minority deliberately take too much for purposes of self harm. Fortunately the majority of these people come to no harm but for those who have taken a large overdose and who have not been treated in hospital early enough, the consequences may be serious liver toxicity, and even death, accounting for approximately 5% of annual medicines overdose deaths in the UK.
When used according to recommendations paracetamol has a remarkably good safety record, but there is a media myth that it is more dangerous than other medicines. The following are some of the causes of this misconception.

• Paracetamol is familiar to the lay public and journalists, who will name it when reporting overdoses. Other less widely known medicines are usually not named in newspaper reports.
• Newspapers often report unsubstantiated and inaccurate stories about overdose deaths from low doses of paracetamol. In fact, death seldom occurs from a single dose of less than 30 tablets, and if it does there are likely to be contributing factors such as chronic alcohol abuse or severe malnutrition.
• Unlike deaths from overdoses of most medicines, a fatal overdose of paracetamol has a relatively long time course to death. This means that virtually all cases spend time in hospital. Hospital doctors and nurses therefore treat more of these cases than other fatal overdose cases (which are likely to be brought in dead), and some may form strong opinions against paracetamol while being less aware of all the other medicines overdose cases.
• The long time course to death is harrowing for relatives, who may, understandably, vent their feelings by becoming angry towards the paracetamol used in the overdose.
• In many inquests paracetamol is mentioned as being found present when it was not actually the cause of death. Such cases are commonly misreported as paracetamol deaths, thus exaggerating the role of paracetamol in overdosage. A report in the British Medical Journal in 1997 suggested that as many as 50% of reported paracetamol deaths were not actually due to paracetamol.
• Fatal overdoses are sometimes rationalised by relatives as being accidental, and due to the taking of different products containing paracetamol. However, research shows that 97-98% of paracetamol overdoses are taken deliberately. In the remaining 2-3% of cases the paracetamol may have been taken for therapeutic purposes but with a reckless disregard for the dosage instructions.