This week Dr. Ezekiel Emanuel wrote a persuasive column in the New York Times laying out a strategy for reducing suicides. He suggests that by simply changing the way we package medication, as Britain has done, we could sharply reduce the number of people who take fatal doses of medicine.
Emanuel, the brother of the Mayor of Chicago and a physician who comments frequently on health policy, notes that every year one million people attempt suicide, more than 38,000 succeed. It turns out that suicides and poisonings from medication have been steadily climbing since 1999. He says that “a good way to kill yourself is by overdosing on Tylenol and other pills”. Emanuel argues that if we make it hard to buy pills in bottles of 50 or 100 capsules that can easily be dumped out and swallowed, we can prevent many deaths. If pills were packaged in blister packs of 16 to 25, anyone who wanted to use them to commit suicide would have to work really hard. The fact is that suicides occur all too often when a person is at a particularly low moment. Research shows that if the opportunity to take pills – or use a firearm – is effectively diminished – often the moment passes and the person lives.
Emanuel cites very persuasive data from Britain. In 1998, Britain changed packaging for the active ingredient in Tylenol, acetaminophen, requiring blister packaging of 16 pills when sold over the counter in places like convenience stores and for packages of 32 pills in pharmacies. The result, published in an Oxford University study, showed that over 11 years or so, suicide from Tylenol overdoses declined by 43%. Accidental poisonings declined as well. The number of liver transplants attributable to Tylenol toxicity went down significantly. In fact, in 2011 the makers of Tylenol added protective flow restrictors and dosing syringes to all liquid infant and children’s medicines, to prevent accidental overdose. There is already a precedent here in the US to modify packaging to prevent adverse events; this isn’t a new concept for industry.
Not only can repackaging acetaminophen-containing products reduce incidence of suicide caused by overdosing, but it will also prevent accidental poisoning of children. Manufacturers should work with the FDA to learn from Britain’s example and continue to improve packaging. With a change in packaging, which comes with a cost to manufacturers of course but could be carried out over time, we could potentially save thousands of lives.