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Comment by freddie_mercury | Hacker News Reader

Most countries have laws limiting the size of paracetamol & aspirin bottles to reduce overdoses & suicides.

The UK passed a law in 1998 about it and saw suicides from overdoses drop 21% and liver transplants from paracetamol poisoning drop 66%.

"Numbers of tablets per pack of paracetamol and salicylates decreased markedly in the year after the change in legislation on 16 September 1998. The annual number of deaths from paracetamol poisoning decreased by 21% (95% confidence interval 5% to 34%) and the number from salicylates decreased by 48% (11% to 70%). Liver transplant rates after paracetamol poisoning decreased by 66% (55% to 74%). The rate of non-fatal self poisoning with paracetamol in any form decreased by 11% (5% to 16%), mainly because of a 15% (8% to 21%) reduction in overdoses of paracetamol in non-compound form."

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Many countries have laws limiting the size of vehicles and weight for non-commercial licenses too :)

What are the limits? (Asked as a US guy who buys the 500 x 500mg bottles at BJ's.)

Interesting. How long does one of those bottles last for you?

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In Australia, the regulating body for that stuff announced new limits back in 2023. They'll apply from Feb 2025 onwards:

https://www.tga.gov.au/news/media-releases/tga-makes-final-d...

* reduce the maximum size of packs available for general sale (e.g. supermarkets and convenience stores) from 20 to 16 tablets or capsules

* reduce the maximum size of packs available in pharmacies without the supervision of a pharmacist (i.e. ‘Pharmacy Only’ packs) from 100 to 50 tablets or capsules

* make other pack sizes of up to 100 tablets or capsules available only under the supervision of a pharmacist (‘Pharmacist Only’ medicines).

Those limits don't seem all that different from the existing pack sizes commonly on shelves though. So there's very likely some existing limits around pack sizes already.

Not sure about the UK, but in Europe typically pills are sold as blister packs. I don't think there's a limit per se, you can still buy a box of 50 at least.

> Countries where pack size restrictions had not been introduced were predominantly Eastern European [Slovakia, Lithuania, Croatia, Czech Republic, Poland (Lodz) and the Russia Federation (Moscow)].

https://doi.org/10.1111/bcpt.12959

You're allowed to purchase 2 packs of any drug containing paracetamol. Normally a pack contains either 12 or 24 tablets I think. Here's a link to a supermarket's policy: https://help.sainsburys.co.uk/help/products/phc-sale-analges...

Here in UK the limit is two packs per person, and packs are usually 8 or 16 tablets(annoyingly the law is about packs not tablets, so you can't buy 4 packs of 8 tablets even though it's the same as buying 2 packs of 16). Tbf if you do need more you can always buy more from pharmacy in almost unlimited amount, you just have to ask for it at the counter(and I guess the pharmacist might not sell it to you if it's "suspicious" whatever that means).

Painkillers are sold in packs of max 16 tablets in the UK (almost always 500mg for paracetamol, 200mg for ibuprofen). In addition they must be sold in blister packs not bottles, and all shops will only allow you to buy two packets per transaction (mix and match, you can’t have 2x paracetamol and 2x ibuprofen). I believe there are some exceptions for prescriptions.

Obviously you can still overdose by going to multiple stores and popping them all out of the blister packs but it puts enough of a barrier in that you have to be more determined (and more knowledgeable about what amount will actually kill you). Apparently it works.

> I believe there are some exceptions for prescriptions.

You can essentially forget the maximum pill numbers for paracetamol/ibuprofen when it comes to prescriptions in the UK. Doctors can prescribe hundreds of either pill to be given to a patient at once (eg if someone is prescribed to take 8 a day and they get their meds monthly, as is the case with one paracetamol recipient I know, the pharmacy gives him multiple 100x 500mg paracetamol boxes each month.)

(To be clear, "given to them at once" as in dispensing the pills, not giving to take all at once!)

> all shops will only allow you to buy two packets per transaction

They do that indeed, though I am not sure wthere it is the law of their own "do-gooder" policies. I don't think it is the law because it happened to me a few times to just pull a sad face and have the employee at the till just go "fine, but just this time".

This is slightly ridiculous, IMHO: You can buy more if you want, just split transactions. And of course no-one stops you from buying a trolley-full of vodka and bleach.

>This is slightly ridiculous, IMHO: You can buy more if you want, just split transactions. And of course no-one stops you from buying a trolley-full of vodka and bleach.

You can split transactions, but committing suicide takes effort, and a relatively significant rate of suicides are impulsive. For impulsive suicide, having a barrier or interruption can prevent the attempt. Something as small as a phone call interrupting you as you get the pills out could be sufficient to move past a particular impulse.

There is also a huge difference in suicide attempt method depending on gender. Women tend to gravitate towards pills, while men are more likely to use a gun.

The impulse has to be to eat the tablets or whatever's on hand. Going all the way to the shop to stock up on tablets does not strike me as impulsive.

So IMHO this restriction is an attempt at limiting the stock people have at home. Although I would argue this is none of the shop's business and, as far as I can gather, this is not a legal restriction.

It is a legal restriction and it has saved hundreds of lives.

https://www.ncbi.nlm.nih.gov/books/NBK374099/

The pack size is a legal restriction, not the number of packs you can buy in one transaction as long as the total number of tablets does not exceed 100 (i.e. legal restriction is in effect 6 packs in one transaction), from what I understand, while the 2-pack restriction is a "voluntary best practice".

Those 'voluntary' limitations, and there are others, are a bit of a pet peeve of mine because they strike me as hypocrisy/posturing/paternalism.

I think the main thing is the blister pack requirement, you can't just unscrew the lid and down a bottle.

Limiting to two... I don't know, it has occasionally annoyed me (when I think I want to 'stock up') but I suppose there's just no reason you actually need more than that at once (other than self-harm or with a prescription) so meh why not if it has a small chance at stopping a few suicide attempts.

> So IMHO this restriction is an attempt at limiting the stock people have at home

Correct. But this isn't a bad thing - it means people are less likely to have a large supply of dangerous pills at hand if they get a sudden urge to kill themselves or attempt a cry for help during a depressive episode.

> Although I would argue this is none of the shop's business

In practical terms it appears that this actually does reduce suicides and poisonings; it's a significant reduction in suffering in the world.

The cost is a very small and temporary limitation on personal convenience. It's surely worth it. See also seatbelt laws.

> and, as far as I can gather, this is not a legal restriction.

It is in some countries, but the legal obligation is on the vendor, not the individual. If you are confident that you do need a larger cache of tablets then you can do that yourself with only minimal extra inconvenience.

I think it's an elegant solution. Suicides are reduced, but the state doesn't overrule individual decision making on what their needs are.

What criteria do you use to evaluate that intervention? Which really means, how do you begin to estimate the actual amount of harm reduction that it provides?

Are there lots of cases where someone tried to overdose but was saved by it 'only' being 16 grams of paracetamol?

The grandparent of the post you're responding to provides stats showing that suicides/overdoses with OTC painkillers went down markedly after the change.

The number of deaths due to paracetamol poisoning fell by 22% in the year after the legislation. There was no significant increase in suicide deaths by other means. We see similar results with interventions like reducing the availability of highly toxic pesticides or installing barriers on bridges.

Most suicidality is impulsive and transient, so simple interventions to reduce access to means of suicide can have very significant results. There's very little you can do to prevent a sufficiently determined person from dying by suicide, but most people who die by suicide aren't strongly motivated to die - they're just briefly overwhelmed by life.

https://www.bmj.com/content/329/7474/1076

https://www.hsph.harvard.edu/means-matter/means-matter/saves...

I'm on an alt account here for obvious reasons.

I can only speak from my experience, but at one point I took all the paracetamol I had (suicidal and pretty drunk, the taste of cheap red wine and paracetamol is... unpleasant to say the least). I ended up fine after a friend forced me to go to the hospital the next day. If I had more tablets around, I would have taken them too. So it likely wouldn't stop someone who planned to kill themselves, however with me anyway not having like 100 tablets around did help due to it being impulsive enough.

It might have been quite a big difference due to how long after the fact I went to the hospital, I took quite a lot but it had done little enough damage that some medicine in my arm over the course of about a day and having to avoid alcohol and paracetamol for a while was enough to fix it.

I imagine a lot of cases are quite similar to mine and it probably did make quite a big difference with me as I only had 2 boxes around and one wasn't completely full.

What do you do with them? I'd guess the total lifetime consumption of any medicine for me and my family is less than 500 pills, a pack of 20 can last more than a year because it's not that often that any of it is needed, and when something happens, you take them for a couple of days and that's it. Do many people in USA pop painkillers or paracetamol or aspirin daily?

>Do many people in USA pop painkillers or paracetamol or aspirin daily?

Yes, it's very common, often around joint pain. Surely obesity and sedentary lifestyle play a role.

60 million Americans take Acetaminophen (paracetamol) on a weekly basis.

https://www.ncbi.nlm.nih.gov/books/NBK441917/

*ding ding ding*

Your nose is running? Pop some NyQuil. Hangover? NyQuil. Headache from the cold? NyQuil. Cold? NyQuil.

Just look at the list of symptoms it helps with at their site: https://vicks.com/en-us/shop-products/nyquil

https://tedium.co/2021/11/03/nyquil-cold-medicine-history/

https://www.npr.org/2022/09/22/1124252556/nyquil-chicken-cha...

https://www.huffpost.com/entry/fda-nyquil-chicken-warning_n_...

Don't want to judge but that's concerning. You can really mess up your internal organs with that much volume (even spread over a year with a family of four).

At Walmart I bought a bottle of 500 Aspirin and I've had it for over 10 years it may even be 15 years. I looked just now and see there are two pills left. I thought I was using too much at that rate.

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