Dr Bartone - Today Show - Paracetamol Overdoses

BEN FORDHAM:    When many of us are feeling pain, we reach for paracetamol for some quick relief. And it's easy to get. Most people see it as harmless. But there are a number of poisoning cases, and they've almost doubled, they reckon, over the past 10 years. It's got docs worried.

So for more, we're joined by the President of the Australian Medical Association, Dr Tony Bartone. Tony, good morning to you.

TONY BARTONE:  Good morning to you, Ben.

BEN FORDHAM:    How concerned should we be?

TONY BARTONE:  Well, this is a report in the MJA out today, it's a concerning finding. That almost doubling of cases, as you correctly point out, is pointing to something that we do need to take on board and look at measures that can help to reduce the incidence of that. Panadol is a very safe drug, when used appropriately, within the recommendations. It's, as you pointed out, it is one of those medications that we reach for, both for simple pain relief and as part of a long-term management pain relief plan. But if it's used incorrectly – mistakenly, or intentionally to cause self-harm - it can result in severe complications including, unfortunately, liver failure and death.

BEN FORDHAM:    We should just point out here, most people use it properly and sensibly, right?

TONY BARTONE:  Absolutely. You're absolutely correct there. So, it's about using it as recommended. And it's a message about all medications: use as directed. And the directions are either on the label, on the pack, or as instructed by your treating medical practitioner.

But it's when used incorrectly, when used without reading and intentionally to cause self-harm, as I did say already, that's when we get into trouble.

BEN FORDHAM:    Doc, we're not going to go down a similar path, are we, as we did with codeine, where these things are taken off-the-shelf and then you've got to the doctor just to access it?

TONY BARTONE:  No. Look, I think what we're seeing is a call - what we've seen overseas in Europe, for example, is a call for smaller pack sizes. Now, it's a message that pain is prevalent and is common, but pain that continues to be a problem does need to be talked over with a treating practitioner. So, if you take one or two Panadol here or there a couple of times a year, you're not going to need pack sizes of a hundred. And what we're really saying here is that, let's look at evidence from overseas where we've seen that reduction in pack sizes has led to a significant reduction in the amount of paracetamol overdosing and complications.

BEN FORDHAM:    Okay. On average, are most overdose incidents deliberate or accidental?

TONY BARTONE:  Unfortunately, the majority are absolutely intentional. The data particularly points out that up to nearly 70 per cent of the cases in this study were found to be intentional in origin.

BEN FORDHAM:    Alright. The accidental ones, what's happening there? They're taking it with something else? They're just taking too much of it?

TONY BARTONE:  Yes, so we've got to be aware that the state of your liver, the medications that you are taking, or conditions that you are suffering from, as well as being in constant pain and taking doses well in excess of what you're recommended, because of bravado, because of lack of education or lack of information, or just simply being frustrated with the intensity of the pain, has led to the situations in the other remaining cases.

BEN FORDHAM:    Should you be empowering pharmacists a bit more to be having these conversations with people, as they do with other medications at the point of purchase?

TONY BARTONE:  I think that's a very good point you make there. I think it needs to be something that's taken away, except in small pack sizes, from the front of shelf, front of store, you might say. It should be probably put behind the counter, so that if you are needing large pack sizes, you are having a conversation with either the pharmacist or, if it's a regular ongoing pain, you really should think about an overarching management plan for your pain. And that's a conversation that requires a history-taking and assessment of all your other conditions and reasons behind that ongoing pain.

BEN FORDHAM:    Alright. Really good practical advice, Dr Tony Bartone from the AMA. Thank you.

TONY BARTONE:  Thanks. Good on you.

2 September 2019

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