Primary prevention

Public health interventions, such as legislation regarding paracetamol availability and packaging, may lead to reductions in deaths from self-harm. There is some evidence that legislation introduced in 1998 in the UK limiting the number of paracetamol tablets purchased at a single time may have had a small effect in reducing the number of suicides related to paracetamol ingestion.[23][24] More recently, a combination tablet of paracetamol and dextropropoxyphene (co-proxamol) has been withdrawn in the UK owing to its implication in a large number of poisoning deaths. In addition to a major reduction in deaths associated with co-proxamol, research suggested that there was little evidence of substitution of suicide method related to increased prescribing of alternative analgesics.[25]

In 2011, the US Food and Drug Administration (FDA) asked drug manufacturers to limit the strength of paracetamol in prescription drug products, predominantly combinations of paracetamol and opioids, to 325 mg per dosage form (e.g., tablet or capsule). FDA: acetaminophen drug safety communication Opens in new window

Secondary prevention

Patients with a history of intentional self-harm should be referred for psychiatric evaluation and disposition only when they are medically stable.

After an episode of self-harm, review (or arrange primary care review of) the patient's regular prescriptions and assess the risks of toxicity from overdose. Use consultations and medicines reviews as an opportunity to address self-harm if appropriate, e.g., ask about thoughts of self-harm or suicide, actual self-harm, and access to substances that might be taken in overdose (including prescribed, over-the-counter medicines, herbal remedies and recreational drugs).[31]

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