Use of analgesics in intentional drug overdose presentations to hospital before and after the withdrawal of distalgesic from the Irish market

A total of 42,849 IDO presentations to 37 of the 40 hospitals EDs operating in Ireland in 2003-2008 were recorded according to standardised procedures. Data on sales of paracetamol-containing drugs to retail pharmacies for the period 1998-2008 were obtained from IMS Health.The withdrawal of distalgesic from the Irish market resulted in an immediate reduction in sales to retail pharmacies from 40 million tablets in 2005 to 500,000 tablets in 2006 while there was a 48% increase in sales of other prescription compound analgesics. The rate of IDO presentations to hospital involving distalgesic in 2006-2008 was 84% lower than in the three years before it was withdrawn (10.0 per 100,000). There was a 44% increase in the rate of IDO presentations involving other prescription compound analgesics but the magnitude of this rate increase was five times smaller than the magnitude of the decrease in distalgesic-related IDO presentations. There was a decreasing trend in the rate of presentations involving any paracetamol-containing drug that began in the years before the distalgesic withdrawal.The withdrawal of distalgesic has had positive benefits in terms of IDO presentations to hospital in Ireland and provides evidence supporting the restriction of availability of means as a prevention strategy for suicidal behaviour.Distalgesic (known as co-proxamol in the UK) is a prescription-only analgesic compound of paracetamol (325 mg) and dextropropoxyphene (32.5 mg). Evidence of the dangers of distalgesic in overdose began with a case-series study in Northern Ireland over 30 years ago [1] and culminated with a study that showed that the drug was the second most commonly used drug in overdose suicides in England and Wales, accounting for 5% of all suicides and with a higher risk of fatal outcome in overdose acts than other commonly used medicines [2]. Death from distalgesic overdose may occur rapidly, even with a relatively low dose, and lethality is increased by use of alcohol and oth