Move extra-strength acetaminophen behind the counter to prevent overdoses, mom urges

The mother of a 12-year-old girl who was rushed to hospital after ingesting nearly half a bottle of extra-strength acetaminophen tablets wants tighter restrictions on who can buy the drug.

Karen Jeffrey of Kitchener, Ont., says her daughter purchased the bottle of pain relievers at a small pharmacy back in September.

“She purchased 100 extra-strength acetaminophen tablets without any question,” Jeffrey said. “My concern is that my daughter took almost 50 of those tablets when she arrived at school.”

The girl has mental-health issues, including a history of self-harm. CBC News is withholding her real name to protect her privacy and will call her Rachel.

Rachel was treated with a drug to reverse the effects of acetaminophen on the liver and kidneys. She was discharged from hospital two weeks later.

Health Canada has told makers of over-the-counter acetaminophen products to provide clearer label instructions and stronger warnings about the potential for liver damage. (David Donnelly/CBC)

 

As Jeffrey waited in the emergency department, she says she couldn’t stop thinking about how to prevent other families from experiencing a similar nightmare.

“My goal is to really put some stronger restrictions on who can purchase over-the-counter medication that has acetaminophen in it,” she said.

• Why acetaminophen is the ‘most common cause of liver injury’ in Canada
• Inadvertent child poisonings rise dramatically

Moving the extra-strength products behind the counter would help young people, said Dr. Michael Rieder, chair of the Canadian Paediatric Society’s drug therapy and hazardous substances committee.

“Putting it behind the counter would actually maximize safety while at the same time dealing with the fact maybe this is something you don’t necessarily want that quick access to,” he said. 

There are about 4,500 hospitalizations in Canada each year due to acetaminophen overdoses, according to Health Canada. Of these, about 700, or 16 per cent, are reported as accidental or unintentional overdoses. That means the other 84 per cent are intentional.

In about six per cent of overdose hospitalizations, patients develop liver injuries, including acute liver failure that could require a liver transplant or lead to death, the regulator says.

Can take life ‘innocently or intentionally’

Last month, Health Canada told makers of over-the-counter acetaminophen products to provide clearer label instructions and stronger warnings to prevent liver damage. 

If extra-strength acetaminophen products were moved behind the counter that doesn’t mean customers would need a prescription. They would simply have to ask the pharmacist for the drug. 

The idea of moving extra-strength acetaminophen products behind the counter warrants a look, says pharmacist Sylvia Hyland. (ISMP Canada)

Jeffrey would also like to see sales restricted to people 16 and older to protect children.

“It is something that can take somebody’s life innocently or intentionally.”

Sylvia Hyland of the Institute for Safe Medication Practices Canada says many people may not realize, for example, that some hot lemon liquid products to treat colds and flu contain 1,000 milligrams of acetaminophen per dose and that they could accidentally overdose.

Unintended consequence

Phil Emberley, director of professional affairs for the Canadian Pharmacists Association, says he understands why Jeffrey wants restrictions to prevent acetaminophen poisoning, but he believes more education about the drug is the key.

“There are a lot of patients who rely on this as a last resort,” he said. “By taking it behind the counter, making it more restrictive, it would actually have an unintended consequence of being less accessible to patients and I think that’s an important consequence.”

‘It is something that can take somebody’s life innocently or intentionally.’
– Karen Jeffrey, a mother from Kitchener, Ont.

For example, Emberley says it’s not uncommon for seniors to take eight tablets of extra-strength acetaminophen a day — about 4,000 milligrams, the maximum daily dose for adults. If packages were restricted to say 50 tablets or less, the cost could become prohibitive.

“What could easily end up happening is they then move to other types of medications that provide their own risk,” the pharmacist said.

He says his profession can provide important information to patients about storing the medication to protect others from using it improperly.

Right dose for you

Sylvia Hyland of the Institute for Safe Medication Practices Canada, who is also a pharmacist, says Health Canada’s effort to improve acetaminophen safety is a good start.

As for Jeffrey’s suggestion to move extra-strength products behind the pharmacist’s counter, Hyland says that would require study to determine if it’s a good option. 

“People could still have access to large doses,” Hyland said. “But I think it will add a mindfulness component … and a chance to talk to the pharmacist [about] what is the right dose for you.”

Health Canada says it continues to review acetaminophen’s safety. If new information emerges suggesting the need for further action, the regulator says it will consider it and act as necessary.

• Why acetaminophen is the ‘most common cause of liver injury’ in Canada