Why Can’t You Buy a Big Bottle of Headache Pills in England?

Last time I was in London I had a headache, and went to the nearest Boots to buy something for it.

Photo: vvvracer

In U.S. drugstores, I’m accustomed to finding half an aisle devoted to headache pills, with bottles ranging from small to very large — at least 200 pills in them. So that’s what I went looking for in Boots, but no such bottle was to be found. The only options were cardboard packets containing maybe 20 pills, with each pill in its own blister packet. (The pills were also larger than U.S. pills.) Hmm, I thought. I guess Boots finds it can charge a lot for a small amount of headache medicine since most people, when they have a headache, aren’t very price-conscious.

But I recently learned the real reason for this phenomenon while interviewing David Lester, a psychologist at the Richard Stockton College of New Jersey who is the dean of suicide (and death) research. (We are producing an hour-long Freakonomics Radio special on suicide.) We were discussing the efficacy of SSRI’s on treating depression (and fighting suicide) when he explained why it’s hard to find a big bottle of headache pills in England:

LESTER: And although there was a lot of publicity in recent years about the dangers of the SSRI, the serotonin reuptake inhibitors, like Paxil, and Zoloft, and Prozac, the death rate of people taking those medications is much less than people taking the older antidepressants. They’re much safer. There are fewer suicides, and there are fewer accidental overdoses. There still is some concern about adolescents, but on the whole they’re the much safer ones. In England and Europe, Tylenol is sold under the name Paracetamol, and that’s used for huge numbers of overdoses, which on the whole aren’t lethal but leave the people with kidney damage and often of dialysis for the rest of their lives.

DUBNER: That’s interesting, yeah. I was in London recently and had a headache, and went to buy some acetaminophen or ibuprofen and noticed that in a drugstore I couldn’t seem to find anything larger than a container of maybe twenty or twenty-five pills in those foil sheets where you have to punch one out.

LESTER: They started doing that about five years ago, and they restrict the numbers, and they put them in plastic blisters so you have to tear them out. And again, you’d think all I have to do is go to six drugstores, you know, buy packets in each of them, all I have to do is just tear them out. But it has cut down the number of overdoses. It’s also cut down the number of serious overdoses that have led to kidney damage. Now, very few people died of an acetaminophen overdose. So it’s been hard to document that it cut the number of deaths, but certainly the number of attempts. The overdoses with it have been cut dramatically. And they did think about other things. You know, they did think about putting bitter tasting substances in it, or a substance that would make you vomit if you took too many. But they decided that was perhaps…That would interfere with the appropriate use of an analgesic such as Tylenol or aspirin. You know, the people who really needed them for headache would find it unpleasant to take them. … It’s been remarkable, a success, that.

DUBNER: Now, let me ask you…

LESTER: I’m glad you had that experience. It shows that it’s, that the drugstores are actually applying it, I mean they are following the rules.

It is of course a larger question as to how valuable such a rule is. But I’m happy to at least have an explanation.

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  1. Murray says:

    Hidden due to low comment rating. Click here to see.

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    • Richard of York says:

      Ibrobufen is an anti-infammatory and does not have the same problem with overdosing as Paracetamol.

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      • Otto says:

        Ibuprofen in large doses can cause kidney problems, including kidney failure. It isn’t nearly as dangerous as acetaminophen, but it’s happened. Google “Alonzo Mourning kidney failure.”

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  2. jonathan says:

    The son of my father’s partner took too many tylenol and destroyed his liver. I don’t know the rate of occurrence.

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  3. Richard of York says:

    This is true and shows how you can get an unexpected behaviour from changing packaging (i.e. for people who really want to suicide, you would not expect them to have a problem with going to 6 pharmacies and emptying the blister pack, would you?).

    Which, therefore, begs the question: how many of the prior cases were highly based on “impulse” – doing this with no planning? And the moment you place a small planning obstacle, they don’t do it? If this is the case, then there are MANY examples where we could think about interfering with peoples lives to give us better EXPECTED outcomes! Slightly un-American but “hey ho”!

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  4. Mr. Moon says:

    The same logic also applies to why we British are only allow to buy rope in lengths of one metre at a time.

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    • Peter says:

      That’s not true. Would you like to provide a source?

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    • Simon Farnsworth says:

      The last time I bought rope, from the Homebase store at postcode OX3 7JN, I was able to buy a 10 metre length, rated to carry 200kg of weight. Ideal for the purpose I had in mind (lifting heavy objects into the loft space, but contradicts your claim.

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      • Mr. Moon says:

        Peter, Simon,

        I apologise – it was a stinking lie designed to make somebody crack a smile. I was applying the same logic to other possible methods of suicides; the joke in this instance being its impracticality.

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      • Peter says:

        I guessed that as soon as I had replied. Sorry! Sarcasm can be easily missed online. But the rope example is different as these drugs are still very useful in packets of 20, unlike a short rope.

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  5. Paul says:

    Ibuprfen is much safer in overdose hence you can buy up to 96(even in packs of 96-38g ibuprofen) however paracetamol/acetaminophen containing products are usually restricted to about 16g. Which could be a toxic dose but probably not lethal if treated in most people.

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  6. Ivo says:

    I doubt that this analysis fully explains the smaller packaging. In the Netherlands, I’ve never, in at least 20 years, seen a package containing more than 40 painkillers. When I was in the US, I was amazed that they sold these bottles with hundreds of pills. Why on earth would I want those? I don’t use more than maybe 15 painkillers a year and the vast majority of people shouldn’t. A large stockpile can go bad, get lost, be spilled, etc. It just doesn’t make any sense to me to buy such a large amount of painkillers. So I think it’s largely a cultural thing, in line with the common saying ‘In the US, everything is bigger’. That at least holds for the average car, steak and bottle of painkillers.

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    • Uthor says:

      Because it’s cheaper per pill, duh!

      (not taking into account all the pills you would waste by not using them all, of course)

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    • Enter your name says:

      Some of the notion is that you don’t have to buy the drugs as frequently:

      You might easily imagine a household in which two adults who each take two aspirin about twice a week. That’s about 200 pills a year. Similarly, you might have an adult taking one daily low-dose aspirin (to slightly reduce the risk of a heart attack); each adult in the household needs 365 pills per year for this purpose. Rather than remembering to buy one small, overpackaged box of 20 pills every three weeks, why not buy one 200-pill bottle every six months?

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    • Tracy says:

      In the US, people are expected to work despite their pain. More so than other countries? I don’t know, but that might be interesting to find out. Meanwhile people I know, finish big bottles of OTC painkillers all the time without getting near the expiry date. Aspirin goes with vitamins and coffee every morning. Or would the worker rather lose his job?

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  7. mfebber says:

    I bought PeptoBismol-type chew tablets at a Boots in Heathrow. Had to ask for them from the pharmacist since it was “behind” the counter and had to sign a paper – they said the signing was due to aspirin in the tabs. Not sure if this was due to bleeding from overdose or what. Trying to imagine a purposeful overdose attempt chewing hundreds of chalky, chewy PB tabs.

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  8. Jay - London says:

    The above reason is correct regarding limits of medicine to prevent suicides and self harm. I used to work in a Boots store in London and customers were not allowed to purchase more than 100 tablets at once (four boxes of 25 – usually Neurofen Plus/Ibuprofen and Codeine). In fact the till would flash up in a red screen, and you would have to clear the sale with the Pharmacist before hand.

    This however does not stop customers leaving the store and coming back to purchase a further 100 tablets from a different Sales Assistant, or from the same Sales Assistant. It just did not allow more than 100 in ONE transaction. Other interesting sales would be addicts purchasing Kaolin and Morphine but asking you not to shake the bottle before hand, so that they would not have to wait so long to filter out the morphine for their fix.

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