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. Joe W. says:

    Hi Stephen,

    you say “I guess Boots finds it can charge a lot for a small amount of headache medicine”, but did you really find that to be the case?

    Typically when I’m buying paracetomol here in England they come in little tubs at a scandalously low 30-50p for around 20 of them. There are brand name products like Nurofen but the generic paracetomol and ibuprofen products are dirt cheap.

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  2. Therese Norén says:

    It’s hard to take someone seriously when he doesn’t know which organ paracetamol/acetaminophen usually cause damage to. Yes, there are cases of kidney damage from paracetamol, but it’s rare. Paracetamol is the second most common agent causing _liver_ damage (after alcohol).

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  3. Trent says:

    Just to correct something above from David Lester: (acute) overdoses of acetaminophen notably cause liver failure, not kidney failure, and it can be fatal at low doses in alcoholics (who probably are more likely to try suicide). There may be concurrent kidney impairment, but not always, and it’s the liver problems that kill you. Long term high dose acetaminophen (not the type used in suicide attempts) use can cause kidney impairment, but is much more likely in non-steroidal analgesics, like aspirin and ibuprofen.

    Ask any physician how you die from Tylenol (or do a google search), and they will answer liver failure. If the patient is otherwise healthy, they usually fully recover without lasting effects, so I don’t know where the bit about lifelong dialysis comes from (though it may be necessary short-term as the patient recovers).

    When a supposed expert makes errors like this, it makes me wonder about the rest of what they are saying.

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  4. MEU says:

    There’s a good NPR article that explores the motive/opportunity components of suicide. One anecdote sticks with me:

    “In England, death by asphyxiation from breathing oven fumes had accounted for roughly half of all suicides up until the 1970s, when Britain began converting ovens from coal gas, which contains lots of carbon monoxide, to natural gas, which has almost none. During that time, suicides plummeted roughly 30 percent — and the numbers haven’t changed since.”

    http://www.npr.org/templates/story/story.php?storyId=92319314

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  5. Jeff says:

    The same restrictions apply in South Africa. You would think if you knew enough to kill yourself with an overdose of Tylenol, you would know enough to buy enough bottles to do the trick. Hard to believe this regulation has actually reduced suicides.

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    • NIc says:

      I bought a massive (30 boxes) shrink wrapped pack of paracetamol boxes each with 16 500mg tablets from Macro no problem at all – Shop owners need to get stock from somewhere. Is there a correlation between small shop owners and kidney failure??

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    • Enter your name says:

      The vast majority of people who attempt suicide spent less than an hour thinking about it or planning it before doing it. A quarter of them spend less than five minutes thinking about it. If committing suicide required going to even two stores, most attempts wouldn’t be made.

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  6. James says:

    Same is true in Switzerland (or was when I lived there a few years ago): aspirin was available only in packets of about 10, at about 12 francs (about $8-9 at the time).

    As for why people would want large bottles, a daily aspirin has been shown to reduce heart disease, some kinds of cancers, delay incidence of Alzheimer’s disease, etc. So a bottle of a couple hundred tablets for a few bucks seems pretty cheap health insurance :-)

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  7. John says:

    So, are there similar restrictions on condom purchases in the UK?

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  8. Kathryn Jordan says:

    The really really stupid thing about this is that there IS something that can be added to paracetamol that will stop it irreparably damaging the liver on overdose, but, while – according to this article -they’ll consider adding something to make it bitter tasting or make you vomit if you take too many, they won’t add this compound. From memory the guy who ‘invented’ paracetamol recommended that the additive be included in commercially prepared formulations, but the pharmaceutical companies declined – presumably in an effort to cut costs. And haven’t they won nicely?

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