An Easy Way to Cut Down on Pill Suicides?

(Photo: Sage Ross)

Ezekiel Emanuel, who’s popped up in our blog and podcasts, writes in the Times about a simple way to reduce suicides:

We need to make it harder to buy pills in bottles of 50 or 100 that can be easily dumped out and swallowed. We should not be selling big bottles of Tylenol and other drugs that are typically implicated in overdoses, like prescription painkillers and Valium-type drugs, called benzodiazepines. Pills should be packaged in blister packs of 16 or 25. Anyone who wanted 50 would have to buy numerous blister packages and sit down and push out the pills one by one. Turns out you really, really have to want to commit suicide to push out 50 pills. And most people are not that committed.

Emanuel cites an Oxford University study which found a 43 percent decline in suicide death by Tylenol overdose after Britain changed the required packaging for paracetamol (the active ingredient in Tylenol). FWIW, we blogged about this a couple years ago. Also, it’s worth noting that most Times commenters think the idea is daft.

(HT: The Dish)

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  1. Jordan says:

    43% decline means nothing without broader context: were the people that would have used acetaminophen using another method instead? It seems like an additional comparative statistic in a broader comparison, such as “% decline in deaths due to OTC/prescription drug overdose)”, would also be needed to discern if there is a corollary of the decline towards overall suicides, or if it just meant that people resorted to other methods.

    I remember hearing a statistic that males have a significantly better success rate when it comes to suicide attempts, because the preferred methods of suicide for males (weapons, jumping off things) had less opportunity for people to seek emergency treatment or be saved compared to females’ preferred methods. (overdoses) Maybe an additional statistic worth looking at is if that 43% decline correlates to a shift in these “success rate” statistics; a correlated increase in success rate by females would imply that the method is simply being replaced by different, more deadly methods.

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    • Mike B says:

      As much as experts and participants claim otherwise, I have a tough time believing that someone who chooses a suicide method that is well known to be ineffective has the same conscious or subconscious level of desire to end their own lives as someone who chooses a more effective method. The study showing a reduction in pill suicide deaths by the use of blister packaging can be seen as evidence for a lack of commitment by those that choose to use pills.

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      • Enter your name... says:

        Most people don’t bother to find out whether their preferred method will work. Suicides are largely impulsive. Most of them go from “I’m going to kill myself” to taking action on it within minutes. They don’t stop long enough to look up things like the fact that Tylenol is a slow (no effect for several hours) and ultimately painful way to die. (And, no, you don’t ‘fall asleep’ like you would from an opiate overdose: you’re awake for every single minute of that pain.)

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      • Mike B says:

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

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      • Iwo Jaros says:

        I think that there is a difference between genders in what type of suicide method they choose. I reckon that females use a form of suicide that is “cleaner” and not such a inconvenience to others afterwards – to clean up – such as pills or killing themselves in bathrooms. While males don’t factor in those types of concerns into their suicide “impulse” and often go for messier – and often more deadly – options that fore fill there needs better. It all comes down to the fact that women are more socially concerned then men.

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      • RicardoB says:

        @MikeB because lots of people aren’t dangerously impulsive all the time forever.

        Why would we be looking to save the life of someone as daft as you? Because I’m sure one flaw doesn’t discount all the positives you may have.

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    • Simon Farnsworth says:

      One thing that makes acetaminophen special in the context of suicide by pill is that it’s not uncommon for it to kill you after you change your mind and present for treatment – it can do enough liver damage that the only possible medical option is an immediate liver transplant.

      Given this, it’s better if attempted suicide by pills use other methods, so that if they change their mind before they die, medics can help them survive.

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  2. Mike B says:

    Instead of forcing people to live lives they aren’t interested in wouldn’t a better way of reducing “pill suicides”, which are often ineffective and result in public medical costs, be to instead offer more reliable suicide on demand services? In additional to being consistent with the ideals of self-determination and liberty it would also result in significant savings for public pension and healthcare funds.

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    • Enter your name... says:

      We’re not talking about people who are thinking this through here. We’re talking about people who swallow a bottle of Tylenol and then are surprised to discover that it hurts when your liver dies. We’re talking about people who change their minds if they have an unexpected ten-minute delay because the first store won’t sell enough of the drug to them and so they have to go to a second store.

      There are some highly reliable, inexpensive, and painless methods of killing yourself, but this type of program is aimed at the many, many people who are being stupid about their suicide attempts, not at the people who are willing to spend even an hour or two planning it.

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      • Mike B says:

        Anyone who doesn’t “think through” something as important as taking their own life is probably a danger to themselves or others.

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    • pawnman says:

      Like the Futurama suicide booths?

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  3. Mark says:

    A study was done on suicide and it’s an oddly impulse decision. Putting a fence up on a bridge dramatically reduced the deaths by suicide but didn’t significantly increase the deaths by other reasons. Likewise when stoves stopped running on city gas(a mixture of hydrogen and carbon monoxide) suicides went down but never went back up.

    by Dorothy Parker

    Razors pain you;
    Rivers are damp;
    Acids stain you;
    And drugs cause cramp.
    Guns aren’t lawful;
    Nooses give;
    Gas smells awful;
    You might as well live.

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    • Joe Dokes says:

      I’ve seen this “mythical” study mentioned on the internet a multitude of times. But I have yet to see a link to the study nor any other evidence. I remain unconvinced.

      For example this “study” is used as an excuse for gun control.

      And now in this context it is being used for “pill control.”

      A long time ago I was in favor of manny “Nanny” laws, like helmet laws, seatbelt laws, laws that restricted smoking. I have come to the conclusion that these are not simply “Nanny” laws that create a nanny state, but these laws are infantilizing all citizens.

      Citizens can’t be trusted to do the right thing so we must enact a law, whether it be a law that bans smoking, a law that bans firearms, a law that bans pills, a law that forces us to eat broccoli.

      When Elana Kagen was nominated to the Supreme Court one of the questions she faced was whether Congress could enact a law that required the eating of broccoli. She said the law was stupid, but she never said it was unconstitutional. I am becoming less and less sure that I want to live in a society that has the power to force me to eat broccoli. Whether it in fact does so or not.

      Joe Dokes

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  4. Matt says:

    If the authors had ever had to deal with arthritis, they would know that even popping one pill out of its blister can be an ordeal for some people.

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    • teh_drewski says:

      Do people take paracetamol for arthritis? I would have assumed one of the anti-inflammatory painkillers would be the drug of choice, such as ibuprofen.

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    • James says:

      People with arthritis would be able to get a prescription.

      This is what happens in Ireland. My parents friend can’t use blister packs because of arthritis so gets a prescription for a bottle of paracetamol.

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      • Joe Dokes says:

        Really, a prescription for acetaminophen. Have we become such infantilized children that we have to ask our doctors, oh could you please write me a script for acetaminophen.

        What have we become, are we like Oliver Twist where we have to go begging to our superiors, “Please Sir, my hands hurt, can I please have a proper bottle?”

        I’d like to think that doctors have something better to do than hand out scripts for an over the counter medication.


        Joe Dokes

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    • and the angel says:

      It seems pretty clear to me, based on this, and the data on gun suicides, bridge jumpers, and the chance from coal ggasin the UK, that suicide is a temporary, transient impulse. Most people won’t try again, and tend not to persevere. Measures like this that reduce the immediate ability to kill oneself are a good idea.

      Although, it does make wonder what the economic impact of suicide is ( quite aside from the human tragedy). In economic terms is it a bad thing?

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  5. Mark says:

    One other quick thought. There is a trade off. Roughly 25 billion doses are taken per year(24.6 in 2008 per FDA). If it takes 20 seconds to open a blister pack (close enough and the math is easier ) That is 5 billion minutes of time lost or 9500 years. Assuming 70 years of lost life, will this save 135 people per year? If not, it will end up killing people. This doesn’t even take into account the extra costs and pollution of the packaging which will end up killing more people. I buy the mega bottle of Tylenol because I save $5 or $6, which is 45 minutes at minimum wage. You’re killing me.

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    • Mark says:

      Oops, my math was based on 12 seconds (5 per minute)

      I checked the numbers. 500 successful APAP suicides per year. It seems to make sense to do, unless the packaging numbers come in terribly.

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  6. Mark Wolfinger says:

    1) Small packages waste packaging material. This idea is environmentally unsound.

    2) Small packages are expensive anr economically unjustified.

    3) Sadly, people who want to kill themselves have many alternatives.

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    • Enter your name... says:

      What’s the environmental cost of spending a week in the hospital while dying? What’s the environmental cost of a liver transplant and a lifetime of anti-rejection drugs?

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  7. James says:

    There’s (at least) one statement in that article which suggests the author has limited experience of the world: “…The other main reason is that some consumers — notably people with arthritis — might find it challenging to open the packages.” Now I don’t have arthritis – in fact, I’m pretty darned athletic – and I still find it a challenge.

    As for accidental poisonings, don’t those big bottles already have child-proof caps? While I can certainly imagine a kid getting intrigued by the pretty candies in the shiny pack, and spending an hour or so popping them out one by one.

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  8. SAO says:

    No! I hate the blister packs with only 10 pills. Even if you have a couple of packs, this is what happens: someone in the family uses one or two every now and then. Then the flu makes the rounds. Suddenly, you have more than one person eating 2 pills every 4 hours. In one day, you’ve gone through two10-pill packs and someone has to dash out to the drug store late at night in the pouring rain.

    I live in Europe and by my NSAIDs in the US, where I can get a big bottle.

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    • teh_drewski says:

      Is there any reason they can’t sell bulk boxes of drugs in blister packs? I can get 100 pill boxes of paracetamol, ie. 10 x blister pack of 10 in one box.

      The convenience of bulk with the inconvenience of it still taking a long time to pop enough pills to kill yourself.

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      • Enter your name... says:

        The UK limits the number of pills that you can buy from a store in the same trip. They do this so that people who are trying to kill themselves have to go to two stores. The research shows that by the time these would-be suicides make it to the second store, they’ve changed their minds.

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