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)


Here in Japan, Tylenol is sold in blister packs, with about 15-20 capsules per box. (Coincidentally, the World Health Organization ranks Japan tenth on its list of countries by suicide rate. )

Prescription drugs in Japan are sold in blister packs. I've never seen such medications sold in plastic bottles. Bottled pills tend to be vitamins, supplements and the like. Aspirin and similar drugs, cough medicines and so on are all sold behind the counter – you need to ask the pharmacist to hand it to you.

By the way, jumping in front of trains is the preferred suicide method in Japan.
Families of those who commit suicide are usually charged a fee. (One anti-suicide method is blue lights on platforms.)
Other suicide techniques in Japan: leaping off the roof of tall buildings; hanging.
Here is an article on my blog about the blue lights in Japan.


Just let them kill themselves, why make their lives even more miserable?


Just thrown out without a viewpoint, but Britain is so different from the US in so many ways in these matters it is hard to even start the discussion. Europeans would take this discussion to turn it to the number of handgun suicides in the US.

But Tylenol with codeine is sold over-the-counter in the UK. Most people in the UK that kill themselves do so by hanging, I believe I've heard. Can't put everything in bubble-wrap....


Unfortunately with some blister packets you have to work to get out one pill. I hate those things.


Already in place in the UK as noted.

This recent news story shows good results from it:


In our algorithm dominated world, I think we need to worry less about what the tiny fraction of the population that might commit suicide, versus the broader population that prefers ease of getting pain pills and a low cost per pill average.

In other words, if giant bottles of pain killers cause people to kill themselves. it's too bad. Let's move on.

Brian Knight

While NAC is bitter tasting (as is acetaminophen) and may have poor oral bioavailability, it would only be necessary to add a small amount to each acetaminophen pill so that if a lethal amount is ingested, a therapeutic amount of NAC will also be ingested. NAC may also prevent chronic renal toxicity from acetaminophen in chronic users which is probably a bigger public health problem than acute liver toxicity.


This brings up a question I've sometimes wondered about. Given the toxic effects from overdose or long-term use of acetaminophen, how the heck did it ever pass FDA review? It's not as though there aren't alternatives that work as well or better, often at lower cost. And meanwhile drugs for life-threatening conditions can be blocked for similar risks...