By Pat Anson, PNN Editor

One of the reasons opioid prescriptions have been reined in over the last few years is concern that some patients may use the drugs to take their own lives. One study estimates that up to 30% of fatal opioid overdoses are suicides.

But the risk of suicide is greater with over-the-counter (OTC) pain relievers. According to an analysis of nearly 550,000 calls to U.S. poison control centers from 2000 to 2018, the number of suicide calls involving acetaminophen, ibuprofen and other OTC analgesics rose 57 percent.

Children between the ages of 6 and 19 accounted for about half of those calls, and females represented 73% of cases among individuals of all ages.

“Because they are easy to purchase and can help alleviate a variety of symptoms, many families have over-the-counter pain relievers readily available in their homes, often in large quantities,” said Alexandra Funk, PharmD, co-author of the study and director of the Central Ohio Poison Center at Nationwide Children’s Hospital.

“Unfortunately, the easy access to these medications is likely a big part of the reason that they are used in suicide attempts and deaths. The fact that they are being used more often with more serious outcomes is cause for concern.” 

The study, published in Pharmacoepidemiology and Drug Safety, found that nearly half (48%) of the OTC analgesic calls to poison control centers involved acetaminophen alone, followed by ibuprofen (33%), and aspirin (19%). Acetaminophen accounted for nearly two-thirds (65%) of the 1,745 deaths that were reported.

Rates of suicide-related cases involving acetaminophen and ibuprofen increased significantly during the study period, while the rate of aspirin cases decreased. About a third of the calls involved exposure to multiple substances, and those cases were twice as likely to result in hospitalization or death.

“The top three substance categories associated with suicide-related exposures in the US are antidepressants, OTC analgesics, and antipsychotics, and of these, OTC analgesics are the only one readily available without a prescription or other restrictions,” researchers found. “With suicide-related exposures involving OTC analgesics increasing in the US, more effective interventions are clearly needed to reduce injuries and deaths from this cause.”

One way to reduce the risk if suicide is to regulate the sale of OTC pain relievers by requiring single dose packaging – also known as blister packs. Rather than emptying a bottle of pills, each individual tablet would have to be punched out of the package.

“Because suicidal ingestion is often a highly impulsive act, this would deter overdoses by limiting the amount of medication that can be extracted at one time,” said Gary Smith MD, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “In addition, the U.S. should follow the lead of other countries that have successfully reduced suicidal ingestions of these medications by limiting the package size and quantity that can be purchased by an individual at one time.”

According to another recent study of calls to poison control centers, gabapentin (Neurontin) and the muscle relaxer baclofen are also involved in a growing number of suicides and attempted suicides.  

Suicide is the 10th leading cause of death in the U.S. Over 48,000 Americans took their own lives in 2018.