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Pain and analgesics

Session: Poster Session A

(333) Fatal intoxications with paracetamol in Sweden – a majority of fatalities had a prescription

Monday, August 26, 2024
8:00 AM – 6:00 PM CEST
Location: Convention Hall II

    Presenting Author(s)

  • LT

    Lova Tralla

    PhD-student
    Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Sweden, Sweden

    • Co-Author(s)

  • AJ

    Anna K. Jönsson, PhD

    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden, Sweden

  • AS

    Anders Sundström

    Department of Pharmacoepidemiology and analysis, Swedish Medical Products Agency, Uppsala, Sweden.
    Uppsala, Sweden

  • LT

    Lena Thunander Sundbom, PhD

    Senior Medical Assessor
    Department of Drug Safety, Swedish Medical Products Agency, Uppsala, Sweden
    Uppsala, Sweden

  • FK

    Fredrik C. Kugelberg, PhD

    Associate Professor
    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden, Sweden

Background: Paracetamol is a frequently used drug in Sweden, available both on prescription and over the counter (OTC). It was dispensed by prescription to 1.2 million people in 2019 (paracetamol in combination with codeine to an additional 240.000), making it the most commonly prescribed substance. By volume (number of DDDs), 68% were sold by prescription and 29% as OTC. In Sweden, paracetamol is also a frequent finding in forensic autopsy cases and one of the most common substances in intoxication suicides.

Objectives: To establish the proportion of individuals who died in fatal paracetamol-intoxications that had a dispensed prescription for the drug.

Methods: In this nationwide retrospective register-based study, cases of fatal paracetamol intoxications in 2019 were identified in the Swedish Cause of Death Register and a database held by the Swedish National Board of Forensic Medicine. The included individuals were linked to the Swedish Prescribed Drug Register to identify dispensed paracetamol prescriptions, including paracetamol in combination with codeine, 365 days preceding the death.

Results: During the study period 829 fatal drug-intoxications were identified in Sweden. Paracetamol caused 37 intoxications and was the 12th most common substance contributing to fatal intoxications in total, and fifth most common substance among suicides. In total, 23 (62%) were women and 29 (78%) had a prescription for paracetamol. The proportion with a dispensed prescription was 70% (16 out of 23) for women compared to 93% for men (13 of 14). In intoxications classified as suicides (N=22, 59%), 17 (77%) had a prescription, the corresponding number for accidental intoxications (N=7, 19%) was 86% and for intoxications with uncertain intent (N=8, 22%) 75%. Among the 29 individuals with a prescription for paracetamol, 13 (45%) were prescribed combination preparations with codeine.

Conclusions: The absolute number of deaths by paracetamol intoxication is admittedly not high, it was nevertheless ranked 12 among (both legal and illegal) substances causing fatal intoxications, and five among intoxication suicides in 2019 in Sweden. The majority (77%) of fatalities had a dispensed prescription for paracetamol and the quantities dispensed by prescriptions as well as packet sizes sold by OTC should be carefully considered.