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A student’s fatal acetaminophen overdose has prompted a coroner to demand limits on the sales of the pain reliever without a prescription, a move that has saved lives abroad.
Alannah Lee Spankie, 20, was unresponsive in her Dunedin apartment in June 2017, about three days after an overdose of a large but unknown amount of paracetamol.
He died in hospital the next morning from acute liver failure.
Coroner David Robinson ruled that she did not intend to take her own life. You want acetaminophen sales to be limited to one packet at a time in supermarkets.
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A UK law change limiting the size of acetaminophen packs resulted in a 43% reduction in acetaminophen-related deaths in England and Wales, Robinson cited in his report on Spankie’s death.
Fourteen of the 21 European countries surveyed in an Australian report had pharmacy pack size limits. Most did not allow non-pharmacy sales.
In New Zealand, paracetamol is sold in supermarkets with no legal limit on how much people can buy. It is the most popular medicine in the country, with around three million written prescriptions and more than 50 million tablets used per year.
Robinson said that a person who overdoses often does not have any significant symptoms immediately afterward and therefore “sleeps” with a false sense of security.
About 12 to 24 hours after ingestion, abdominal pain and nausea developed. In the next 24 hours, symptoms may appear to improve, but blood tests will show significant abnormalities.
“Often when symptoms appear, it is too late to administer the antidote as the damage will already be done.”
That was the case with Spankie.
The science student at Auckland’s Otago University, suffering from mental health problems, had been deeply affected by the end of a long-distance relationship about a month before her death.
On the night of June 17, she called her ex-boyfriend in a state of discomfort and told him that she had taken a large amount of paracetamol and was drunk. They had had a similar conversation a week before.
On June 18 Spankie vomited blood, but went to the library to study for an exam.
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Spankie’s roommates found her largely unconscious in bed and called an ambulance. But she died in the hospital.
Her parents called her later that night and told her to go to the doctor. Spankie decided to sleep and see how she was in the morning. She texted her mother on the morning of June 19 saying that she had been up all night vomiting and had not slept.
One of her roommates saw Spankie come home from her exam and head straight to bed. The next morning she was heard moaning. Her roommates found her almost unconscious in bed and called an ambulance.
He later died at Dunedin Hospital.
Coroner Robinson said that although Spankie deliberately took an “excessive amount” of acetaminophen, he did not believe it was with the intention of ending his life. Many other unused medications were found in his room, all of which would have been toxic if taken in excess.
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There are currently no limits on the amount of acetaminophen that people can buy in supermarkets.
The Drug Classification Committee previously rejected his recommendation for limits on quantities sold in pharmacies and other outlets.
He said he concluded in 2016 that the benefits of having the drug easily accessible outweighed the risks, although he supported limiting sales in supermarkets.
The Executive Director of the Food and Grocery Council, Katherine Rich, said the coroner’s report was a “harrowing read” but doubted that any restrictions on the sale of acetaminophen could have prevented Spankie’s death.
“[The coroner’s] the suggestions are well intentioned but not practical, ”he said.
“Education, label reading, better medical and mental health support are more likely to make a difference for at-risk patients.”
Spankie’s parents, Mark and Caro, support the coroner’s recommendations.
Caro Spankie said that people did not know how dangerous acetaminophen was.
“There is nothing to stop someone from going to the supermarket and buying 10 packages.”
Mark Spankie said he was scared that his daughter would overdose, but thought the next day she had dodged a bullet.
“By the time they found out what he had done, it was too late, the damage was … irreparable.”
New Zealand Consumer Healthcare Products Association CEO Scott Milne said the coroner’s suggestion was understandable, but not a solution on its own.
“The best place to get acetaminophen is your local pharmacy, where advice is available and the best advice is to read and follow the directions on the label.”
WHERE TO GET HELP:
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1737, do you need to talk? – Toll free or text 1737 to speak with a trained counselor
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Depression.org.nz – 0800 111757 or text message 4202
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Life line – 0800 543 354
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Suicide Crisis Helpline – 0508 828865 (0508 SUPPORT)
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Kidsline – 0800 54 37 54 for people up to 18 years old. Open 24/7.
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Youthline – 0800 376 633, free text 234, email [email protected], or find online chat and other support options here.
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Rural support trust – 0800 787 254
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Samaritans – 0800 726 666
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What happens – 0800 942 8787 (for children from 5 to 18 years old). Telephone counseling available Monday through Friday, noon to 11 p.m. M. And weekends from 3 pm. M. A 11 p. M. Online chat is available from 3 pm to 10 pm every day.
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thelowdown.co.nz – Web chat, email chat or free text 5626
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Anxiety New Zealand – 0800 ANXIETY (0800 269 4389)
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Supporting families with mental illness – 0800 732 825.
