Preventing Pill-Chugging

Ezekiel Emanuel believes a small change in packaging could make a big difference in overdoses:

A good way to kill yourself is by overdosing on Tylenol or other pills. About 90 percent of the deaths from unintentional poisonings occur because of drugs, and not because of things like household cleaners or bleach. There is a simple way to make medication less accessible for those who would deliberately or accidentally overdose — and that is packaging…. 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.

He cites a British experience as evidence:

In September 1998, Britain changed the packaging for paracetamol, the active ingredient in Tylenol, to require blister packs for packages of 16 pills when sold over the counter in places like convenience stores, and for packages of 32 pills in pharmacies. The result: a study by Oxford University researchers showed that over the subsequent 11 or so years, suicide deaths from Tylenol overdoses declined by 43 percent, and a similar decline was found in accidental deaths from medication poisonings. In addition, there was a 61 percent reduction in liver transplants attributed to Tylenol toxicities. (Although it was a long and detailed study, some studies got a different result. One in Ireland, for example, found no reduction in overdoses.)

Update from a reader:

Such packaging would be disastrous for one of the largest groups of people who use pain-killers and anti-inflammatories: those with arthritis. Many can’t even manipulate a “child-proof” cap (hence the sale of larger quantities in bottles specifically touted as “arthritis-friendly”); imagine their frustration in trying to get a pill or two out of a blister pack.