KEY POINTS
- Australia's medicines watchdog is considering a proposal to restrict the sale of paracetamol products like Panadol.
- Changes include only allowing people to buy one or two packets of paracetamol at a time
- The proposals have raised concerns about impacts on women and those living in regional areas in particular
This article contains references to suicide/self-harm.
A proposal to restrict the sale of paracetamol products like Panadol is likely "scaring" the millions of Australians who rely on these products to get through their daily lives, according to one advocacy group.
A committee of the Therapeutic Goods Administration (TGA) met on Wednesday to consider feedback from public consultation on limiting the sale of products.
Advocacy group Pain Australia, who delivered a presentation to the committee, is concerned about four changes in particular:
- Restriction of paracetamol to a pack of 16 tablets;
- Allowing people to only buy one or two packets at a time;
- Only allowing over 18s to buy tablets without a prescription; and
- Forcing those buying slow release paracetamol such as Panadol Osteo to get a prescription for these products.
The changes were developed in response to a 2019 research paper, which found a 93 per cent increase in overdoses in young Australians aged five to 19 years old between 2006 and 2016.
One of the aims is to reduce the stockpile of paracetamol in people's homes. A NSW Poisons Information Centre survey found only 10 per cent of people who had self-poisoned with paracetamol had recently purchased the painkillers.
But Pain Australia chief executive officer Giulia Jones is concerned about the unintended consequences of the changes on the one-in-five Australians (aged 25 years and over) , which is pain that does not go away after three months.
"These people often have great trouble getting out of bed each day," she said. "It's sort of hard to imagine if you've never lived with someone with chronic pain, how much it affects their daily life."
Authorities are considering introducing limits to how many paracetamol tablets people can buy. Source: AAP / David Crosling
Who relies on paracetamol?
Paracetamol is used by many Australians with a wide variety of health issues.
Ms Jones said the "modified release" paracetamol, also known as slow release paracetamol, could be used by people with arthritis or those who have had recent joint replacements they are still getting used to.
Others could be taking standard paracetamol for spinal issues, period or pelvic pain including endometriosis, headaches and fibromyalgia, which causes musculoskeletal pain.
Ms Jones noted that a submission to the TGA from pain specialists pointed out that paracetamol is one of only three non-analgesic pain medications they recommend people use.
"Many people can't use the others because of their stomach or their other physical conditions or other medications that they're on," she said.
"Paracetamol is the one with the least adverse reactions with other drugs and other physical conditions. So it's really like the safest medicine we have.
"You can imagine being a mum with a back problem, who's trying to keep up with a young family or a dad with fibromyalgia whose life is pain, but they want to keep working, they need to keep going for their family.
"We really don't want to impact those people's ability to manage their own pain."
'Unintended' consequences of paracetamol proposals
Ms Jones said those living with chronic pain could safely be taking six to eight paracetamol tablets a day. Limiting them to a packet of 16 tablets meant they would only have enough supply to last two days.
"If you limit the number [to two packets] that's every four days, you have to go back to the supermarket," she said.
"For many of these people daily living is really difficult. So we want them to be able to buy a fortnight supply on payday."
If you limit the number [to two packets] that's every four days, you have to go back to the supermarketPain Australia CEO Guilia Jones
Forcing people under the age of 18 to get a prescription could also impact young carers picking up paracetamol for their parents, or those who suffer from chronic period or pelvic pain.
Ms Jones said requiring people to get a prescription for slow release paracetamol would also be creating another barrier to people getting what they need.
"I know here in Canberra, GP visit is $80 a pop, if you can get in, when you can get in. Very few doctors are bulk billing these days," she said.
Critics say forcing people to go to a doctor for a prescription for paracetamol could cause unnecessary hardship. Source: Getty / Luis Alvarez/Getty Images
"What they need, is to be empowered to self-manage. And we encourage people to self-manage, because it gets them into the right mindset for what we call 'leaning into your pain' rather than recoiling from it," she said.
The change would also disproportionately impact those in regional areas. Ms Jones said someone working on a station in a regional area may have to drive several hours to get to the shops.
"You need to be able to buy a fair supply of these things because the trip costs money and time that you don't always have," she said.
"They also have pharmacies that aren't open late hours. In the cities, you can often find a late-night chemist."
Proposed changes 'scaring' Australians
When asked how she thought Australians were responding to the proposed changes, Ms Jones said "I think it's scaring people living with chronic pain".
"They already were told by government, 'you shouldn't be taking opioids', and before that, 'you shouldn't be taking codeine' ... and people have accepted that but it was really stressful," she said.
"People who had just been taking their doctor's advice were suddenly sort of treated like there was something wrong with them for doing that.
"So there's already been a lot of stress on this cohort and their view is 'paracetamol? You're going to make it harder to buy paracetamol? That's kind of all we have left'.
"So I'm very concerned about this cohort and how they're responding. I imagine that people are already buying up packs of paracetamol to keep in their stockpile at home, which is exactly what we don't want."
Australia should be considering a mental health approach
The 2019 research from the University of Sydney and the NSW Poisons Information Centre that sparked the proposals for change, found an alarming increase in the number of overdoses among young people, with women outnumbering men by three-to-one.
It found the substances they were using for self-poisonings were widely available in the community, including household products and over-the-counter medicines like paracetamol, rather than prescription medications like antidepressants.
The proposed changes are being supported by Suicide Prevention Australia but it has also highlighted the need to address any unintended consequences for those with chronic pain.
About one-in-five Australians suffer from chronic pain. Source: AAP
"Emma is very capable woman, she actually was a pharmacist herself before being a politician. She has all the tools and the governmental support to address issues such as behaviours of young women if they have concerns with regard to their mental health - are they wanting relief, or they're looking for ways of self-harming?
"I wouldn't put that in the hands of the TGA to be honest."
What happens now?
The TGA's Advisory Committee on Medicines Scheduling (ACMS) is expected to announce an interim decision on the changes to paracetamol by February, with another round of consultation before any final decision, which is expected to be made in April 2023. Any changes would likely not be implemented until late 2023 or early 2024.
Ms Jones said she hoped the pack limits, the limit on sizes and the requirement for prescriptions would all be dropped.
"Because they just do affect so many people detrimentally, and this group of people living with chronic pain have already had so much to deal with over the last few years - losing access to medical care during the lockdowns, scripts were hard to get, they've had the mental health strain.
"People living with chronic pain are two to three times more likely to be suicidal than those who live without chronic pain in our country. They have stresses and strains as well to consider. So I really hope that that part of the TGA's proposal gets dropped."
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