Background

Intentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance.

Objective

This cross-sectional study aimed to determine how much paracetamol is present and therefore accessible in urban New Zealand households, and sources from where it has been obtained. This information is not currently available through any other means, but could inform New Zealand drug policy on access to paracetamol.

Methods

Random cluster-sampling of households was performed in major urban areas of two cities in New Zealand, and the paracetamol-containing products, quantities, and sources were recorded. Population estimates of proportions of various types of paracetamol products were calculated.

Results

A total of 174 of the 201 study households (86.6%) had at least one paracetamol product. Study households had mostly prescription products (78.2% of total mass), and a median of 24.0 g paracetamol present per household (inter-quartile range 6.0-54.0 g). Prescribed paracetamol was the main source of large stock. Based on the study findings, 53% of New Zealand households had 30 g or more paracetamol present, and 36% had 30 g or more of prescribed paracetamol, specifically.

Conclusions

This study highlights the importance of assessing whether and how much paracetamol is truly needed when prescribing and dispensing it. Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it. Prescribers and pharmacists need to be aware of the risks of such accumulation and assess the therapeutic needs of their patients. Public initiatives should be rolled out at regular intervals to encourage people to return unused or expired medicines to pharmacies for safe disposal.

The stocks of paracetamol-containing medicines (acetaminophen) held at a single time point in New Zealand households are described in this dataset. These data were collected via a cluster-sampling survey of two cities in New Zealand.

A door-to-door survey study with random, clustered sampling of consenting household members in two cities in New Zealand was designed. A total of 201 households in 40 meshblocks in two Major Urban Areas (MUAs; areas of 100,000 or more residents) of Dunedin and Auckland were sampled. Meshblocks are Statistics NZ’s smallest geographic unit, and roughly correspond to a city block or part of it. Random cluster-sampling of 20 meshblocks in each city was performed by deprivation level, where all eligible MUA meshblocks were stratified by their New Zealand Deprivation Index 2013 (NZDep2013) index scores, which describe the level of area deprivation by taking into account multiple relevant area and household variables. Six meshblocks were randomly selected from each city from NZDep2013 8-10 meshblocks (most deprived), eight from NZDep 4-7, and 6 from NZDep2013 1-2 (least deprived), for a total of 40 meshblocks. This was done to obtain a sample that would be representative of the general New Zealand population by levels of deprivation. Each meshblock was sampled by starting from a random end of the street and then tossing a dice to choose a house to approach, and repeating this until either five households were recruited or there were no more households to sample. 

Trained Research Assistants (RAs) knocked on the doors of domiciles in each meshblock to be sampled, chosen by tossing a dice as described. Inclusion criteria: person present and usually residing in a domicile in a meshblock which was sampled, and aged 16 or over. Exclusion criteria: not able to give informed consent (intoxicated, aggressive, otherwise not safe to approach – nobody was excluded for this reason).

Household members aged 16 years and over were eligible to participate, and if consent was obtained, basic demographics were collected about the household (number of people usually residing in the household, their age, sex, ethnicity). Participants were then shown images of paracetamol-containing products (sole and combination), and requested to bring out all paracetamol products of their own, and any that were shared by the household in communal areas of the domicile. Private stock of any other residents of the household who were not present and were therefore unable to consent was not recorded for ethical reasons. If there were no paracetamol products present, that was recorded. If there were paracetamol products present, product type, strength, expiry date, purchase date and means of obtaining (by prescription, pharmacy over-the-counter [OTC], other retailer [i.e. not a pharmacy; e.g. supermarket, petrol station], other, unknown) were recorded.

The data were entered into a main database which is fully de-identified. Meshblock numbers are included in the dataset, but households are only given an identifier derived from the meshblock code. It would not be possible to identify a specific household from the data. Paracetamol product names were cleaned in the dataset (if there were any misspellings), and new variables were calculated to summarise the data (e.g. total household stock of prescribed paracetamol products, etc.).

The data file has a data dictionary tab which describes the variables in the dataset. 

Notes on missing values:

- Household Median and Average age: 7 households did not give full responses

- Expired paracetamol stock: 36 households did not give full responses