Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis
Open accessAbstract
OBJECTIVE: To assess the effect of the UK Committee on Safety of Medicines' announcement in January 2005 of withdrawal of co-proxamol on analgesic prescribing and poisoning mortality. DESIGN: Interrupted time series analysis for 1998-2007. SETTING: England and Wales. DATA SOURCES: Prescribing data from the prescription statistics department of the Information Centre for Health and Social Care (England) and the Prescribing Services Unit, Health Solutions Wales (Wales). Mortality data from the Office for National Statistics. MAIN OUTCOME MEASURES: Prescriptions. Deaths from drug poisoning (suicides, open verdicts, accidental poisonings) involving single analgesics. RESULTS: A steep reduction in prescribing of co-proxamol occurred in the post-intervention period 2005-7, such that number of prescriptions fell by an average of 859 (95% confidence interval 653 to 1065) thousand per quarter, equating to an overall decrease of about 59%. Prescribing of some other analgesics (co-codamol, paracetamol, co-dydramol, and codeine) increased significantly during this time. These changes were associated with a major reduction in deaths involving co-proxamol compared with the expected number of deaths (an estimated 295 fewer suicides and 349 fewer deaths including accidental poisonings), but no statistical evidence for an increase in deaths involving either other analgesics or other drugs. CONCLUSIONS: Major changes in prescribing after the announcement of the withdrawal of co-proxamol have had a marked beneficial effect on poisoning mortality involving this drug, with little evidence of substitution of suicide method related to increased prescribing of other analgesics.
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Primary prevention programs of greatest demonstrable relevance to suicide in communities where firearms and medications are dominant suicide methods include legislation restricting access to unsafe firearms as well as mandates concerning the manufacturing, packaging, and distribution of medications.
“Primary prevention programs of greatest demonstrable relevance to suicide in communities where firearms and medications are dominant suicide methods include legislation restricting access to unsafe firearms as well as mandates concerning the manufacturing, packaging, and distribution of medications [93,94].”
From A systematic review of social factors and suicidal behavior in older adulthood (2012) · cites this paper as [94]
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“…economic circumstances (at least earlier in the period) 2 better recognition of risk in a range of frontline agencies 3 specific steps to prevent suicide in settings such as prisons and by methods such as selfpoisoning with paracetamol (Hawton et al, 2001) or co-proxamol (Hawton et al, 2009).”
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MethodA-t-on raison de retirer du marché les spécialités à base de dextropropoxyphène ?
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RETRAIT DU DEXTROPROPOXYPHÈNE ASSOCIÉ : VÉCU DU MÉDECIN GÉNÉRALISTE ET RELAIS THÉRAPEUTIQUE.
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- Authors
- Hawton, K., Bergen, H., Simkin, S., Brock, A., Griffiths, C., Romeri, E., Smith, K. L., Kapur, N., & Gunnell, D.
- Affiliations
- Warneford Hospital (GB)
- Office for National Statistics (GB)
- University of Oxford (GB)
- University of Manchester (GB)
- University of Bristol (GB)
- Corresponding author
- Hawton, K.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2009-06-18
- Volume
- 338
- Issue
- jun18 2
- Pages
- b2270-b2270
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC3269903
- OpenAlex
- W2116463642
- Cited by
- 82
- References
- 21
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 8 · 2018: 7 · 2017: 7 · 2016: 6 · 2015: 2 · 2014: 2 · 2013: 3 · 2012: 12
- FWCI
- 12.38
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- Figshare (submittedVersion, cc-by-nc)
- Leicester Research Archive (University of Leicester) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0606-1247)
- University of Oxford
- Economic and Social Research Council (ES/G007543/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Keywords
- drug withdrawal, analgesic prescribing, suicide, accidental poisoning, paracetamol, codeine, drug safety regulation
- MeSH terms
- Acetaminophen, Analgesics, Drug Combinations, England, Humans, Mortality, Poisoning, Dextropropoxyphene, Suicide, Wales, Drug Approval, Prescription Drugs
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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