Scotland (Bond and Hite, 1999; McLoone and Crombie, 1996). In the Scottish study, the rates among male and female adolescents aged 15–19 were approximate 150 and 350/100,000, respectively (McLoone and Crombie, 1996). Hospitalizations due to acetaminophen rose rapidly from the 1970s through the early 1900s, especially in adolescents and young adults (McLoone and Crombie, 1996). This increase is explained in part by the increased availability of acetaminophen. High correlations have been noted between sales of acetaminophen and overdose rates in Oxford, England (r=.86) and in France (r=.99), with similar correlations between sales and completed suicide (Gunnell et al., 1997). In addition to availability, adolescents’ general ignorance about the risk for hepatotoxicity appears to contribute to the use of acetaminophen. Almost half of adolescents underestimate the potential lethality and toxicity of acetaminophen (Harris and Myers, 1997; Myers et al., 1992). Awareness is also limited that ingestion of acetaminophen in combination with alcohol greatly increases the likelihood of both hospitalization and of hepatotoxicity (Schiodt et al., 1997).
Restriction of drug content per purchase and the use of blister packs (requiring individual pill removal from a card with each pill in its own “bubble”) may reduce the morbidity and mortality due to acetaminophen overdose (Chan, 1996; Hawton et al., 1996). Restriction in the amount of drug available in a purchase resulted in a 4-fold lower fatality from overdose in France, compared to England (Gunnell et al., 1997). The introduction of blister packs as a method for dispensing acetaminophen was associated with a 21 percent reduction in overdoses and a 64 percent reduction in severe overdoses, whereas overdoses due to benzodiazepines, which were not subject to these restrictions, remained stable (Turvill et al., 2000).
Some have considered the benefit of labels warning of hepatotoxicity, but it is unclear if warnings would alter the behavior of impulsive adolescents (Harris and Myers, 1997). In one survey, only 25 percent thought that a warning would deter them (Hawton et al., 1996). The addition of methionine to prevent the hepatotoxic effects has been suggested but not yet evaluated.
The rate of self-poisoning by prescription drugs in New York City is highest in Manhattan, which has the higher per-capita density of physicians of any of the boroughs of New York (Marzuk et al., 1992). The greater number of prescribed psychotropic agents is correlated with an increased risk of overdose, at an estimated rate of 3.8/1000 prescriptions (Forster and Frost, 1985). However, Moens and van Voorde (1989) found no relationship between availability of prescription drugs and completed