Restricting means for suicide is a key
element in suicide prevention strategies of all countries where these have been introduced. Preventing deaths from
analgesic overdoses is highlighted in the National Suicide Prevention Strategy for England. The problem of self-
poisoning with the prescription-only
drug co-proxamol (
dextropropoxyphene plus
paracetamol) has received attention in several countries. We have conducted a review of the international literature related to possible strategies to tackle this problem. In England and Wales in 1997-1999, 18% of
drug-related suicides involved
co-proxamol; these constituted 5% of all suicides. Death usually results from the toxic effects of
dextropropoxyphene on respiration or cardiac function. Death from
co-proxamol overdose may occur rapidly, the lethal dose can be relatively low, and the effects are potentiated by alcohol and other
CNS depressants. The majority of
co-proxamol overdose deaths occur before hospital treatment can be received. The risk can extend to others in the household of the person for whom the
drug is prescribed. While there is limited evidence that educational strategies have been effective in reducing deaths from
co-proxamol poisoning, initiatives in Scandinavia, Australia and the UK to restrict availability of
co-proxamol have produced promising results. Given the paucity of evidence for superior therapeutic efficacy of
co-proxamol over other less toxic
analgesics, there are good reasons to question whether it should continue to be prescribed.