Selling Paracetamol Law
Suggested logos for the packaging of over-the-counter medications to highlight the ingredients of acetaminophen and aspirin. This image shows the suggested logos for over-the-counter medications containing aspirin (top left) and acetaminophen (top right). The logo has been incorporated into a product to indicate how it could be used (below). However, it seems that more can be done. In preliminary research, we found that some retail stores other than pharmacies sold 48 acetaminophen tablets/caplets (500 mg) and promoted the sale of three boxes (3×16 tablets) as bargains. This triggered the first mystery shopper exercise to examine the extent to which a number of retailers comply with MHRA guidelines in non-pharmacy retail stores (Level 1). These results triggered further investigations (step 2). Our aim was to determine how many shops were willing to break MHRA guidelines and the law. Mystery shoppers indicated that most stores (41/62) displayed signs informing them that they would not sell more than 32 acetaminophen tablets (Figure 4A-F). Mystery shoppers also noticed posters encouraging consumers to purchase more than two packs of acetaminophen (>2×16, 500 mg) (Figure 4G, H), which clearly contravenes current MHRA guidelines. Many types of over-the-counter medications have been placed alongside daily consumables such as shampoo, deodorants, etc., especially in bargain stores. It was also observed that some stores placed the term “current value” under products (Figure 4I). Example 2: While trying to purchase 96 (500 mg) of acetaminophen from an independent newsagent, the mystery shopper was told that he could only buy 32 that day.
After hearing the scenario, the cashier said they could sell them two packs (i.e. 32×500 mg of acetaminophen) each day until they had enough. When traditional stores containing pharmacies were included (8 out of 62 stores), mystery shoppers on both levels presented only merchandise to be paid for at the cash registers of other pharmacies and self-service vending machines. Mystery shoppers were asked to keep records at both stages: whether cashiers voluntarily authorized transactions, whether questions were asked about why a sale had been rejected, whether cashiers would accept multiple drug transactions to bypass any obstructions in payment systems, and any comments on cashiers` sales. All remarks were recorded immediately after the sale of drugs by a spreadsheet filled out by mystery shoppers. Customers were instructed not to visit a store more than once and to avoid effervescent acetaminophen and aspirin preparations. In Ireland, 7933 drug overdose cases were recorded in 2004, 31% of which involved acetaminophen.4 It is illegal for Irish pharmacies to sell more than 24 paracetamol tablets (500 mg) in a single transaction.5 In early 2007, we visited 20 pharmacies in Dublin and tried to buy quantities of acetaminophen in excess of this legal limit: Ten pharmacies allowed us to do this. They also recommended limiting the purchase of acetaminophen without a prescription to adults 18 years of age and older. They observed differences in the packaging recommendations for anti-influenza drugs compared to the contents of acetaminophen and other drugs: All types of boxes purchased printed a message on the front indicating acetaminophen use, but the different font size often made it difficult to distinguish between the word “acetaminophen” and the other ingredients listed and the brand name of the product.
Consumers indicated that a handful of stores in the “consumer” group also contained pharmacies (8 of 62); But cashiers never referred shoppers to a store pharmacist for professional advice on managing their pain or flu-like symptoms. Mystery shoppers are justifying much-needed change to protect consumers from the reckless sale of over-the-counter drugs on a large scale across the UK, and stricter regulation of stores that violate legal guidelines and limits on the maximum amount of acetaminophen or aspirin sold in a transaction to the same customer. Such a widespread failure of OTC regulation puts public safety at risk, due to the apparent lack of training of retail personnel, poor checkout security systems, and limited information to customers on packaging and sales staff. Fifty-four non-pharmaceutical retail stores located in the same four locations in Shropshire and Staffordshire were selected; Many outlets similar to those on Level 1 (29 mainstream stores and 25 cheap stores). Four medical students were recruited and presented as mystery shoppers, each to purchase two packs of acetaminophen (16×500 mg) in conjunction with a pack of anti-flu medication containing paracetamol and a bottle of Lucozade. They were given the short film “My roommate has the `flu` they were supposed to use when they were interviewed. The MHRA strongly advises against the sale and supply of large quantities of over-the-counter painkillers (acetaminophen, aspirin and ibuprofen), as they may undermine the intent of the package size restrictions the government has put in place to protect public safety. The MHRA`s guidelines on best practice for the sale of analgesic medicines state that no more than two packs at a time should be provided and that promotional offers that promote the sale of more than one pack should not be used. We found that 98% (53/54) of the stores included in Stage 2 were willing to sell a package of acetaminophen (16×500 mg) in conjunction with an anti-influenza medication containing paracetamol.