A Lancet Regional Health study found most paracetamol poisonings are intentional, with repeat cases facing worse long-term survival.
A Lancet study of nearly 20,000 NSW patients shows that one in five people hospitalised for intentional paracetamol poisoning will reattempt, and those who do are at a higher risk of poorer long-term survival.
Researchers analysed 24,092 admissions for paracetamol poisoning among 19,895 individuals between January 2011 and September 2020.
Most poisonings were intentional and impulsive, occurred during acute crises, and were concentrated among women aged 18 to 42 years – with those aged 15 to 19 forming the largest subgroup.
Patients who intentionally self-poisoned had high rates of substance use and psychiatric comorbidities, placing them at high risk for repeated self-harm and suicide.
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Over 20% of patients experienced another intentional poisoning, with repeat cases having the lowest survival and higher ICU admission, at 17.6%.
Often, subsequent poisonings occurred within a year of the first (78.7%), and nearly a third of patients (31.2%) had a repeat within two months. Method switching between episodes was also common.
Over a third (38.5%) of patients admitted for intentional poisoning were transferred to a psychiatric ward or hospital.
Accidental poisonings had the highest within-group mortality, with 13.8% of patients dying by the end of the study – greater than intentional poisonings, mainly due to delayed presentation, by which point hepatotoxicity may have already set in.
Among intentional poisoning admissions, 90% extended beyond a single day, and more than a third (38.4%) ran longer still – length-of-stay patterns that point to a prolonged burden on New South Wales’s hospital capacity.
Admissions were concentrated in major cities, followed by inner regional areas, with patients of very low socioeconomic status over-represented in both intentional and accidental poisonings.
Pack size restrictions implemented in February 2026 by the TGA were unlikely to reduce the recurrence of poisoning, with researchers instead pointing to post-overdose management and continuity of mental health care for patients who intentionally self-poison.
The admitted-patient dataset likely understates the true frequency of paracetamol poisoning, according to the study, since it excludes non-admitted cases such as those treated at home or in the emergency department.
Other research suggests several drivers of accidental poisoning, including taking multiple paracetamol products, inadequate pain control, and limited patient understanding of toxicity risk and correct dosing.
Australia’s high-visibility warning statements have had little demonstrated effect.
The study reported that the efficacy of paracetamol remains limited for many common pain conditions, suggesting that improved referral pathways to chronic pain services could address dose escalation.
