Intended for healthcare professionals

  1. Research
  2. Effect of withdrawal...
  3. Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis
Research

Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2270 (Published 18 June 2009) Cite this as: BMJ 2009;338:b2270

All rapid responses

Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.

From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.

The word limit for letters selected from posted responses remains 300 words.

Erratum: Effect of withdrawal of co-proxamol on prescribing and deaths from drug poisoning in England and Wales: time series analysis.

The data used in study have since been revised by the Office for
National Statistics because of problems identified in the coding of deaths
involving analgesic compounds. The altered results do not affect the
general findings or overall conclusions.

Our revised analyses show that
during the three-year withdrawal phase (2005-2007) following the UK
Committee on Safety of Medicines announcement in January 2005 (that co-
proxamol was to be withdrawn totally from the UK market from 2008), there
was a very marked reduction in suicide and accidental deaths involving co-
proxamol alone (with or without alcohol), in keeping with trends in
prescribing, but no increase in deaths involving other prescribed
analgesics (in spite of increased prescribing of some of them).

The
changes in the results are that compared to expected numbers based on
trends for 1998-2004, during 2005-2007 there were 226 (95% CI =190 to 262)
fewer deaths by suicide involving co-proxamol (48% decrease), and 268 (95%
CI = 235 to 300) when accidental poisonings were included (47% decrease).

Prior to 2005 deaths due to co-proxamol were 17.5% (95% CI = 15.5 to 19.5)
of all drug poisoning suicides, whereas between 2005 and 2007 they
constituted just 8.3% (95% CI = 4.3 to 12.3).

Keith Hawton
keith.hawton@psych.ox.ac.uk

Competing interests: No competing interests

06 April 2011
Keith E Hawton
Director
Centre for Suicide research, Oxford University

Why the delay?

I stopped prescribing co-proxamol some 25 years ago, with the
exception of patients settled on repeat prescriptions who insisted on it
despite my advice of its danger in overdose. I changed my practice after I
read a paper (sorry I can't cite the reference, either BMJ or Lancet late
1970s) stating that it was the most important drug in completed suicide. I
remember reading that it was the dextropoxyphene that did it by causing
respiratory arrest before the ambulance arrived. Codeine or
dihydrocodeine are more likely to cause vomiting.

The deadliness of co-proxamol wasn't a secret. The crime writer P D
James, always one for meticulous research, used it (Distalgesic) as the
mode of (intended and premeditated) suicide for a protagonist in her novel
'Innocent Blood'.

Competing interests:
None declared

Competing interests: No competing interests

27 August 2009
Stephen F Hayes
GP
66A Portsmouth road, Woolston, Southampton S019 9AL
Back to top