Offer TWO important comments on the effect of City (Auckland/Dunedin) on the key variables relating stocks of paracetamol products.

Background Intentional self-harm is a common cause of hospital presentations in New Zealand and across the world, and self-poisoning is the most common method of self-harm. Paracetamol (acetaminophen) is frequently used in impulsive intentional overdoses, where ease of access may determine the choice of substance. Objective This cross-sectional study aimed to determine how much paracetamol is present and therefore accessible in urban New Zealand households, and sources from where it has been obtained. This information is not currently available through any other means, but could inform New Zealand drug policy on access to paracetamol. Methods Random cluster-sampling of households was performed in major urban areas of two cities in New Zealand, and the paracetamol-containing products, quantities, and sources were recorded. Population estimates of proportions of various types of paracetamol products were calculated. Results A total of 174 of the 201 study households (86.6%) had at least one paracetamol product. Study households had mostly prescription products ( 78.2% of total mass), and a median of 24.0g paracetamol present per household (inter-quartile range 6.054.0g ). Prescribed paracetamol was the main source of large stock. Based on the study findings, 53% of New Zealand households had 30g or more paracetamol present, and 36% had 30g or more of prescribed paracetamol, specifically. Conclusions This study highlights the importance of assessing whether and how much paracetamol is truly needed when prescribing and dispensing it. Convenience of appropriate access to therapeutic paracetamol needs to be balanced with preventing unnecessary accumulation of paracetamol stocks in households and inappropriate access to it. Prescribers and pharmacists need to be aware of the risks of such accumulation and assess the therapeutic needs of their patients. Public initiatives should be rolled out at regular intervals to encourage people to return unused or expired medicines to pharmacies for safe disposal. City City - Auckland - Dunedin - Auckland - Dunedin Auckland Auckland 0 200400 600 200 Solid_load_present_g City City - Auckland U2 - Auckland - Dunedin - Dunedin Auckland 10 Liquid_load_present_g 30 40 15