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There's a common argument that if you ban guns, people will just find another way to kill themselves, so why bother? And no doubt this is true of the sufficiently determined suicidals. But the convenience factor of firearms (and other methods) does appear to play a big role. The example of gas ovens in the UK is illustrative:
In other words, there was no replacement effect: people didn't immediately switch over from inhaling oven fumes to another method. There's a non-negligible chance that Sylvia Plath would have lived to a ripe old age if the UK had made the switch to natural gas a few years sooner.
Another example is here in Ireland, in which, although it's available over the counter, it's illegal to sell more than 24 tablets of paracetamol* in a single transaction. For years I thought this was silly: what's stopping you from driving or walking to three pharmacies or supermarkets to stock up on enough paracetamol (hell, even newsagents and corner shops sell it)? And obviously this is true for the sufficiently determined suicidals, about whom there's little we can do to stop them from killing themselves short of sectioning them. But adding in the trivial inconvenience of forcing people to go to multiple different shops does appear to serve as an obstacle: by the time you've walked into your third newsagent in an hour, you might well be thinking to yourself "Do I really want to do this?"
Decades of psychological evidence strongly suggest that the vast majority of suicides are impulsive, opportunistic ones (perhaps even "cries for help" that were rather more efficacious than their user strictly intended), and that these suicides would not have occurred if not for the convenience and ease of use of the method employed. If someone is so determined to kill themselves that they voluntarily choose an extraordinarily painful method of doing so like hanging, I think it's fair to say there's little we can do about them. But on the margin, there are huge savings to be made among the less-than-maximally determined suicidals. In the counterfactual world where the US had banned guns ten years ago, I don't think that all of the people who killed themselves with firearms in our world would have instead hanged or drowned themselves. In fact, I don't think that even 50 or 25% of them would have done so.
I'm not arguing that this, in itself, is a persuasive argument in favour of banning guns, and can see the merits of both sides of the debate (particularly the "guns as a check against encroaching authoritarianism" argument advanced by many, including Handwaving Freakoutery, formerly of these parts). But the causal role that guns play in suicide owing to their convenience factor is something that opponents must take seriously. "If we're going to ban guns to stop people from killing themselves, why not go the whole hog and ban ropes to stop people from hanging themselves?" is not a serious argument, for the reasons outlined above.
*A.k.a. acetaminophen, sold under the brand name Tylenol among others.
To be fair, the fact that Costco (et al) sell giant containers of acetaminophen is kinda scary to me. It's substantially more dangerous than naproxen (also available in that size). The 24-count restriction sounds pretty reasonable to me.
It's a piece of legislation I fully support. Some Irish legislation carries a whiff of nanny-stateism, but I really can't imagine why a household would ever need more than 24 paracetamol pills in a week. I think implementing something similar in the US would be a no-brainer, especially when you consider paracetamol poisoning is the leading cause of death by acute liver failure. I assume a significant portion of that is accidental: because it's an OTC drug, a lot of people severely underestimate how toxic it is. My dad (PhD in organic chemistry) says there's no way it would have been made available OTC if it was discovered today. I always urge people to use ibuprofen instead when possible.
Four people with headaches easily covers that. And 24 pills is still enough to kill you, painfully. Making the vast majority of people who just want to keep APAP around the house go more often to the store and pay a higher per-unit price just to slightly inconvenience those who want to die isn't reasonable. Nor is it reasonable to go full retard like with pseudoephederine and have a registry to make sure no one is buying a fatal dose by going to multiple pharmacies.
Tylenol is somewhat uniquely dangerous, it would possibly not have been approved as over the counter in the U.S. in today's regulatory environment.
This is for a couple of reasons.
-The therapeutic and toxic range are way too close (aka it's really easy to overdose accidentally, which does happen).
-It has significant interaction with some medical problems (aka liver metabolism). This is admittedly pretty minor in most situations.
And most importantly:
-Tylenol overdose is one of the worst possible ways to die. It is long, and slow, and for a while you think you are fine. This gives people lots of time to decline in misery knowing they made an irreversable choice. It's awful. Most other forms of overdose kill you quickly or rapidly alter your sensorium.
This creates agony on the part of the victim and their family, and also a significant amount of angst and distress in the healthcare team.
If you like you aren't paying for the minor inconvenience of harder to pull out of the packaging pills vs. fewer suicides, you are doing to reduce clinician burnout and doctors and nurses in the workforce longer.
It's also expensive to manage.
I'm not sure we'd have any OTC drugs in the US starting from zero in today's regulatory environment. Analgesics especially even get banned for prescription use (like the COX-2 inhibitors), because regulators refuse to consider that trading off risk of death against pain is valid in the first place.
That's a failing of today's regulatory environment, and has no bearing on whether I should be able to buy a big bottle of death.
My APAP related disgust is reserved for drug warriors who ensure that oxycodone with APAP is the most available formulation of oxycodone, because they consider people trying to abuse it dying horribly to be a feature and not a bug.
I think these days they would argue that the reason is mostly because of synergistic analgesia (which is not incorrect) but yes I agree it's a questionable cost/benefit.
But ultimately society is organized around tradeoffs in your rights to enable you to have rights and the conveniences of civilization. Having to deal with mildly annoying blister packs or smaller bottles doesn't seem like a high price to pay for the amount of pain you can prevent.
Yes, that's one reason the combinations are popular, but not the reason oxy with APAP (Percocet) is so favored over oxy with ASA (Percodan, no longer available) or oxy with ibuprofen (Combunox, no longer available). That's drug warrior pressure.
No, society is organized around what those with power want.
There is a bunch of research out there suggesting that OTC and milder agents are just as good as stronger agents for managing acute pain. Example:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786200
Lots of research. You might not find that research convincing but it is absolutely out there.
Additionally APAP is a safer choice than ASA or Ibu if taken as prescribed, which is easier to ensure in an acute course (less potential for severe side effects or interaction with chronic medical conditions).
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