A review of the way Soham murderer Ian Huntley is supervised in jail is under way after his latest suicide bid, the Home Office has said.
Huntley was found unconscious in his cell at Wakefield Prison at 0119 BST on Tuesday after a suspected overdose.
He is now under heavy sedation at Pinderfields Hospital in Wakefield where his stomach has been pumped.
The 32-year-old received two life terms for murdering Jessica Chapman and Holly Wells in Soham, Cambridgeshire in 2002.
Prison sources told the BBC that Huntley was on liquid medication and it was unclear how he had stored medicine for his latest suicide bid.
The former school caretaker first tried to kill himself in June 2003 after saving up 29 anti-depressant pills in a box of teabags while awaiting trial for the murder of the two 10-year-old schoolgirls.
An official report into the suicide attempt, which was released by the Home Office eight weeks ago, said Huntley presented an "ongoing significant risk of self-harm".
"In managing him, the safest strategy is to assume he will commit another act of self-harm if given the opportunity," it said.
The Prison service said a review of how Huntley is handled would now be carried out by the head of its Standards Audit Unit, Rob Kellett, who wrote the 2003 report.
General secretary of the Prison Officers Association Brian Caton said that if suicides by administered drugs were to be reduced then liquid medication must be used, regardless of cost.
"The Prison Service say that most of Huntley's medication was liquid - but all of it should be, along with all of the medication of those people with whom he comes into contact," he said.
"Tablet medication can be held in the throat and coughed back up."
John Powley, Soham's county councillor and a governor at Huntley's former workplace, Soham Village College, said the prison authorities needed to keep a much closer watch on Huntley.
"I am very concerned that this is the second time he has managed to attempt suicide while in prison," he said. "It may be third time lucky next time.
"My view is that he committed a heinous crime. He was properly convicted and now he should serve his sentence. If that means he spends the rest of his life in prison so be it."
In September 2005, High Court judge Mr Justice Moses ruled that Huntley, originally from Grimsby, North East Lincolnshire, must serve at least 40 years in prison.
He said the killings did not meet the criteria for a "whole-life tariff", but the 40-year term offered "little or no hope" of his release.
Mark Leech, editor of the Prisons Handbook, said it was difficult to stop inmates who were determined to kill themselves from making suicide attempts.
"The Prison Service's anti-suicide procedures are not infallible and they will inevitably fail," he said.
"The prison officers have to be lucky every time and one day he will succeed, no matter how good their measures are."
Mr Leech suggested there may now be a case for offering voluntary euthanasia to prisoners who face the rest of their lives behind bars.
"It raises the question of whether people in his position ought to be given the opportunity of a way out," he said.
"I think it is a position that needs to be explored rather than simply pooh-poohed."