Finland is one of the few western countries left in the world where medication is administered by just a few state-licensed pharmacies that are often few and far between. In other countries, many more accessible establishments, such as general stores, supermarkets, and petrol stations can sell select drugs that are available without a prescription.
The Finnish Medicines Agency, known as Fimea, is Finland’s official agency in charge of regulating pharmaceuticals and operates under the Ministry of Social Affairs and Health. The authority is now saying that a recent incident in Sweden has only made them more steadfast in their opposition to freeing up the pharmaceutical market, despite calls to do so from Finland’s leading trade associations and consumer authorities.
Sweden began to allow the sales of certain non-prescription drugs in stores, kiosks and petrol stations in November 2009. The medications that proved the most popular were painkillers and eye drops.
Since this granting of general sale status, the number of paracetamol poisoning cases doubled in Sweden, to total about 4,400 incidents per year. The Swedish Medical Products Agency followed the development with concern and in August 2014, called to restrict the sale of paracetamol tablets to only pharmacies once again.
The Finnish equivalent, Fimea, says the Swedish example should serve as a warning to those parties in Finland who are lobbying to introduce the general sale of non-prescription drugs.
“This is but one example of the kind of problems anti-inflammatory drugs and painkillers, in this case paracetamol, can cause. It is good to remember that while they are effective medicines, they also have associated risks. It is therefore completely justified that drugs like this are only sold in pharmacies,” says Fimea’s Evaluation Director Erkki Palva.
Second most popular painkiller in Finland
After ibuprofen, paracetamol is the most widely used analgesic in Finland. The pain and fever relieving drug is sold under the name of acetaminophen in the US and Canada. It is widely favoured by Finnish physicians, as about 80 percent of the paracetamol sold in Finland is obtained with a doctor’s prescription.
All painkillers and anti-inflammatory drugs contain risks if used incorrectly, even if they have been prescribed by a doctor. Paracetamol is particularly tricky, because its maximum recommended dose is dangerously close to a level that could be considered toxic. The maximum daily dose of paracetamol for adults is currently 4 grams.
Just a 150 milligram dose of paracetamol per kilo can cause liver damage in a healthy person, i.e. 15 grams for someone weighing 100 kilos, or 7.5 grams for someone weighing 50 kilos. The drug is widely acknowledged to be the leading causes of sudden liver deficiencies in the west.
“In the proper amounts, it is a well-tolerated and safe drug, but its margin of safety is quite small and overdoses can be life-threatening,” says Palva.
Consumer advocate sticks to its guns
Finland’s leading consumer advocacy association, the Finnish Competition and Consumer Authority (FCCA), has called for the general sale of non-prescription drugs in Finland on several occasions. It justifies the proposal by saying that the price of medications went down in Sweden and Norway after general sales were introduced there.
Recent events in Sweden have not swayed the FCCA in its recommendation, and Timo Mattila, Director of the FCCA’s Competition division, says it is still the best solution.
“We can’t take a stand on any individual medication, but it goes without saying that if the sales of non-prescription drugs were freed up to retail locations, it must to be done in way that ensures the safest use of the drugs in question.”