Deregulated Sales of Analgesics – A Failed Scandinavian Experiment?

Scandinavian liberalisation of analgesics sales during the 2000s increased accessibility in chemists/pharmacies and legalised sales in grocery retailers, which quickly established themselves as amajor retailer of analgesics. In 2015, grocery retailers’ shares of analgesics sales in Denmark, Norway and Sweden were among Western Europe’s highest at 17%, 26% and 21%, respectively. Nevertheless, increased accessibility has not come without its adverse side-effects, which have seen more stringent regulation come into force in 2011 and 2013 in Denmark and in late 2015 in Sweden.

Rate of teenage suicide attempts and poisonings in Denmark and Sweden soars

Suicide attempts and self-injury with the aid of analgesics increased fivefold in Denmark from the late 1990s to their peak in 2009. A disproportionate share of hospitalisations were young girls aged 12-20, also dubbed Panodil-pigerne,or the Panodil-girls. Experts noted that analgesics were used impulsively, typically by young teenage girls wanting to escape the stress and anxieties of their lives.

Ease of access to large quantities of analgesics was recognised as the main cause of the development, as analgesics products were sold without prescription in grocery, convenience and forecourt retailers as well as chemists/pharmacies. Perhaps most startling was that Danes could buy bottles containing up to 300 pills without prescription in chemists/pharmacies. In 2011 and 2013 stricter regulation was put in place and accessibility restricted. In 2016, Danes under the age of 18 could only buy analgesics at chemists/pharmacies with a prescription and products with 20 or more pills now require a prescription for everyone.

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Sweden legalised analgesics sales in grocery retailers in 2009, despite the alarming developments in neighbouring Denmark. Inevitably, the Swedish experience turned out to be not all that different. Poisoning cases over the next five years would increase by 40% and the Swedish Medical Products Agency noted most cases were related to self-injury and impulsive behaviour. To address the issue, acetaminophen products were removed from grocery retailers in late 2015, and are now exclusively sold by chemists/pharmacies.

Worrying signs in Norway

The ubiquity of analgesics in Norway was a major contributory factor to the astounding 6% current value CAGR recorded over the review period, second only to Austria in Western Europe. Regulation remains untouched, despite poisoning cases increasing by more than 100% between 2005 and 2015. The Norwegian Pharmacy Association published a survey in 2015 that found that one in three teenage girls always had analgesics with them and 70% had used acetaminophen products in the last month. Furthermore, one in three stated they used analgesics preventatively. The developments have received increasing attention in Norway and have become a part of a wider debate on educating consumers about the side-effects associated with OTC medicines.

Stricter regulation and OTC reversals

The Danish regulatory changes have so far worked as intended. The number of hospitalisations following overdosing on analgesics is falling, with a steep decline among teenage girls. In the wake of the regulatory change that came into effect late 2013, current value sales of analgesics sharply declined by 23% in 2014. Norway has yet to address the issue, although multiple solutions are being proposed. One suggestion is to move a large number of OTC products, not only analgesics, to prescriptions. Then link the already existing public health portal with an app, where the consumer could show his or her prescription at the point of sale. This suggestion still seeks to keep the products available in grocery retailers, but would require the cashier to check consumer’s prescription. Regardless of the solution decided upon in Norway, the Scandinavian experience has proved the importance of regulation in analgesics to protect consumers from the dangers and misuse of the products.

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