Cyprus Mail
CyprusHealth

Painkiller rules are a real headache

Typical selection of painkillers available in a British supermarket

By Angelos Anastasiou

PHARMACISTS’ stranglehold over the sale of some non-prescription, over-the-counter painkillers shows no sign of loosening despite a four-year-old court ruling that ibuprofen-based Nurofen should be freely available in supermarkets and kiosks.

A seemingly inexplicable distortion in the supply of non-prescription analgesic drugs allows paracetamol (Panadol) and aspirin to be sold in pharmacists, kiosks and supermarkets, while ibuprofen (Nurofen) can only be sold in pharmacists.

Nurofen’s Greece-based distributors, Reckitt Benckiser, have been trying to break the restrictive confines of pharmacies and join Panadol and aspirin on kiosk and supermarkets shelves for years. Reckitt Benckiser sued the Cypriot pharmaceutical services in 2010 seeking inclusion of their painkiller in the country’s ‘general sale list’ (GSL) – the list of drugs allowable for sale outside of pharmacies – citing unfair treatment in that paracetamol and aspirin products were on the list. Pharmaceutical services had denied such inclusion on grounds of “public interest”, but the court deemed the justification offered by the state body irrelevant to the case and ruled in the company’s favour in 2011.

Four years later, Nurofen is still not eligible for sale by anyone other than pharmacists. And its continued ban is more complex than you might think.

A 2006 law governing the operation of kiosks allowed the sale of “painkillers for which no prescription is required”, but subsequent regulations limited this to aspirin and paracetamol – but not ibuprofen.

“Not quite,” a pharmaceutical services official told the Sunday Mail. “In fact, the only over-the counter analgesic permitted for sale at kiosks by law is aspirin, and we are working to have Panadol removed from kiosks as well.”

But if that is the case, why can anyone get Panadol from any kiosk at any time of day or night? The official suddenly got defensive.

“Look, I can only speak about the two years I’ve been here,” she said. “I couldn’t speak about what went on before I got here.”

Even so, the fact remains that one non-prescription painkiller can be sold in kiosks and supermarkets – as well as pharmacies – another technically can’t but is, and a third is available only at pharmacies. On the face of it, it makes little sense, and the fact that no one can explain it convincingly makes even less.

“This law is very old,” was all the pharmaceutical services official could muster, presumably implying it was made before paracetamol and ibuprofen were widely accepted as alternatives to aspirin.

Old or not, the law affords the health minister – following a recommendation by the Pharmacy Board, a committee of seven pharmacists – the right to amend the GSL list, i.e. which drugs can be sold by kiosks and supermarkets, and the House of Representatives a veto over the health minister’s decision.

Meanwhile, three parliamentarians are pharmacists by trade – DIKO’s Athina Kyriakidou and Angelos Votsis, and DISY’s Nicos Nouris – which could render their position loaded: the more drugs stay out of kiosks, the more will be sold at pharmacies. It is no surprise, then, that they oppose the sale of any drugs by kiosks.

Votsis dismissed the potential conflict arising from the fact that the people responsible for deciding which drugs, if any, can be sold freely – the Pharmacy Board – exclusively comprises pharmacists.

“There is no issue of financial interests at play,” he said. “We are talking about extremely cheap products – it’s not like there are millions to be made from over-the-counter analgesics.”

Votsis ventured a guess as to why paracetamol and aspirin are permitted to be sold at kiosks, but ibuprofen is not – perhaps the key factor is that they are “older drugs that have proven their innocence over time”. But the core of his argument was that abuse – deliberate or accidental – of even the most innocent of drugs can be dangerous.

“If you ask me, no drugs should be sold at kiosks,” he said. “Whatever the circumstances, if someone takes a box of aspirins, he will get an ulcer. That’s why a professional should always be in charge of dispensing any drugs, even food supplements.”

Unsurprisingly, Kyriakidou’s views mirrored those of Votsis.

“Good,” was her response to news of the pharmaceutical services’ efforts to have Panadol removed from kiosks.

“In my opinion, none of these drugs should be freely available at kiosks,” she added. “It makes no difference that they are non-prescription, over-the-counter drugs. They all have side-effects and should not be dispensed by anyone but a trained professional.”

Asked to explain the apparent illogicality of allowing one non-prescription analgesic to be sold on every street corner but not another, Kyriakidou employed her pharmacist training.

“It’s not illogical,” she explained. “The difference lies in the substances found in each drug. Ibuprofen is much more addictive than aspirin and paracetamol, and its abuse could be potentially much more dangerous.

“Generally, abuse of any of these drugs could cause serious health problems, which is why the right to sell them should be restricted to trained pharmacists.”

Aspirin
Aspirin

The argument seems fairly patronising, as it assumes that the average Cypriot is either criminally ignorant or can’t be trusted to stick to the dosage instructions on the box of a non-prescription drug, and that a kiosk owner will ignore the red flags raised by a walk-in asking for 10 boxes of Panadol. A similar argument was made by pharmaceutical services during the Reckitt Benckiser lawsuit.

“Public-interest reasons cited include polypharmacy, uncontrolled abuse, unregulated storage, and supply with no professional advice offered by properly trained staff, but failed to detail the potential serious risks stemming from supplying this particular non-prescription drug outside of pharmacies,” the court ruled.

Such nebulous “public interest” reasoning notwithstanding, the example of the United Kingdom is telling. Not only are supermarkets there permitted to sell regular-strength versions of all three of these analgesics (plus others), but they also produce their own generic brands, typically at a much lower price.

But perhaps most importantly, pharmacies in Cyprus follow a customer-unfriendly, unflinchingly rigid schedule of working hours. This includes closing on Sundays, Wednesday afternoons and every public holiday and a three-hour afternoon break during the summer. A few pharmacies are designated by a rota system to stay open until 10 pm during the winter and 11 pm in the summer months, but a customer has track down where these are. After the later closing hours, pharmacists are only obliged to sell drugs if the customer presents a prescription. This means, of course, that over-the-counter pain killers cannot be obtained after closing time and until the next morning.

Basically, it’s a good idea to anticipate pain well ahead of time, particularly if your painkiller of choice is Nurofen.

The purported need for the presence of a “trained professional” even for the sale of run-of-the-mill analgesics negates the need for those deceptively small inserts folded into each box, listing the drug’s uses and side-effects.

The issue boils down to the restriction of individual choice, given that the object is non-prescription, over-the-counter painkillers, those who wish to seek professional advice before taking any should be free to do so, as should be those who are capable of reading an insert and care little for received wisdom shoved down their throat.

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