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Cyprus

Pharmacies tighten grip on pain relief

Typical selection of painkillers available in a British supermarket

By Angelos Anastasiou

THE HEALTH ministry has now banned the sale of all non-prescription painkillers outside of pharmacies except for aspirin.

In “Painkiller rules are a real headache” on April 5, the Sunday Mail delved into the paradox of rules governing the sale of over-the-counter, non-prescription analgesics in which we criticised the practice of allowing only certain types to be sold outside of pharmacies.

Back then we discovered that ibuprofen-based painkillers such as Nurofen could only be purchased from pharmacies, while aspirin-based painkillers such as Aspro Clear and paracetamol-based analgesics such as Panadol could be bought from pharmacies, kiosks and supermarkets.

We contacted three parliamentarians, who happened to also be trained and licensed pharmacists, and they were unanimous in their opposition to the sale of any drugs, prescription or other, outside of pharmacies, citing the risks inherent in self-medication.

Digging deeper, we were advised by the health ministry’s pharmacy board – a board of government-appointed pharmacists – that, by law, only acetilsalicylic acid, or aspirin, may be sold outside of pharmacies, and that the paracetamol-based pills being sold at kiosks and supermarkets was against the law.

Panadol is no longer available in kiosks and supermarkets
Panadol is no longer available in kiosks and supermarkets

Since then, the health ministry – at the urging of the pharmacy board – approved “all actions necessary” to ensure compliance with the law. In a letter, the board asked the importers of Panadol to immediately withdraw all stock from kiosks and supermarkets, and thenceforth only supply pharmacies with the analgesic. The importers complied.

“They just quietly stopped bringing it,” said Andreas Theodoulou, head of the mini-markets’ union SYKADE.

“I don’t know why – it’s like they are trying to strangle us, just like they did with the Sunday law,” he complained, referring to the controversial law voted by the House on shop working hours.

“I mean, why are we allowed to sell Aspro Clear but not Panadol? What sense does that make?”
The pharmaceutical services confirmed the above, explaining that the law bans the sale of any medication to any person, except for pharmacists.

“The only exceptions to the law are listed in a table, attached to the law as an appendix, which includes a small number of products, among them acetylsalicylic acid (widely known as Aspirin),” the pharmaceutical services’ Ioannis Kkolos told the Sunday Mail.

This was quite easily verified as the truth – but not the whole truth. The same law that defines the small list of products that can be sold freely affords the pharmacy board and the health minister power to amend the list.

“Any person may sell to the public any of the drugs listed in the table, provided that the drugs are sold in their original casing, or casings placed, or replaced, and sealed by a pharmacist,” the law reads.

“The [health] minister may, following an opinion by the pharmacy board, […] amend, change, withdraw, or replace the aforementioned table.”

So it’s not a matter of legal restrictions – it is a matter of the government wanting to regulate the free availability of over-the-counter, non-prescription analgesics.

In our April report, the main argument against the liberalisation of the market for painkillers was the risk of over-medication. This time, the argument was strengthened with health and safety issues, the need for proper professional advice, and safe-storage standards.

“Indicatively, please be informed that the most common instances of overdose globally (whether intentional or not) happened with paracetamol-based preparations, and this is believed to be owed to its widespread availability,” Kkolos argued.

The argument remains specious. The absurdity of attempting to prevent intentional non-prescription drug overdose through limiting delivery channels is self-evident – the simplest way around it would be for one to just visit numerous pharmacies and buy one or two packs from each. And it seems highly unlikely that anyone would unintentionally poison themselves unless they were in severe pain, in which case any rational person would visit a doctor, not take another handful of painkillers.

On the other hand, the downside remains glaring. First, regulating the delivery channels for most non-prescription drugs limits consumers’ choices and adds to the hassle of having to find a pharmacy each time you need a little pain relief. There is also the issue of the middle-of-the-night catch-22: you find yourself in pain sometime after 11 pm and need non-prescription painkillers, but ‘overnight’ pharmacies will not serve customers after 11 pm unless they produce a prescription.

One would think that the restriction of choice and consumers’ rights might get consumer rights advocates fired up. The Sunday Mail contacted Frini Michael, head of the Consumers’ Association of Cyprus, to ask whether the body plans to take any action.

“I was not aware of all this,” Michael said.

“We have not received any complaints from consumers yet – if we do, we will study them and issue a response.”

It’s hard to see what might drive a consumer-rights advocacy group to ignore such a blatant violation of the right to free choice, unless consumer protection is, for some reason or other, given a backseat.

As with most professions, pharmacists’ business depends on information asymmetry – a situation during a transaction where one party has more information than the other – so it makes sense that they would try to play up the value of “professional advice” in dispensing any medication.

But there is a reason some drugs do not require a prescription from a doctor: it’s because they’ve been “generally recognised as safe and effective” under normal conditions. And arguing that people can’t be trusted to stick to dosage instructions, and thus only a trained pharmacist can give them regular-strength paracetamol, is grossly offensive.

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