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Finnish pharmacies list misused over-the-counter medicines

Nine over-the-counter medicines are regularly misused in Finland, so much so that some pharmacists have taken pains to keep some of them out of sight in their shops.

Lääkkepurkkeja ja laatikoita apteekin hyllyllä
Image: Heikki Rönty / Yle

The Association of Finnish Pharmacies surveyed over 700 pharmacists from all parts of Finland to determine which non-prescription medicines they felt were commonly misused and abused by customers. Up to half of the respondents report customers buying over-the-counter (OTC) medicines for the wrong purposes on a weekly basis. One in four witnesses misuse at least once a day.

The advocacy association surmised that some customers are just too laid back about self-medication. The majority, 77 percent, were aware that non-prescription medicines had adverse effects, but were still less careful about following the dosage directions than in the case of prescription medicines.

Pharmacists agree that OTC medicine wrongly chosen or misused may be harmful or even dangerous. That is why they recommend that customers should always ask a pharmacist for an assessment before buying them.

"Some pharmacists say they feel as if certain customers' misuse of the products will continue no matter what they say. Customers don't stop to think about the potency of the medicines in question," says the group's communications manager Elina Aaltonen.

The survey finds that some customer misuse products designed for short-term use by using them long-term or continually, while others use them as intoxicants. The following is a list of the nine most misused and abused non-prescription medicines in Finland.

1. Cough medicine

Close to 70 percent of pharmacy workers in Finland see customers misusing cough medicines. Some end users even use the products as intoxicants, as many of the products contain codeine.

"If a pharmacist suspects drug abuse, the cough medicines are transferred to a place where they are out of reach to the customers and sold on request only. We assess sales of the products to problem customers on a case-by-case basis." says Aaltonen.

Cough medicines are also commonly misused in the treatment of coughs.

"A cough brought on by an influenza virus shouldn't be treated with a mucus relief medicine, as the cough in question is usually triggered by irritation. In addition, research has shown that the efficacy of mucus relief medicines in general is quite negligible," Aaltonen says.

2. Nasal decongestants

Misuse of nasal sprays and drops to clear up a stuffy nose is almost as widespread as cough medicine misuse. The pseudoephedrine often contained in nasal decongestants can be used as an intoxicant, but the medicine is addicting in another way, too. Long-term use could mean that the nose eventually stays congested without it. Important mucus membranes are also destroyed.

3. Painkillers

Many Finnish residents are guilty of using anti-inflammatory drugs or paracetamol for too long or at doses that are too high. The study shows that many customers also chose the wrong painkiller to treat their ailment.

"People are really carefree about using painkillers because they are so widely used. Customers don't want to heed advice from the pharmacists if they are used to using a certain product," says Aaltonen.

The Finnish Medicines Agency Fimea has earlier estimated that hundreds of people in Finland die each year from painkiller abuse. For example, the mistaken notion that painkillers can be used to treat stomach pain caused one-third of bleeding and deaths from ulcer complications in 2013. On the other hand, paracetamol doesn't harm the stomach, but long-term use can do damage to the liver.

"Use among people with heart diseases increases their risk of cardiac arrest, and new research shows that long-term use of painkillers reduces male fertility," Aaltonen says. 

4. Drinks for treating flu symptoms

Finnish pharmacies sell powders that can be dissolved in hot water for treating flu symptoms. People forget that the oral solutions also contain ibuprofen, for example, and drink them in tandem with other medicines. This means the recommended dosage is often exceeded and the risk of harmful effects grows.

Pharmacists say customers often drink the medicine just to be soothed by the warm drink, but advise people without a fever or pain to avoid using it. Professionals have also noted that many Finns believe that drinking the oral solutions will somehow prevent a cold or the flu.

"Influenza is brought on by a virus, which cannot be killed or blocked. The only choice is to try and alleviate the symptoms," says Aaltonen.

5. Laxatives

Two non-prescription drugs are available in Finland for self-care. Pharmacists have noted that many people that suffer from chronic constipation use medicines designed to treat acute cases instead because they are easier to use. Unfortunately, misuse of laxatives in this way can eventually cause the bowels to become more relaxed, worsening the problem.

6. Cortisone lotions

Medicinal lotions such as cortisone are intended for the treatment of sun-burnt skin and mosquito bites. Many Finns use it regularly "just to be sure", however, as they believe it can help with a variety of skin issues. Long-term use of cortisone thins the skin and can cause permanent damage.

7. Antibiotic ointments

Lotions containing antibiotics are misused in the same way.

"At worst, they can cause an allergic reaction. In general, the use of all unnecessary antibiotics should be avoided, in skin creams too. Lotion cannot heal a wound that is not infected, for example," says Aaltonen.

8. Motion sickness medication

OTC medicines used to treat nausea and vomiting caused by motion sickness are often abused because they contain drugs that affect the central nervous system. High doses are taken to induce intoxication in the same way that medicines with codeine are abused. Finnish pharmacies keep these non-prescription medicines behind the counter, available by request only, for this reason.

The Finnish Medicines Agency Fimea maintains that abuse of these kinds of OTC medicines in Finland is not enough to warrant them being reclassified as prescription drugs.

9. Aspirin

Acetylsalicylic acid, better known as aspirin, is a familiar pain reliever and fever reducer that is regularly used by some Finns in small amounts to prevent blood clotting. When taken in too-high doses or for too long a period, however, use of the medicine can trigger aspirin poisoning. Excess use can also cause bruising and thin the blood too much, increasing the risk of internal bleeding.

"A neighbour or acquaintance might have given someone the advice that it prevents strokes. People don't go to a doctor for an aspirin prescription because [the state benefits administrator] Kela doesn't reimburse them," says the pharmacy association's Aaltonen. 

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