Doctors: Tranquillizers and sleeping pills too easily available in Estonia

Pills. Photo is illustrative.
Pills. Photo is illustrative. Source: Priit Mürk/ERR

The Estonian Psychiatric Association, the State Agency of Medicines (Ravimiamet) and the Estonian Society of Family Physicians (Eesti perearstide selts) all say that tranquillizers and sleeping pills are too easily available in Estonia. In their view, the legislation regulating prescriptions needs to be updated with, for instance, a time limit added regarding the frequency with which prescriptions can be obtained.

The use of tranquillizers such as diazepam and Xanax, as well as sleep-inducing drugs zolpidem and zopiclone, is widespread in Estonia, especially among older people. Around 10 percent of people (in Estonia buy at least one prescription for sedatives or sleeping pills a year, Ott Laius, deputy director general of the Estonian State Agency of Medicines (Ravimiamet), told ERR.

"Although these medicines should ideally be used over a short period, we see that there are quite a few long-term users in Estonia," Laius said.

In an appeal to Minister of Health Riina Sikkut (SDE), the Estonian Psychiatric Association also points out that studies show that, in Estonia, there are over 7,000 long-term and high-dose users of tranquillizers and sleeping pills. However, the long-term use of these types of drugs can impair judgment and reaction speed. They may also have a negative impact on the attention span of users meaning that, for example, drivers, who take them, could be more at risk of traffic accidents.

According to Mari Amos, adviser on pharmaceutical policy at the Ministry of Social Affairs, the state is also aiming to significantly reduce the long-term and excessive use of pharmaceuticals. One of the ways to reduce drug dependence is to raise awareness," she said.

"Some GPs have already begun working with their patients, who have been using larger quantities of these sedatives and sleeping pills for long periods of time, in order to start weaning them off them and find other approaches to alleviating their (medical) complaints. This is also to do with the social care system, counselling and psychological support," Amos explained.

At the same time, they believe that the rules concerning access to these medicines should also be reviewed. At present, the only limit on tranquilizers and sleeping pills relates to the quantities, which can be prescribed - up to 60 tablets per prescription.

According to Laius, limits should be introduced regarding the frequency with which prescriptions for these kinds of medicines can be handed out.

"In future, there should be a maximum prescription quantity, which cannot be exceeded. We are still talking about quantities of this medicines, which are higher than the safe daily dosages. The vast majority of patients using these medicines today would not be affected by the changes. However, there are indeed some extreme examples, where patients are getting hundreds of prescriptions written (for them) each year."

According to Amos, an amendment to the social affairs ministry's regulation required in order to introduce these restrictions has been agreed, with the changes now being finalized.

"Indeed, one of the priorities for the Estonian Health Board (Terviseamet) this year is to monitor the prescribing of these substances with addictive potential more closely, and they are starting to do this now." Amos said.

Among other things, the regulation includes plans to ban paper prescriptions for sedatives and sleeping pills.

"Prescriptions for narcotic and psychotropic substances will become digital only in the future. This excludes veterinary prescriptions of course, as there are no digital prescriptions for those yet," said Laius.

"In practice, this will not lead to such a significant change, as there have been only four paper prescriptions made out for these substances since the beginning of this year, and thousands of digital prescriptions" he added.

However, according to Laius, one of the main benefits of abolishing paper prescriptions will be an increased ability to supervise the amount and frequency of prescriptions.

"We would be able to use our existing digital solutions to prohibit over-prescribing altogether."


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Editor: Michael Cole

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