Expediency, patient volume, computer system problems, education, tradition and lack of information.
These are factors that help doctors in Finland prescribe exceptionally high addictive pain medication.
Most common are combinations of paracetamol and codeine, used for example after accidents and operations, or in pain relief for cancer patients. One of the best known commercial names is Panacod.
Earlier this year, the National Pension Service sent a letter to more than 4,500 physicians who had prescribed the drug combination in large quantities to new patients.
Problem Slowly Falling
Since a peak in 2009, statistics from the Pharmaceutical Safety and Development Centre show that the use of addictive painkillers has been falling slightly ever year. But still, drugs like Panacod, which is refundable under the KELA scheme, are being used by some 270,000 people each year. Although use is declining, Finland continues to use these types of drugs more than other neighbouring countries.
Professor Hannu Kokki at the University of East Finland suspects that some of the patients got the prescription “a little for easy reasons”, because t is not the type of medicine that can be given for just any condition.
“If the doctors themselves were to think about what the drug combination contains, what the effects are, and what constituents they have, I think we would finally get rid of the excessive use of paracetamol and codeine drugs” says the Professor.
Experts say the combination of paracetamol and codeine are required, and are effective, when properly prescribed and used. But one must be careful when prescribing them. They are usually intended for short term use only.
Electronic prescriptions and the National Health Archives Kanta, allow doctors to see all prescriptions written to a patient. The purpose of the system and checks, is to prevent the patient from asking several doctors for the same prescription. At worst, a patient could potentially go to dozens of different doctors.
But even the best systems are only useful if they work.
“It’s annoying that it happens quite often that the system crashes and you do not see anything at all,” says Hannu Halila, Vice Operations Manager at the Finnish Medical Association FMA.
Chief physician Riitta Pöllänen at the Valvira supervisory authority is aware of the interruptions and that the system’s downtime interferes with practical work.
“Maybe it is also that if you’re in a hurry, you cannot look up the information, or have to trust what the patient says” she adds.
The combination of codeine and paracetamol is traditionally prescribed more often in Finland than in other countries, too.
Chief physician Jari Välimäki at the National Pension Institute says these drugs are already suggested to young doctors during training, even if they might choose something different.
Professor Kokki points out that the strong marketing machine of the pharmaceutical industry also increased the use of the drug combo.
The combination of paracetamol and codeine may develop into an addiction, in the worst cases, with only a tablet. The painkiller function of the codeine works to transform it into morphine in the body. In some people, about one in fifteen, the morphine is transformed exceptionally efficiently.
For those people, the risk of addiction is high. The medicine not only removes the pain but also provides a euphoric feeling.
“It can lead to addiction if the medication continues for a long time,” says general physician Margareeta Häkkinen at the A-Clinic Foundation’s hospital.
The Finnish Medical Association’s Halila admits that not all doctors may really understand the risks of long-term use of the drug combination.