Deregulation of Nicotine Replacement Therapy Products in Finland : Reasons for Pharmaceutical Policy Changes and Reflections on Smoking Cessation Practices

Nicotine Replacement Therapy (NRT) products, having been in the pharmaceutical market for over three decades and sold without prescription for a long period of time in many countries, are the most commonly used smoking cessation (SC) pharmacotherapy. This study explores the deregulation of NRT products from pharmacy-only distribution to general sales in Finland, which took place in 2006. The overall aim of this study was to assess the reasons for the NRT deregulation and its reflections on SC practices in Finland. NRT deregulation was explored from three perspectives: 1) NRT deregulation as a policy-making process; 2) community pharmacists as health care professionals providing guidance on NRT use; and 3) NRT users’ perceptions of NRT in SC. This multi-method study applied quantitative and qualitative methods. The study of NRT deregulation from the policy-making perspective was based on an inductive content analysis of all the publicly available documents and interviews of 12 Finnish Members of the Parliament (Study I). A nationwide representative survey of every second pharmacy owner and community pharmacist (n=2 291) was conducted a year after the deregulation in 2006-2007 (Studies II & III). The NRT users’ perspectives of the role of NRT in SC were explored by analysing postings in the national internet-based discussion forum (STUMPPI) supporting SC (Study IV). This study was based on a qualitative analysis of smokers’ and quitters’ postings (n=24 481) in five discussion areas during 2007-2012. The NRT deregulation was politically communicated as a safe and evidence-informed decision promoting public health by advancing SC in Finland. On the basis of the analysis of all the documents and interviews, the following five themes emerged: 1) how deregulation may influence on SC; 2) appropriate and safe use of NRT products taking into account the characteristics of these products. The debate extended beyond NRT and SC to become 3) a debate of the principles of who is allowed to sell medicines and what is the importance of professional advice for treatment outcomes; 4) debate on how evidence-informed the decision was; and 5) the way the political process was carried out. Finally, the analysis revealed that two of the most important motives for the deregulation, poor NRT availability and NRT’s effectiveness in SC, were largely based on assumptions instead of actual scientific evidence. At the time of the pharmacy owners’ and community pharmacists’ survey in 2007, half of the respondents reported to be familiar with the Finnish SC Guideline. Guideline familiarity enhanced guideline implementation: in addition to counselling on NRT use, the pharmacists familiar with the SC guideline used other guideline-based SC methods more frequently compared with respondents unfamiliar with the Guideline. According to the survey respondents, (n=2 291), NRT deregulation had sizeably diminished the sales of NRT at pharmacies as well as the contacts between NRT customers and community pharmacists. In particular pharmacy owners’ motivation towards counselling NRT customers had decreased. However, community pharmacists still saw it as their duty to guide and support SC.