From Dysfonction érectile - Tobacco Info No. 7 - October 2011
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“Take two cigarettes and call me in the morning”

Iceland considers prescription-only cigarettes

Imagine walking into a drug store, making your way to the pharmacist’s counter and handing him or her a prescription written by your physician... for cigarettes.

A politician in Iceland is suggesting just that by proposing a private member’s bill banning the sale of cigarettes, with the exception of a physician’s prescription.

Iceland’s former Health Minister Siv Fridleifsdottir, who sponsored the bill, worked with the Icelandic Medical Association as well as a coalition of tobacco control groups to come up with the radical initiative. It is part of a broader ten-year plan that aims to ban smoking in all public places, including sidewalks, parks and in cars transporting children. In addition, Iceland would like to follow Australia’s lead by legislating plain packaged cigarettes.

Under the proposed law, doctors will be asked to encourage people to quit using treatments and education programs. It is only if these methods do not work that they may then prescribe cigarettes.  Only pharmacies would be allowed to provide cigarettes to those aged 20 and over, with a valid medical certificate.

“The aim is to protect children and youngsters and stop them from smoking,” Fridleifsdottir told the United Kingdom’s The Guardian. The proposal would initially result in an increase in cigarette prices by “10% per year, in line with World Health Organization proposals. Evidence shows that a 10% increase results in a 4 to 8% reduction in consumption.”

However, according to Thorarinn Gudnason, President of the Icelandic Society of Cardiology and one of the experts who helped draw up the proposal, prescription-only cigarettes will actually end up being cheaper toward the conclusion of the decade-long initiative. Gudnason noted that smokers who are given prescriptions will be diagnosed as addicts and should not be taxed by the government.

The tobacco proposal also includes classifying nicotine as an addictive substance and licensing cigarettes like a medicine, which would mean they would have to go through the same rigorous trials as any other drug. “I doubt that cigarettes would ever [have been introduced onto] the market now that we know their side effects – lung cancer, heart attacks and chronic obstructive pulmonary disease, among others,” said Gudnason.

The plan will be debated in the fall in Althing, Iceland’s Parliament located in its capital Reykjavik, when politicians return from recess. A spokeswoman from the Icelandic Ministry of Welfare deemed the proposal a very serious one, generated by a very serious politician, but that it had a limited chance of success.

The Nordic country has successfully halved smoking rates over the past 20 years with only 15% of the population regularly lighting up. Furthermore, as an isolated island, the country with a population of over 300,000 stands a better chance of success than most other nations in applying such exigent measures because, among other things, with no neighbouring countries and strict customs controls at air and sea ports, smuggling will be difficult.

Canadian perspective

The sale of tobacco products in pharmacies is banned in all but three provinces and territories in Canada. BC, Manitoba and the Yukon are the only jurisdictions that have not passed legislation of this kind, and Ontario was the first to do so in 1994 with the help of the Non-Smokers’ Rights Association and its executive director Garfield Mahood.

And although the idea in Iceland brings the possibility of intervention at the point of sale, with advice from the people selling cigarettes on how to quit and the harms of smoking, Mahood believes that there are just too many questions about prescribing cigarettes than answers. “Think of the impact on pharmacists. They are health professionals that would have the responsibility of dispensing a product that kills half of its users. Will it cut consumption? I’ve not seen research that really supports this kind of idea. How would the physician’s responsibility be defined and what’s the social impact if someone decides to skip the doctor and go straight for contraband.”

However, he did support the fact that the Icelandic proposal takes the retailing of tobacco seriously, recognizing that it shouldn’t be sold like other consumer goods.

“Bottom line, it would be more cost effective to eliminate retail outlets and put it into a controlled environment, removing recidivism,” said the NSRA leader. “Many times people start smoking again after quitting because cigarettes are readily available after a stressful day at work or an argument with their significant other, but having it in controlled outlets eliminates that impulse purchase. They’d have to go there specifically for cigarettes.”

The Canadian Pharmacists Association said, in an email, that they don’t have an official position on the idea of prescription cigarettes, but back in 1996, the Quebec Order of Pharmacists laughed off a suggestion by a group of pharmacy chains including Jean Coutu, Uniprix and Pharmaprix that pharmacies become the exclusive vendors of tobacco products in the province. The idea, proposed in response to legislative measures being taken to ban the sale of smokes in pharmacies in Quebec,  would place pharmacists in a “chaotic situation, contradictory to Canadian and international views of smoking and pharmacists’ responsibilities,” said the then president of the Order, Janine Matte. 

By Joe Strizzi