For years, Estonia has followed the principle that all medicines, whether prescription drugs or over-the-counter ibuprofen, belong exclusively in pharmacies. In practice, this means that access to non-prescription medication depends entirely on the location and opening hours of a pharmacy. In larger cities, options are available and the capital has round-the-clock pharmacies, but in smaller towns and rural areas, it often means driving to another settlement or waiting until the next business day.

For example, in Sadala, Jõgeva County, there is a local Coop store, but the nearest pharmacy is about ten kilometers away and only open for a few hours on weekdays. The next closest pharmacy is in Mustvee, nearly 20 kilometers away, and it too operates on a limited schedule.

If the state plans to allow the home delivery of over-the-counter medications via courier, it is effectively admitting that the current system does not meet people's needs. The problem is not the danger of buying medication without speaking to a pharmacist, but rather the lack of access.

An over-the-counter (OTC) medication is neither a luxury item nor an impulse purchase. Headaches, fever or sore throats don't ask for a convenient time or place. When the nearest pharmacy is tens of kilometers away, theoretical accessibility becomes practical inaccessibility.

In smaller towns and settlements, the role of the local store has changed over time. Often, it's no longer just a place to shop but a hub where people go for a wide range of services. Parcel lockers have been installed near stores because the postal service has decided it's no longer reasonable to maintain a separate service point.

You can pick up your passport or ID card from the store because the nearest police service point is far away. Stores offer banking services and provide access to cash because banks have closed their branches and even ATMs. Community bulletin boards with information about local services and events are found in shops. For many people, especially the elderly, the store is a daily point of contact — a place to get food, information and basic services.

In this context, a very practical question arises: why should someone have to go elsewhere — sometimes even to another town — just to buy an over-the-counter medicine? If they're already coming to the store for bread, cash or a parcel, it makes little sense to force them to search for a pharmacy just to get a basic pain reliever or fever reducer, especially when such a pharmacy often doesn't exist nearby.

The real effect of the restriction

It is often claimed that purchasing over-the-counter medication must always be accompanied by a pharmacist's consultation. In principle, that sounds reasonable, but in practice, it simply isn't the case. People already order non-prescription drugs from pharmacy websites: open the site, add ibuprofen to the cart, pay and wait for the delivery. No interaction, no questions, no mandatory advice.

The same applies if the state allows home delivery via courier services. There's no automatic personal consultation there either. So the argument that "buying from a store eliminates the consultation" doesn't hold water because consultation isn't mandatory now. The real issue is whether advice is available if needed and whether the information provided with the medication is clear and understandable. Stores are also prepared to offer pharmacist or assistant pharmacist consultations via video directly from the sales floor.

The restriction that keeps over-the-counter drugs exclusively in pharmacies doesn't inherently increase safety. What it does is limit choice and access. When sales locations are geographically concentrated, the consumer becomes dependent on a single channel.

This isn't about unregulated sales, but clearly defined, low-risk products whose use is widespread and which in the future could be ordered through a courier service app. How is delivery by courier, a paid service, somehow safer than picking it up yourself from the nearest grocery store?

Price not a secondary issue

In addition to accessibility, there's another issue that shouldn't be treated as secondary: price. When over-the-counter medications are sold through a very narrow channel — pharmacies — price competition is limited. The Competition Authority has already recommended allowing OTC drug sales in retail chains to bring prices down for consumers. Pharmacies enjoy healthy profit margins on OTC products and low competition doesn't compel them to lower prices.

If we allow the sale of over-the-counter medications in retail stores and gas stations, competition will emerge not only between points of sale but also within supply chains. Competition brings downward pressure on prices — not as a slogan, but as a functioning economic mechanism. Sweden's experience with nicotine patches shows that allowing OTC medications in regular stores lowered consumer prices by about 15 percent. This didn't happen because the medications changed, but because the market became more open.

Price matters especially for people with limited purchasing power. In rural areas, where incomes are often lower and options fewer, a price drop combined with better access in the same shopping trip is a tangible benefit. If we're talking about equal access, we can't ignore the issue of cost.

How to do it sensibly?

The solution doesn't require radical steps. First, a nationally approved list of over-the-counter medications permitted for sale outside pharmacies must be agreed upon. This selection should be made by competent authorities, based on safety, storage conditions and international best practices.

Second, clear and enforceable rules must be established: smaller package sizes, quantity limits and sales practices that prohibit aggressive advertising. If access to consultation is a priority, it can be integrated into the solution — for example, by offering the option to consult a pharmacist via video or phone from the grocery store before making a purchase. These measures have proven effective elsewhere in Europe and mitigate risks without sacrificing accessibility.

Third, implementation must be transparent. Stores would be registered as authorized sales locations, requirements for storage and product information must be clearly defined and oversight should be proportionate. The retail sector is already familiar with such frameworks — this isn't a matter of capability, but of political will.

If the state is looking for ways to improve access to over-the-counter medications, half-measures won't be enough. Home delivery by courier may be one option, but it shouldn't be the only one. Allowing a limited range of OTC medications to be sold in retail stores will improve access, increase competition and help bring prices down.

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