Pain Medications in Sweden — Regulation, Use, and Challenges

Pain medications, known as analgetika in Sweden, are divided into several categories: over-the-counter (OTC) nonprescription drugs, prescription non-opioids, and prescription opioids. The Swedish regulatory system for pain medication is strict, aiming to ensure safe and effective treatment of pain while minimizing misuse, addiction, and adverse effects.

The Swedish Medical Products Agency (Läkemedelsverket) oversees the safety, approval, and marketing of medicines, including painkillers. The Swedish e-Health Agency (E-hälsomyndigheten) manages the national electronic prescription system, ensuring secure and traceable prescriptions. Almost all prescriptions in Sweden are issued electronically, allowing for precise monitoring and reducing the risk of fraud or misuse.

Prescription medications can only be dispensed by licensed pharmacies. However, some mild OTC painkillers, such as certain types of paracetamol or ibuprofen, can be purchased in grocery stores or petrol stations under age and quantity restrictions. Pain Medications in Sweden — Regulation, Use, and Challenges highlight the importance of proper control and responsible use, and pharmacists play an important role by advising patients on appropriate use.

Sweden also has a pharmaceutical cost-protection system, known as högkostnadsskydd. This scheme limits the total out-of-pocket cost for prescription medicines over a 12-month period. Once a patient has spent a certain threshold amount, further prescriptions are heavily subsidized or free.

Types of Pain Medications

The different types of pain medications are listed below.

1. Non-opioid OTC Analgesics Paracetamol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are the most common pain relievers used in Sweden. They are available for self-treatment of mild pain such as headaches, muscle aches, or fever. Although widely used, paracetamol misuse has become a public concern, as overdoses can cause liver damage. Swedish health authorities have debated restricting non-pharmacy sales due to increased cases of overdose.
2. Prescription Non-opioid Analgesics Stronger NSAIDs, combination drugs, topical painkillers, and certain medications used for nerve pain require a prescription. These are typically used when OTC options fail or when the underlying condition requires stronger management.
3. Opioid Painkillers Opioids are prescribed for acute severe pain, such as after surgery or in cancer treatment, and occasionally for chronic pain. Sweden maintains a cautious stance toward opioids due to the risks of dependency, tolerance, and overdose. Opioid prescriptions are closely monitored and generally recommended only for short-term or carefully supervised use.

Patterns of Use and Public Health Concerns

Research shows that around one-third of patients with chronic non-cancer pain in Sweden have received at least one opioid prescription in a year, and about one-fifth remain on long-term opioid therapy. Prolonged use after surgery is also a concern, with about 7% of post-operative patients developing continued opioid use. Rising numbers of opioid-related poisonings and deaths have prompted national discussions about prescribing practices and addiction prevention.

The Swedish National Board of Health and Welfare maintains a comprehensive Prescribed Drug Register, which records all dispensed prescriptions. This data allows researchers and policymakers to track trends, identify risk factors, and improve prescription safety.

Challenges and Policy Debates

Sweden faces the complex challenge of ensuring that people with severe or chronic pain receive adequate treatment while preventing misuse and addiction. There is ongoing debate about the role of long-term opioid therapy for chronic non-cancer pain, as evidence shows limited long-term benefit and significant risks.

Public health officials also monitor OTC misuse, especially paracetamol overdoses, which have led to increased calls to poison control centers. Another issue is the continuation of opioid prescriptions after hospital discharge or intensive care, sometimes without regular follow-up or reassessment.

Best Practices and Responses

Swedish authorities encourage healthcare providers to carefully weigh benefits and risks before prescribing opioids, to use the lowest effective doses, and to limit treatment duration. Patients are assessed for mental health conditions or substance abuse risks before starting opioid therapy. Non-drug alternatives such as physical therapy, psychological counseling, and rehabilitation programs are increasingly promoted as part of integrated pain management.

Regular prescription monitoring and national data systems help identify patterns of overprescribing or misuse. Public education campaigns also raise awareness about the dangers of excessive painkiller use.

Conclusion

Pain medications are vital to improving quality of life for those suffering from acute and chronic pain. Sweden’s comprehensive regulatory and healthcare framework ensures that these medicines are used safely and effectively. Despite challenges related to opioid dependency and OTC misuse, Sweden continues to refine its policies, focusing on balanced access, patient safety, and evidence-based pain management. The country’s approach reflects an ongoing commitment to reducing harm while maintaining compassionate care for people in pain.