Bulgaria responds to unproven TikTok trend with tighter medicines rules

Sofia: Bulgaria’s health ministry plans to limit children’s access to medicines, citing an unproven TikTok trend allegedly causing paracetamol poisonings. The unverified trend also prompted other EU agencies to act.

Bulgaria’s Ministry of Health has announced plans to restrict the sale of medicines through vending machines, citing safety concerns. It follows alleged reports of students influenced by the ‘paracetamol challenge’, a ‘viral’ TikTok trend – but there’s no evidence of a trend.

Bulgarian authorities said, “The main reason behind the regulatory changes in pharmaceutical vending is the recent misuse of over-the-counter medicines by minors. Though these drugs do not require a prescription, excessive consumption poses a direct threat to life and health.”

“The TikTok trend has led young people to compete over who can take the most paracetamol, causing dangerous intoxications,” they stated.

Several serious cases of paracetamol poisoning have been reported in Bulgaria. But TikTok told Euractiv that they have investigated the matter and found no evidence of a trend.

Euractiv and other news agencies were also unable to verify any paracetamol challenge, though there are sporadic instances of paracetamol overdose across Europe.

When asked by Euractiv to verify the source of the TikTok trend, the Bulgarian Health Ministry said that the warning about the TikTok challenge came in February from “authorities in a number of European countries, including Germany, Switzerland and Belgium.” However, the ministry did not provide a specific link to such a challenge.

In January, the Belgian Poison Control Centre issued a warning about paracetamol overdose, and the ‘paracetamol challenge’. As in the Bulgarian case, no substantive evidence of a trend was verified by Euractiv or other news agencies.

A spokesperson for the Bulgarian ministry said: “These countries warned about a new dangerous trend on social networks, known as the ‘Paracetamol Challenge’ – a challenge with the popular painkiller. According to the information, on the social network TikTok users compete to see who will drink the most paracetamol and film themselves swallowing tablets of the drug.”

“Almost at the same time, the life of a 13-year-old girl, who was intoxicated after drinking an unknown amount of paracetamol tablets, was saved at the Pazardzhik Hospital (in Bulgaria). The child was hospitalized and later discharged in good health.”

The hospital in Pazardzhik also issued a warning after the girl’s case.

The ministry claims that because of this, a warning has been issued that the use of medicinal products, including those sold without a prescription, should be carried out only for certain indications and the presence of symptoms.

“Then we drew attention to a new dangerous challenge on the social network TikTok, which is spreading among young people in Western countries, without giving further details, so as not to give additional publicity to the dangerous trend,” the Ministry claimed.

Euractiv was not able to verify any related trend in Europe.

The health ministry said that in May, it launched an initiative, ‘Health is not a game!’ – they said they did this because of “another dangerous challenge” on social networks, in which children compete to hold their breath or otherwise block the access of oxygen to the body.

The spokesperson said children in the Bulgarian cities of Sofia, Burgas, and Stara Zagora were hospitalised in critical condition after overdosing on paracetamol purchased from vending machines.

The new rules will reduce the range of medications available in vending machines, and certain products will only be sold in the smallest possible package sizes. Under current regulations, vending machines are allowed only on the premises of licensed pharmacies and can be used only after regular working hours.

Paracetamol overdose can lead to severe damage to the liver, kidneys, and central nervous system, and in extreme cases, can be fatal.

Among the proposed restrictions are limits on the availability of painkillers, fever reducers, antacids, digestive aids, laxatives, anti-diarrheal medicines, antihistamines, antiseptics, disinfectants, and anti-inflammatory drugs.

Almost all combination medicines, except three products used to treat heartburn and ulcers with a high safety profile, will be banned from sale via vending machines.

Popular medications, such as aspirin and paracetamol-based combinations, will no longer be accessible through vending machines. Paracetamol will now be sold only in packages of up to 12 tablets (500 mg each), and ibuprofen will be limited to 10 tablets (200 mg each). Currently, both are available in packs of more than 20 tablets.

The painkiller and anti-inflammatory ketoprofen has been removed from the list of approved vending machine medicines, along with pitofenone, a popular anti-spasmodic.

“The goal of these changes is to reduce the risks of overdose, adverse drug reactions, and the misuse of medications with addictive potential,” the Ministry of Health said.

The initiative for stricter control was proposed by the Bulgarian Pharmaceutical Union.

“Only medicines that are truly safe for self-use in small doses will remain in vending machines,” said Dimitar Marinov, President of the Union, in comments to Euractiv.

“Anyone determined to do something reckless will always find a way. Just because someone might hang themselves with a rope doesn’t mean we should ban ropes. But we can try to prevent accidental harm and warn children,” Marinov added.

Machines will now carry clear warnings that medications are intended for use no longer than three days, and users should consult a doctor if symptoms persist.

While Marinov expressed hope that the paracetamol challenge trend is over, he emphasised that safe access to medicines must be guaranteed.

The issue may influence ongoing discussions in the Bulgarian Parliament about expanding access to drugs, including prescription medicines, in smaller towns and villages, where pharmacy services are often unavailable due to a lack of financial incentives.

The Pharmaceutical Union argues that expanding vending machine sales poses serious risks and that the state should instead subsidise new pharmacies to improve healthcare access in rural areas.