This summer I had the opportunity to visit Raeapteek, which is believed to be the oldest still-active pharmacy in Europe. Housed in its original buildng dating back to 1422 on the town square in Tallin, Estonia, Raeapteek offers its visitors an in-depth look into the past and the future of pharmacy in Estonia. Along with neighboring Latvia and Lithuania, Estonia gained its independence from the Soviet Union in 1991. Tallin, its capital and charming cobblestone town, is a popular cruise port destination in the Baltic.  

Today, people can walk up the steps of this unassuming white stucco building and enter a charming apothecary complete with pharmaceuticals displayed in glass cases as well as hidden in carefully labelled drawers in beautiful wooden cabinetry.  With crowds of tourists coming through, pharmacist Ulle Noodapera takes care of their travel needs and questions. One tourist asks for antibiotics, but without a prescription, Noodapera explains, they are not available.

Given the surge of medical marijuana in the United States, a chocolate bar (in the glass counter display case) containing 40% cannabis seed caught my eye. According to Noodapera, it is sold not for its psychoactive effects but rather for nutritional benefits. Unbeknownst to many, the seeds contain omega-3 fatty acids and are rich in B vitamins. For tourists, the best-selling products, however,  are a "remedy" wine called Klaret, which is made using a secret medieval recipe with 8 different spices and that contains 14% alcohol. Another big seller is a medieval prescription for marzipan, which contains 72% almonds and is believed to "cure" broken hearts.

Step beyond the current pharmacy and Raeapteek's history comes alive via documents and pharmacy artifacts housed in a museumlike setting. During its long history as a pharmacy, a special honor belongs to the Burchart family. Between 1582 and 1911, the pharmacy was owned by 10 generations of this Hungarian family. According to the tradition of the family, the oldest son was always named Johann and studied as a pharmacist. Their fame was so great that in 1725, Russian tsar Peter the Great called for Johann Burchart V to attend to him on his deathbed. However, the tsar died before the pharmacist could reach St. Petersburg.

In the museum, an archived pharmacy price list, circa 1695, includes 54 different types of water, 25 fats, 128 oils, 20 tusks, 49 ointments, 71 medical teas and more. Also included on the list are more nonconventional medicines including burnt bees, wolf guts, rabbit ears, earthworms in oil, rainbow trout, white bleached dogfish, and yes, mummy juice. These were obtained from the local drug traders who had contacts with overseas businssmen who provided such exotic products.  

In addition to the wild herbs havested by the local people, the pharmacy also had its own garden where it grew valerian, chicory, liverwort, honeysuckle, tobacco, chamomile, and more. It was from over 100 different herbs, blossoms, and roots that pharmacists made specific spiced syrups, hard spirits, tinctures,  essential salts, and salves, which local doctors ordered for their patients. Given the colder climate of Tallin, it is surprising these herbs and medicinal plants grew. While liquids were kept in glass or ceramic containers, dried herbs were stored in wooden coffins that contained no metal parts. One coffin is still on display.

Today, in the historical warehouse located in the basement of the pharmacy, workshops are organized for both school children and adults. One can mix together various infusions, make the pharmacy's famous marzipan, or take a workshop on medicinal plants.

What is in store for pharmacy in Estonia? While still holding onto its nearly 600-year-old legacy, the future of pharmacies will soon be changing. Today,  the availibility of pharmacy services are very good. 99% of Estonia's population is within a 15-minute drive of a pharmacy. Between 70% and 80% of the market is divided between 5 chains; 2 of them have about 50% to 60% of the market. One-third of current pharmacies are owned by pharmacists, mostly in rural areas.

However, big changes are coming as of April 1, 2020. At this time there will be a pharmacist-based system, which means the majority shares (>50%) of a pharmacy must be owned by pharmacists. Pharmacists will be able to own up to 4 pharmacies.  Vertical integration, when a company controls more than one stage of the supply chain, will also be prohibited in 2020. Wholesalers will no longer be able to own pharmacies, giving pharmacists more independence, fewer restrictions, and more protection of public health.