Morning After Pill Availability

http://www.cbc.ca/health/story/2008/05/16/morning-afterpill.html

Pharmacists unhappy about new morning-after-pill availability
Last Updated: Friday, May 16, 2008 | 12:20 PM ET
CBC News

The emergency contraceptive drug known as Plan B will likely be coming out from behind the pharmacy counter, a move the Canadian Association of Pharmacists is not happy about.

The National Association of Pharmacy Regulatory Authorities accepted a recommendation this week to change the way the drug is sold, allowing it to be freely available on drugstore shelves instead of behind the pharmacy counter.

Currently, women who want to buy the drug have to ask pharmacy staff, a condition critics have contended may discourage some women from using it to prevent unwanted pregnancies.

The proposed change would see Plan B stocked on shelves near the dispensary, so purchasers could easily ask for advice on its use if they need it.

The national body advises provincial and territorial pharmacy regulatory authorities, each of which will have final say over the matter in their own jurisdiction.

The Canadian Association of Pharmacists (CPhA) does not support the proposed changes.

“Health Canada’s decision in 2005 to take emergency contraception off prescription status [but keep it behind the counter] was based on the need to have a trained health professional provide advice on the appropriate use of ECP,” said Janet Cooper, CPhA’s Senior Director of Professional Affairs, in a news release Friday.

"What will be lost is the opportunity for a pharmacist to use consultation on emergency contraception as a bridge to a referral to other health care providers, when needed, as well as providing important education regarding contraception and reproductive health.”

She says many women don't actually need to take the pill, which can be used within three days of unprotected sex to prevent pregnancy. And once the pill is easily accessible on pharmacy shelves, they'll be losing out on key information about the product, its correct usage and contraception information that pharmacists currently provide.

She says previous studies have shown that many women have misconceptions about Plan B, also known as levonorgestrel, and are confused about birth control generally.

In taking the decision, Canada, where the drug is sold by Montreal-based Paladin Labs Inc. Research, becomes the fifth country to agree to allow Plan B to be sold as an over-the-counter product. Other countries where the drug is sold this way are Norway, the Netherlands, Sweden and India.

"CPhA is also disappointed by the lack of an open and transparent consultation with health professionals on this issue," said Cooper. "We believe that such decisions should be both evidence-based and socially responsible."

It could be some time before the result of the decision is seen on drugstore shelves, even if provinces and territories accept the recommended change. Where some can almost automatically accept a decision of the national body and incorporate it into their own provincial drug schedules, others may have to go through more regulatory steps to make the change.

If you have ever tried to obtain Plan B, an over-the-counter emergency contraceptive, from a pharmacist in Quebec, you can (or maybe are, but I've not been to every pharmacy in the province) be required to have a consultation with the pharmacist. It's a hassle, it's a long wait to listen to things you probably already know, but it's a small price to pay for being able to control your own reproductive system, even after you've had an "oops." What you may not know about this consultation is that it actually does have a high price to be paid, and it's paid by the medicare system to the pharmacist. Its sale can be also recorded in order to catch those who are supposedly abusing or unnecessarily taking the medication.

This system disengages women in vulnerable situations from access to reproductive power: if they are for any number of reasons not covered by medicare (e.g. if they are newly arrived in the country, if they have no fixed address) they will have to pay for the medication, and will also have to pay out of pocket for the consultation to receive the medication.

It is essential that women have as much access to as many options for their reproductive health as society can legitimately provide. Who should we lobby?