Getting it right on pharmacists and the morning-after pill

Although Arboleda does a brilliant job covering the emotional turmoil of buying (or worse, being denied) Plan B, she makes several factual errors regarding the legalities and regulations of dispensing Plan B. I understand Arboleda’s anger at her situation, but this is no excuse for spreading misinformation on such a sensitive topic.

Arboleda has taken her information regarding the regulations for dispensing Plan B from the Canada’s National Association of Pharmacy Regulatory Authorities (NAPRA), and, it appears, the Plan B website itself. NAPRA’s name might be a little misleading. It was formed “by Canada’s pharmacy regulatory bodies, to enable members to take a national approach in addressing common issues.” It is an advising board, not a national authoritative regulating body. The regulating bodies for pharmacists are the provincial colleges of pharmacists, as health care falls under provincial jurisdiction. It is therefore the right of the provinces to determine how Plan B is to be dispensed there. Most follow the recommendations of NAPRA, but they are not obliged to do so.

As the Plan B website makes clear, pharmacies in Saskatchewan keep Plan B behind the counter, and Quebec requires a pharmacist’s prescription to dispense it. This is not because, as Arboleda claims, pharmacists “decided that [their] own moral compass should somehow supersede [their] legal and professional duty as a pharmacist”. It is provincial regulation, decided by a diverse board of elected officials. B.C. regulations have changed from Plan B being dispensed under a doctor’s prescription to pharmacist’s prescription, to being a behind-the-counter-drug to an over-the-counter drug since Plan B became available here.

The changes in regulations for Plan B have happened quickly in B.C., and it is possible that the relief pharmacist who saw Arboleda did not regularly dispense Plan B (most hospital pharmacists do not, for example) and was not aware of these changes. This, however, is no excuse for her behaviour as it is her job to know such regulations. Regardless of the pharmacist’s responsibilities, all potential Plan B users should be aware of the requirements for dispensing in their home jurisdiction, as these are highly variable and can lead to a great deal of confusion and stress for users if they are unaware of them or take their information from other jurisdictions.

A pharmacist’s prescription (which can only be obtained by answering questions on the “questionnaire” that Arboleda herself took) was previously required in B.C., and the forms are still available in pharmacies here as a means of guiding the conversation should the patient express doubts about Plan B’s use. (An example of such a form can be found here.) Given the nature of Plan B, some of the questions are highly personal, and may include, in addition to those found on the example form, questions about assault and incest (for which the pharmacist can give a referral to appropriate services). The standard questions, like when the sexual incident for which you are seeking Plan B occurred and whether you have had unprotected intercourse since your last period other than the incident for which you are seeking Plan B, are necessary to determine whether the pills will be effective for you. While this questionnaire is not required in B.C., pharmacists may still opt to conduct a formal interview with patients to ensure that Plan B will be effective for them, and that they know how to safely use it. It should be noted that drugs dispensed under a pharmacist’s prescription will be subject to a dispensing fee of around $9 to $12. Having it dispensed this way may allow the user to claim it under her health insurance plan. Your insurance provider can tell you whether or not they cover Plan B.

Floating around in the comments section of the first article (I myself made many of them) is the issue of “conscience rights” for pharmacists. Arboleda openly stated in her second article that if the pharmacist had a moral objection to dispensing Plan B to her, she had “every right to tell me that her religion or her experience made her wary of dispensation”. This is patently false, and young women should not expect or accept such statements from their pharmacists.

Under the College of Pharmacists of B.C.’s professional practice policies, pharmacists are “permitted to object to the provision of a certain pharmacy product or service if it appears to conflict with the pharmacist’s view of morality or religious beliefs”. However, a pharmacist’s moral or religious objections “should be conveyed to the pharmacy manager, not the prescriber or the patient” (emphasis added). These are the regulations which the London Drugs representative cited in the company’s response to Arboleda’s article. In the case that an alternative pharmacist is not available to dispense the products requested, regardless of moral objection, “the pharmacist has a duty to the patient to provide the service or product” without informing the patient of their objection. So, if you ever find yourself having to purchase Plan B or any other potentially objectionable materials (which might include things like “syringes and needles for drug addicts” at a pharmacy with only one pharmacist on staff, it is that pharmacist’s duty to provide the requested material for you, regardless of their objections and without comment. It is important to keep in mind, however, that, when more than one pharmacist is available, it is also the right of a pharmacist with moral objections to not personally provide those services to you. The balance of rights between patient and pharmacist, as the College of Pharmacists of B.C. says, is a compromise.

Purchasing Plan B can be an embarrassing and nerve-wracking experience. I am personally aware of this, as I have both purchased it myself and worked with pharmacists who dispense it. The regulations regarding how to purchase it can change rapidly in any given place and vary greatly between provinces and countries. Because of the different regulations, the information found online in forums and in the comments sections of articles like Arboleda’s can be confusing and often tells a very different story from what is legal and required in your location. It is important for woman to stay abreast of local regulations through official websites, such as Plan B’s. By keeping ourselves informed, we can better handle the stressful situation of requiring emergency contraception should the need arise.

Kyla Turner is a master’s student at the University of Toronto. She completed her BA in English at Simon Fraser University in 2010.