Morning-after pill may head over the counter

Thirty years ago, Caryn Duncan remembers, you couldn't buy condoms without first talking to a pharmacist. Ditto yeast-infection cream. That was ridiculous, she said. Now, just as outrageous, Duncan added, the morning-after pill is still stuck behind the counter, with a prying pharmacist sometimes blocking access to the drug.

"Women are smart enough to figure out when and how to take it," the Vancouver Women's Health Collective member told the Georgia Straight. "Why can't we just walk into a store and buy it?"

Buying morning-after pills alongside gossip mags and lip gloss inched closer to reality on January 20. After a meeting of its board, the College of Pharmacists of British Columbia (CPBC) quietly wrote a letter recommending to the B.C. government that Plan B, a morning-after pill used for emergency contraception, become an over-the-counter, nonprescription drug. That means any woman could walk into a pharmacy, verbally answer a couple of questions, pay her money, and take the pills.

The morning-after pill can be taken up to three days after unprotected sex. It's a high dose of estrogen, about four times the level of a normal birth-control pill. Depending on when during a woman's cycle it's taken, the pill may prevent ovulation, fertilization, or implantation of an egg.

By the Georgia Straight's deadline, the government had not yet considered the college's recommendations, which would bring B.C.'s treatment of Plan B in line with other provinces.

"This is a pipeline process; it wouldn't happen overnight," CPBC spokesperson James Nesbitt told the Straight. "But the wheels have been set in motion."

The changes will affect a vast number of women. In 2005, B.C. pharmacists prescribed 22,689 sets of Plan B pills to 18,819 women, according to B.C. Ministry of Health spokesperson Sarah Plank. That's one Plan B prescription for every 40 women between the ages of 15 and 45 last year, if you divide the number of prescriptions into Statistics Canada's population record of females in that age bracket in B.C.

The new regulations, if they're accepted, will have two immediate consequences. First, extended health plans and the low-income government insurance plan Pharmacare would probably stop picking up the tab, Nesbitt confirmed. That means women may be out-of-pocket about $60 per Plan B set. It also means the government could save up to $1.4 million per year by offloading those costs to the consumers. Second, the Ministry of Health and the provinces' doctors will no longer be able to keep track of the number of times a woman uses the drug because, as Nesbitt explained, purchases will no longer be recorded on Pharmanet.

Currently, pharmacists prescribe the pill directly to women after asking three questions: the date of her last period, the date she had unprotected sex, and if a contraception method failed, what that method was. The prescription is recorded on her Pharmanet file, according to Victoria's director of the Office of Information and Privacy Commissioner (OIPC), Mary Carlson.

The change would eliminate the third question and the recorded information.

Duncan said she welcomes the change but thinks it doesn't go far enough. She pointed out that without the pharmacist intervention and attendent fees, if Plan B were just available on the shelf the drug's cost would drop from about $60 to about $25 per dose. The new, nonprescription status of Plan B won't really hurt women's wallets, she argued, because most women don't have an extended health plan and are already paying the full cost.

"This is about controlling women's bodies and choices," she said. "Pharmacists are trying to preserve their role in the health-care system. They're overreaching their role."

The change wasn't initiated by pharmacists though; it was a January 6 letter from Victoria's OIPC to the college that got things started. Director Carlson told the Straight that the commissioner's job is to minimize government collection of individuals' information, and this looked like it stepped over the line.

"You can get it [Plan B] anonymously in every other province," she said. "We asked, 'Why would you collect this information? Why can't there just be a dialogue [between the client and the pharmacist]?'?"

In March 2005, Carlson pointed out, Ottawa opened the door for the provinces to offer Plan B as a nonprescription drug. Most provinces did so immediately. At the time, B.C. didn't change its legislation because local rules offered similar benefits. (In 2000, the B.C. Ministry of Health had already begun to offer Plan B through a pharmacist-the first province to do so.) It's still considered a prescription, though, and it is not anonymous. The nonprescription format offers better privacy, Carlson said, adding that the OIPC deals only with privacy issues, not ethical or safety issues.

But Cristina Alarcon, a pharmacist for 16 years, told the Straight that safety should be at the top of the decision makers' minds when changing access to Plan B. She said there's little information about the long-term consequences of morning-after pills, and especially their repeated use.

"I think this is a really bad idea [to provide the drug over-the- counter]," she said. "I can't sell hemorrhoid suppositories without a prescription, but this is much more harmful. It's a potent hormone."

Alarcon compared Plan B to the menopausal hormones doctors formerly prescribed to women. After years on the market, studies determined that the estrogen-progestin mix was linked to increased risks of stroke, breast cancer, and heart problems. Although the hormones in Plan B are different, Alarcon thinks it's worth more study before they are offered over-the-counter.

"I foresee women taking it as though it were nothing," she said. "This is giving the wrong message to the public, that this is as safe as baby Aspirin, which is also over-the-counter.íƒ ¢í¢”š ¬í‚ ¦If it's so easily available, why would women restrict themselves to using it just once?"

Apart from the health issues, Alarcon has other trouble with the drug. Eight years ago, she helped start B.C. Pharmacists for Conscience, a professional group that advocates for pharmacists to act within their own ethics. A life-long Catholic, Alarcon chooses to not distribute Plan B at all.

"I don't think it's good for society to have something as readily available to solve something so complex," she said. Plus, "if a woman has conceived, this will act to impede implantation. And I believe life begins when fertilization takes place."

Alarcon claimed that more and more young women come to see her, looking for natural methods to prevent pregnancy-ones that don't include ingesting hormones. Most doctors don't explain to their young patients the rhythm of their bodies or how their hormones work and when they are and are not fertile in a month, she said. Understanding those rhythms is the first step to girls and young women respecting their bodies, Alarcon noted.

"We treat our bodies as though our fertility is pathological, as though it's a disease. It's not."

Duncan, however, believes it's the pharmacist's role to dispense the drugs, not counsel the consumers. Asking a woman too many questions can be a barrier to access, she said, and in this case that can mean more abortions or unwanted pregnancies.

"This drug has a high success rate. It needs to be available to women when they need it, affordable, and women can figure out for themselves whether they need to take it or not."

Neither the CPBC nor the Office of the Information and Privacy Commissioner have received complaints about access to the drug or complaints from women who believe pharmacists ask too many questions.