|Yes, It Makes Safe Birth Control More Available||
Editor’s Note –
A new California law that allows pharmacies to distribute emergency contraceptives (EC) – commonly known as the morning-after pill – without doctor’s prescriptions was enacted in January. Individual pharmacies make the decision whether to carry EC. Participating pharmacies should be ready to do so by April.
To inform your local pharmacy of your views, contact them directly. To locate participating pharmacies, call 1-800-323-1336 or visit ec-help.org. To locate other sources of EC, call 1-888-NOT-2-LATE or visit www.not-2-late.com.
The authors would like to thank the UCSB Molecular Cellular Developmental Biology Dept., Student Health, the California Pharmacists Association, and Central Coast Family Planning.
Owen Salisbury/ Daily Nexus
|No, Doctors Should Be Involved in the Decision|
| Allowing pharmacies to distribute emergency contraception is a good idea. Perhaps the most important thing to realize about this arrangement is that it is not over-the-counter. Before distributing EC, a pharmacist must sign an agreement with a doctor called a collaborative practice agreement. Basically, the doctors present the set of circumstances under which they would prescribe EC, and the pharmacists must agree that they will only prescribe the drug under those specific circumstances.
Currently, a patient seeking EC must go to a doctor or a family planning clinic at a cost of around $35 and then to a pharmacy to get their prescription filled for $25. Allowing EC to be prescribed at the pharmacy cuts the price of a doctor’s visit and, for many women, the experience of waiting in lines for a full day at a clinic.
Now a patient can come to a pharmacy and receive a packet of information on EC. They fill out paperwork on the details of their need for EC and their health conditions. If any of the patient’s responses indicate that she may be pregnant, the pharmacist will not prescribe EC. After a pharmacist has had a chance to go over this paperwork, he or she will meet with the patient privately in the back room all pharmacies are required to have for consultations.
Pharmacists are also mandated reporters, meaning that they must report instances of child abuse and sexual assault whenever they encounter them. Even if the bill did not require it, pharmacists would be inclined to meet privately with any patient requesting EC because of the liability they would incur by prescribing such medication anonymously.
Although California law allows children to be responsible for their own medications at age 12, no child can request the medication without encountering a pharmacist who, by law, must report an incidence of statutory rape.
As medical practitioners, pharmacists are qualified and expected to consult with patients on the effects and risks of medications and to make referrals to other sources of medical assistance. When people fail to utilize this resource, they end up bogging down other areas of the medical establishment. Allowing pharmacists to distribute EC is not so much expanding their duties as allowing them to do their job.
Also important is the fact that EC medication is not RU-486 – it is not the abortion pill. EC is intended to prevent people from seeking abortions and in fact, the California Pharmacy Board insists that studies show it does.
Concerns over the potential for EC becoming a primary source of birth control for women appear unwarranted. In Washington, where EC is already distributed in pharmacies under a similar program, there has been no significant change in the number of women using other methods of birth control. In a 1998 study at a New York City family planning clinic, 92 percent of women receiving EC said that it was a method that should be reserved only for emergencies. Seventy-five percent said that since using EC, they were more likely to use pre-coital methods of birth control.
Even advance prescriptions for EC probably do not indicate that women are using them as a primary means of contraception.
EC does not protect against STDs, but neither do many other methods of birth control on the market and people have shown enough intelligence to discern between them. If offered nationwide in pharmacies, it is estimated that EC could prevent 1.7 million unwanted pregnancies each year, all of which result from the use and failure of other methods of birth control.
Josh Braun is the Daily Nexus science editor and a junior sciences in the media major.
| Imagine a young woman in search of EC (emergency contraceptives) arriving at the pharmacy of your local drug store. She waits in line for 15 minutes and listens to the pharmacist advise everyone in front of her to return in 30 minutes to pick up their prescriptions because the pharmacist is running so far behind.
She finally reaches the desk and she is scared and nervous. The pharmacist is busy and in a hurry. Is she supposed to ask for an emergency contraceptive pill in this environment? No way.
The most significant problem with offering emergency contraceptives over-the-counter is the lack of counseling that would be available from a pharmacist.
Currently, there is a two-part program that claims to train the pharmacists in the area of emergency contraceptives. It includes a two-hour home study program and quiz and a four-hour live course to teach them how to communicate with the patients. However, there is skepticism regarding the extent of their training to handle such a sensitive issue.
In many cases, the sensitivity and care required for this type of a situation will not be available from a preoccupied pharmacist that does not have 15 minutes to spare for EC training. In some situations the patient may need 30 minutes or more of counseling. The pharmacist simply does not have the time for this.
At Student Health, a woman who needs EC schedules an appointment with a nurse practitioner. This ensures that each patient receives the care and guidance that is necessary.
The quality of the information source at the pharmacy is the main question at hand. Allowing a woman to go to a pharmacist to obtain this drug takes her out of her gynecologist’s (or doctor’s) office, and sends her into a less private environment with little confidentiality.
Currently, doctors have the ability to write advance prescriptions that allow women to obtain EC when they need it. This option is beneficial because the patient has expressed her concern to her doctor and received counseling.
Conversely, this method is debatable because it could cause a woman to use EC as a backup method because she and her partner chose to act irresponsibly. This irresponsibility could expose her to a number of sexually transmitted infections (STI).
Another issue that should be discussed is that even doctors do not know exactly how the EC pill works.
There are three possibilities of what EC could do. It could stop or impede ovulation, stop fertilization or stop implantation of the egg. If there is so much doubt on exactly what EC does it should not be so easily accessible.
In addition, if doctors do not know how a medication works, there is no possible way that they can know if there are any negative long-term side effects. This high dosage of estrogen (the primary hormone found in EC), if abused, is thought to increase the risk of breast cancer.
It is not necessary that EC be offered over-the-counter. It is much more beneficial to encourage every woman to obtain the guidance from her doctor or nurse practitioner that the situation requires. If a strong relationship is built between the doctor and patient, more information will be known about the woman’s overall health. If there is a reoccurring problem with the young woman repeatedly asking for EC, a nurse or doctor is the best source to encourage other long-term contraceptives.
Remember to use the resources available. Consult a student health representative for more information.
Stephanie McCoy is a junior business/economics major.
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