Sunday, May 18, 2008

Plan B for all ... sort of

We hear the stories all too often of pharmacists in the United States who refuse to stock any kind of family planning products because of "moral conscience," which really means imposing their will (the vocal minority's) against the silent majority. Others are even worse: They'll provide condoms and dental dams and even sell impotence pills for the guys, but will refuse to sell birth control pills or diaphragms to women.

Both positions are untenable. Pharmacists are licensed professionals and they're bound by the rules of their profession, which in some cases are tempered by the law. In this case, if a drug is legal or device is legal to sell it should be available to all. Controlled substances, of course, require a prescription; but if one is presented it should be filled -- without any alleged presumptions by the man or woman behind the counter about the patient's moral code. Any whatsoever.

So it is good to hear the story that "Plan B," the so-called morning after pill, will soon be available in Canada over the counter and without a prescription -- no questions asked. Everywhere, that is, except in Québec; where it will be dispensed upon request on a qualified OTC basis, that is the pharmacist will still advise the woman about the risks involved which means females in that province will pay $15 more than in the rest of Canada.

I think that last part is ridiculous, even if the drug is covered by Medicare or private insurance. There is an argument that this mandatory consultation will leave vulnerable women, especially teenage girls, more so -- and even more reluctant to discuss the risks of sex with their partners and if under 18 with their parents or guardians. As far as adult women go, there may very well be a reason why a woman might not want to get pregnant especially if she is being abused by her partner.

From a personal standpoint, I do think there is a role for parents to encourage their kids, male or female, not to have sex of any kind until they are at least eighteen and in a committed relationship, if neither is possible to use protection each and every time, and to practise serial monogamy -- only one partner at a time, period. All women, regardless of age, also require protection from their abusive partners and strict enforcement of the sexual assault laws based solely on the facts at hand and not question a woman's prior history as police are so wont to do.

But if a woman wants to use the morning after pill, that should be her decision and no one else's. As far as the concern that a pharmacist may be able to flag whether a woman's been raped, it's a fair one; but I know too many women who've had to elect to have an abortion or were forced to get one by their partners after they were raped and were too embarrassed to discuss either scenario until years later. In such cases, disclosure of a rape should be voluntary and not coerced; but if a woman volunteers that is why she is getting the drug then of course the pharmacist should call law enforcement straight away and provide whatever other assistance he or she can.

As far as drug interactions go, such as for epileptics -- a store's computer already keeps track of what pills and inhalers a patient is taking and normally that patient will go to only one store as they have all the drugs on file for insurance purposes. The red flag would come up, and an alternate and less harmful combination of drugs dispensed.. Women in Québec shouldn't have to wait two more years to get Plan B on a true OTC basis. Besides which, the drug is only an emergency contraceptive; if a woman is sexually active and has no plans to get pregnant then she should be taking The Pill anyway, if she is not allergic to it, and insist her partner use condoms.

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