Doctors pushing for easier access to ‘morning after' pills
By Tony Gosgnach
In their relentless push to make so-called emergency contraceptives or "morning-after pills" as available as possible, some doctors – with the approval and even urging of certain leaders in the medical community – are issuing open-ended, "just in case" prescriptions for the medications.
"We're going our own way," declared Ted Boadway, executive director of the Ontario Medical Association. "Lots of doctors are doing it ... If you want a perfect example of regulators ignoring patient needs, this is it."
The practice, though not illegal, is said to be unusual and a skirting of federal rules on the matter. Still, Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynecologists of Canada, supports it. "We have been telling our members to write an advance prescription for (the morning-after pill) Plan B, so they can carry it with them," he said.
It has been claimed that sales of Plan B, distributed by Montreal-based Paladin Labs Inc., have exploded ever since Health Canada approved of its use in February 2000. However, pro-life advocates have doubts about this assertion, since Preven (a previous version of the morning-after pill produced by Oakville, Ont.-based Shire Pharmaceuticals) was pulled from distribution because of poor sales despite a drastic markdown in price.
Agitation is also continuing for the introduction of Plan B as an over-the-counter, non-prescription drug. Health Canada says it can't grant such status until an application is made. Paladin says it plans to apply for it this year.
Pro-life advocates contend that Plan B and other morning-after pill formulations are not actually contraceptives at all, but rather abortifacients, because apart from preventing ovulation, they may also prevent an egg already fertilized from implanting in the uterine wall.
That point of view is supported by the government of the Philippines, whose bureau of food and drugs recently removed a morning-after pill from its registry of drug products. Local licensee, Schwarz Pharma, marketed the medication under the brand name Postinor. It was manufactured in Hungary by Gedeon-Richter.
The food and drug bureau said it found Postinor "has abortifacient effect and contravenes existing provisions of law on the matter."
Apart from being abortifacient, the morning-after pill is said to carry health risks as well. Canadian Physicians for Life, in a position paper, notes that manufacturers have already been reducing the hormonal content of oral contraceptives because of serious side effects and health risks. Yet, women are now, through morning-after pills, being encouraged to consume the same hormones in multiple doses.
However, Canadian Physicians for Life president Dr. Will Johnston told The Interim that the practice of doctors prescribing morning-after pills on a "just in case" basis is "not a big deal."
"It really isn't (a big deal), in terms of it being a common procedure to give people prescriptions and letting them decide whether they will fill them in the future ... It's just not an issue."
Dr. Johnston said the pro-life movement would be better advised to focus on the conscience rights of doctors and pharmacists not to be involved in the dispensing of such medications. "I'd like to re-emphasize that we need conscience protection in Canada. It's long overdue that the government took a look at it."
Mike Izzotti, a co-ordinator for Pharmacists for Life Canada, told The Interim that the issuing of "just in case" prescriptions "has been going on for a long time." However, he stressed the risks inherent in such a practice.
"It's dangerous. First of all, a woman may take it improperly, or a woman may give it to someone else. There's nothing to stop her." Most important, he said, "Whether they call it abortion or not, it kills a human being. They're trying to fish around definitions. They're confusing everybody."
Izzotti encouraged people in Ontario to quiz their pharmacists on the issue when Pharmacists Awareness Week takes place in the province March 4-10. "You can ask a pharmacist any question you like. If there's a question about the morning-after pill, whether it causes an abortion or not, that's the time to ask."
Dr. Richard Haughian, executive director of the Catholic Health Association of Canada, took a more serious view of handing out just-in-case prescriptions of morning-after pills, calling it "irresponsible."
"The potential impact of high-hormone doses is particularly troublesome and frequently, the impact of long-term use of the pill is not addressed," he said. As well, "If fertilization has occurred, (the morning-after pill) may prevent implantation in the womb, in which case it would be an abortifacient."