Plan B-Emergency Contraception

I prescribe Plan B a few times every week. Young women who have had sex without using any form of birth control or who used a condom and it somehow failed come to see me. Sometimes, a woman will want it in addition to the condom because she has sex only once every few months and want another form of birth control besides the condom. As a form of birth control, it isn't the best, but better than nothing. Each time I prescribe it; I also have the opportunity to discuss more effective birth control methods, choices about when one has sex, concerns about sexually tranmitted diseases, general health issues and concerns about rape or assault. I find the opportunity very useful. I hope the young women appreciate our discussions as well. Sometimes it's a little hard to tell with college students.

Plan B has been in the news a lot. I'm not sure those who have opinions about Emergency Contraception really understands what it is and why it is used.

The Facts:

Plan B is an artificial form of progesterone. Other examples of hormonal birth control are the oral contraceptive pill, the contraceptive patch, the contraceptive vaginal ring and the shot that lasts 3 months. The latter is the only other common form that is only artifical progesterone. The rest are combinations of artificial estrogen and progesterone. All of these methods are safer than being pregnant, which is why women choose to take contraception. Pregnancy is wonderful and the outcome is outstanding, but the process of child bearing carries it's own risks.

Plan B or levonorgestrel prevents pregnacy by preventing ovulation and/or by changing the lining of the uterus so that a pregnancy won't occur. The second method prevents implantation of the egg. I believe that a fertilized egg which is not implanted and therefore not receiving nuturance from the mother is not even a potential life. I don't see any ethical issues here in terms of the potential for life.

The medicine itself is very safe. It may cause mid cycle spotting or nausea immediately after taking the medicine. There is no risk for heart attack, stroke, blood clots following a single ingestion of Plan B. There are no long term side effects. It is medicine and it has the disadvantages of: having to take it properly, expense and taking time out of a busy life to get the prescription. These are all issues for the young women who seek Plan B. They are deterents enough that most are motivivated to have another form of contraception in use before there is a need again.

The Big Deal, Two issues:

1.) Should Plan B be sold over the counter without a prescription?
2.) Do pharmacists have the right to refuse to dispense Plan B based on their own beliefs?

Plan B is a medicine that is essentially safe, works best when taken as soon after the event as as possible and using it properly is well explained in the package insert. I think the cost is sufficient to deter most young women from using it excessively or exclusively as birth control. According to Drugstore.com, it costs about $30.00 per package. Plan b should be over the counter, like it is in the state of Washington, in the entire nation.

Some pharmacists have chosen to refuse despensing Plan B based on their personal beliefs. I say they are poorly informed about the medication and about their professional responsibilities. They may have a personal belief regarding Plan B so that they don't agree with it's use. But that is not their job.

The pharmacist's job and indeed, professional duty, is to serve the client and to carry out the orders of the prescribing provider. Pharmcists should advocate for the client and question dispensing a medication that seems unsafe or contraindicated for an individual. For instance, pharmacists should be aware of medication allergies of their clients so that if a prescriber writes a prescription for a penicillin type medciation and the client is allergic; the pharmacist can question that prescription and intervene on the clients behalf in a positive way. This is professional behavior.

In dispensing medications, pharmacists are acting as the agent for the prescriber and following the prescription as written. As a nurse, I have done this plenty of times when working in the hospital. The doctor writes the orders, the staff implements them in the hospital. As a hospital staff nurse it is my responsibility to be certain that the orders make sense, and are prudent, and to question if I have any concerns. But, I also respect that the physician and hospital patient have a relationship and the patient has asked that physician to care for him by writing the orders. Sometimes, not frequently, but sometimes I have carried out orders that I didn't agree with. My disagreement may be as simple as my belief that appropriate treatment for a wound is different than the doctor's. Other times, I have had a personal disagreement with the whole plan of care. I have continued patient suffering by implementing curative treatments in a patient who, in my belief, was not going to be cured. In this instance, I can advocate for providing comfort care. If this is not the agreement between those who decide (physician and patient) it becomes my duty, as a staff nurse, to carry out their wishes and the doctor's orders. I am an agent for the physician in that situation. Other health professionals are responsible to carry out the orders of the person in charge. The person in charge is the patient and patients often turn this responsibility over to their physician. This is the system. In the same way, the pharmacist has a responsibility and a duty to carry out the orders of the prescribing person, even if in their belief they would never use that particular medication themselvses.

I will mention another class of medications that pharmacists don't refuse to dispense but they may not agree with the ultimate use of medications:
When dispensing Viagra and other medicines for erectile dysfunction the pharmacist may not agree with the context in which the individual is using this medication. Viagra-like medications may be used outside of marriage and at times in sexual relations that are not the standard male/female couple. The Catholic Church does not condone the use of any alteration to the natural way of conception. So,the use of viagra-like medications is not condoned by the Catholic Church along with its anti contraception stance.

The bottom line:

Plan B is safe as it is. It should be over the counter and the governmental authorities that are currently trying to block this change are just avoiding real work by their efforts to block Plan B being over the counter.

Pharmacists are a part of a team that provides health care to patients. It is their duty to do the part of the job that the prescribing provider asks of them. It is also their responsibility to make sure the medications are safely dispensed as ordered. It is not their job to decide that a certain medication should never be dispensed.

Phew!

That's my first blog adventure. I could spend hours refining this, but it's not the point. It is quite a rant, I have a lot of feelings about this issue. I have a lot of feelings about other stuff. I will save them for other future blogs and also try to do some lighter stuff, too.