Buying birth control pills over the counter is studied

SEATTLE -- Step right up to the pharmacy counter, answer 23 questions and walk out with birth control pills.

That's all it takes for women in a University of Washington study believed to be the first effort in the nation to offer hormonal contraceptives at drugstores without a prescription. The project aims to find out if women and pharmacists are comfortable with drugstore delivery of birth control pills, patches and vaginal rings.

That doesn't mean women should stop going to the doctor for annual checkups to guard against sexually transmitted diseases and other problems. But most medical organizations agree it is not necessary to have a pelvic exam to get birth control pills.

The best situation is for every woman to have immediate access to medical care, "but there are women who don't have access, and there are some barriers and difficulties," said Dr. Robert Palmer Jr., an obstetrician-gynecologist on the study's advisory board. Palmer is also state chairman for the American College of Obstetricians and Gynecologists.

http://www.chron.com/cs/CDA/ssistory.mpl/front/2450885

I always felt like my pills were being held hostage to get me into the stirrups. You shouldn't have to feel that way simply because you don't want to get pregnant. I hope this trend to make the most reliable BC more available to all woman continues. It will cut down on unplanned pregnancies and abortions. The latter ought to make the fundies happy and get them to support it, but probably not.

I can't get my 12 prescriptions per year unless I dutifully go see Mommy and spread 'em and pay my co-pay because I can't be trusted to take care of my health and fertility by myself, you know.:eyes:

By the way, I've gotten a new gyn this year. While I do prefer female doctors, that doesn't preclude them from being paternalistic! When I complained last year about symptoms of early menopause i.e. hot flashes and night sweats, my gyn dismissed me with, "Oh, you're too young to worry about that." I am 43 years old, for God's sake! Luckily, I've found a doc that specializes in menopause/peri-menopause, and hope to have a better experience this year.

One thing I appreciate about growing older is that I have, over the years, completely lost that "doctors are kings/queens and must never be questioned" feeling that I had in my 20s. I never let any health practitioner come near me without knowing exactly what they are doing and why, and if I disagree with it, I say so. Wish more people would do the same! My SIL dutifully got a hysterectomy yesterday at the age of 39 for minor uterine fibroids and never sought a second opinion. That's sad!

You don't have to stick with a provider, unless your insurance is that sticky about it...

If they suck, fire 'em!

Though it does seem to be pretty much standard. It does piss me off, though, because I've had issues with basically running out of pills due to this policy (I usually do fairly long-term archaeological fieldwork every year, and prefer to stay on active pills the whole time to avoid period hassles, and the doctor knows and approves of this). Last fall, for instance, I called my Dr. to get an extra refill or two phoned in; they wouldn't do it until I scheduled my yearly exam. Okay, I said, I'm due to come in the last couple weeks of December. Oh, no, they said, we don't know what the doctor's schedule will be for those weeks yet. Call us back before your last pack runs out and we'll take care of it. Now, I have been on the same brand for eight years, and have NEVER ONCE missed a yearly appointment. I find it truly bizarre that my doctor, on the basis of recent research, approves of patients skipping a period or two by skipping the inactive pills, but will still only prescribe 12 packs at a time. :crazy:

I can hear it now, "first adult women will want this, then teenagers, the Federal govt can not allow teenagers to get BC pill"

will burst yet another blood vessel over this. It'll never happen, it makes too much sense. The only way to prevent unwanted pregnancies and STD's is abstinence. Hasn't the world learned that lesson yet? :eyes:

And that's got nothing to do with fundies.

I hate having to ante up every year so I can get BCPs. We should make it as easy as possible for people to get birth control. It would certainly cut down on unwanted pregnancies and abortions.

I hope that going over the counter would also bring the price down a bit. Even with a prescription co-pay those damn things are too expensive.

It will probably take a while before the price goes down depending on sales. Otherwise, it may or will be more expensive because prescription co-pay is no longer an option. BUT if considering the total cost of everything associated with obtaining the BCP via the doctor vs. OTC it may cost less.

all this study does is give "prescriptive authority" to the pharmacist. The drugs themselves are still prescription drugs, it's just that a pharmacist, acting under the auspices of a licensed physician and using an approved protocol to determine if a patient should be taking the pill, is "prescribing" the drug.

You mean to tell me it is SAFE? That women really CAN take one pill a day and not screw it up? I am so worried about some woman screwing it all up!

::Sarcasm off::

Ok--I had to do it! I had to give vent to that one. It has always amazed hell outta me that BC pills are so difficult to get for most women. They are OTC in other countries and it seems to be working just fine. It is high time the US looks at doing it too.


Laura

Now, you can slap a patch on your ass once a week. How could anyone possible screw that up?

It's funny how we have the most educated general population of women in history, yet we are not to be trusted with buying our own birth control pills -- yet birth control pills are OTC in at least two Mexican states where I have purchased them myself -- cheaper too.

:eyes:

.

That's where the rubber (pardon the pun) really hits the road. What would be the minimum age? Can some teenaged girl who's being sexually abused by her stepfather (or other 'guardian') get BC? There are over 40 million Americans without heath care coverage, the majority of whom are female.

Watch the reichbots foam at the mouth over this one. :eyes:


Remember -- The prototypical parental attitude is: "You follow my rules as long as you live in MY house!" :shrug: (The "age of consent" seems to be economic in the minds of most parents.)

but why stop at Birth Contol Pills. I went to my doctor to ask for an anti-spasmodic drug to keep my stomach from churning up when I play chess. She told me she wouldn't give it to me and i would just have deal with it.

With the exceptions of antibiotics, i think all drugs should be OTC

Yeah ... I want some Vicodin to help with the pain of hitting myself over the head with a hammer. :silly:

I do not know the progress that has been made in this field of medicine. Are their allergic reactions, interactions with other medicines or counter effects by other substances? Also, what are the percentages of occurrences? Thanks

From my experience as a consumer, negative side effects for the majority of users are pretty standard and depend on the brand in question because of the differences in dosage: mood issues, weight gain or loss, nausea at first, etc.

For certain categories of users, including those who smoke and/or have blood clotting problems, there's an increased risk of circulatory system clots.

http://www.arhp.org/healthcareproviders/onlinepublications/clinicalproceedings/successfulloccp/mar99e.cfm?ID=189

http://www.health.ufl.edu/shcc/healthed/ocp.htm

http://www.afpafitness.com/articles/oralcont.htm

http://www.plannedparenthood.org/bc/bcfacts11.html#PILL

Having pills available OTC would probably be a great help to women who must try several brands before finding one they can easily tolerate -- they would be able to work these issues out with the pharmacist's help rather than having to possibly schedule (and pay for) repeated doctor appointments.

As far as drug interactions, the one that is probably the most important in terms of frequency has to do with antibiotics -- there are a number of antibiotics out there that make birth control pills less effective. I'm not sure how many antibiotics this applies to; I tend to err on the side of caution and always use a backup when on any kind of antibiotic. My own and my friends' experience with this issue leads me to believe that pharmacists would do fine as far as helping women deal with this interaction -- I've only rarely had a doctor warn me that an antibiotic s/he was prescribing might affect my pills' effectiveness, but the pharmacist almost always gave the caution.

I know I'm going to be in the minority, but I think this is just another way for insurance companies and pharmaceutical companies to make money.

First, women will not get yearly exams despite the fact they are recommended. Insurance companies won't have to pay for the exam, pap smears, and routine blood work as often. You can count on cervical cancer rates rising and women have more advanced diseases once diagnosed. I would bet that insurance companies will start paying for visits only every two years, like with vision insurance. Of course, they won't have to pay for any birth control, but you know your costs will continue to rise

Second, this will give so much more money to insurance companies. They won't send reps to explain the medicines to doctors or give out all the free samples, but the price will be higher for consumers. For example, the co-pay on allergy medicine was much lower than the cost now that some are OTC.

Third, everyone is not savvy about medications and many think OTC means safe. The pharmacist won't be checking all the prescriptions to remind women that antibiotics make the Pill less effective or the potential for serious side effects.

Personally, I think this is just another example of not providing adequate heath care to women.

really? I beg to differ. This is not the same thing as the pill being over the counter. This is more similar to the pharmacist having prescriptive authority. I'm not involved with this study, but I bet you that the questionnaire/interview includes a review of other medications. It would be a breach of professional duty not to inquire about other medications and provide education.

In fact, when you get a prescription filled, the pharmacist only has a record of what you've gotten at their pharmacy. People may go to more than one pharmacy, so just because the pharmacist does something behind the counter, doesn't mean that they were able to thoroughly check for interactions.

That said, requiring the pharmacist to do a face-to-face interview with the woman requesting BCPs may be a BETTER way to check for drug interactions since an interaction between the pharmacist and patient is required.

out here in Washington, pharmacists have prescriptive authority for the morning-after pill, and the system works beautifully. The pharmacist has a list of questions/issues to review, and if the patient has no contraindication, the pharmacist dispenses Plan B, no doctor visit required. This is going to be a similar system.

If you read my post, I said that it was important to have pharmacists fill prescriptions because they are best equipped to explain side effects and potential interaction problems.

I think a better solution to your concerns would be a database that connected different pharmacies. This would also deter people from going to various pharmacies to avoid detection of prescription abuse.

Hopefully, morning-after pills are not something a woman is going to use month after month. To me, this is an emergency medication. A woman needs to be able to receive this as soon as possible, so going directly to the pharmacist, as opposed to waiting for a doctor's appointment makes sense. BCP are different because being held hostage by the doctor means women will get a yearly exam which they need to do.

I'd say health care providers do a better job helping explain side effects to patients, in general. And they certainly do a better job of helping them learn how to deal with side effects, when necessary. Further, health care providers get the constant feedback lowdown on side effects, so they know what really happens to people.

Pharmacists are a very necessary part of the health care equation, but that doesn't mean they can suddenly do what physicians, nurse practitioners and physicians assistants do.

I just don't believe that the only reason women have yearly exams is to get their birth control prescriptions. Most of us are actually bright enough and concerned enough about our health to get an annual exam even if we're not on the Pill, assuming of course that we can afford it. I also very much doubt that insurance companies could get away with paying for a pelvic exam et al. only every two years, even if the availability of OTC birth control did have the effect you posit on the rates of yearly doctor visits. In any case, somewhat less than half of American women are on hormonal birth control anyway, not to mention the fact that a yearly appointment is the standard medical recommendation for all women. I don't think the insurance companies would get away with refusing to pay for one gyn exam a year, given that it's the accepted standard of care. Heck, even my highly restrictive insurance does. (The vision care analogy is flawed -- the reason it pays for one visit every two years is because that's what optometrists recommend.)

I had a tubal ligation in 1985, so don't need to get BCP prescription, yet I get a Pap smear & exam every year. Imagine that!

The US system of requiring yearly Dr visits for BCP is SO paternalistic. We are assumed to be irresponsible because we are women. Many countries have been selling BCP OTC for years. What is required is education on the importance of regular exams, not holding a means of contraception hostage.

This claim of paternalism just doesn't wash. This is a public health matter that is pushed in every nursing school in this country. So call it maternalism, as well, if you want to do so, but don't just put it on the men.

We all know plenty of people of who won't get annual checks, under such a plan. It's simply going to make that too much of a hassle. If that leads to an increase in the number of deaths and/or severe surgical procedures from cancer and other problems, who pays in the long run? We all do.

skip her annual exam if she could get birth control over the counter. I'm sure that there are some women who might quit going to the doctor if this plan were widely available, but I doubt that for most of them, it would be for the reason you posit. At least IME, and from what I've read, the main obstacle to women getting regular preventative care is not that it's a "hassle," but rather that it costs money, and I see no reason why that would be any different if birth control were available over the counter. It's entirely possible that some women might, under this plan, decide to forego the annual appointment and put the money towards a more pressing need (and how many women in such straits today end up foregoing the birth control and getting pregnant -- society pays for that, too). I'm not saying that's a good thing, but rather that if we're really serious about women's health, easier access to reliable, effective birth control is one important step. And, as another poster said, if we're really serious about getting more women in for yearly exams, the way to do that is through education, outreach, and increased funding for community clinics, not by holding their contraception hostage.

My experience is very different. Many women would skip this exam.

I guess according to your post that I'm not bright or concerned about my health because I would skip my yearly exam, if there was OTC birth control pills. Like millions of other women, I don't have insurance and needing my prescription forces me to see the doctor. In fact, I don't have a general practitioner any longer because I didn't see him for so long that he dropped me as a patient.

I think you're giving insurance companies far too much credit. Womens' health is always the lowest concern. They have already said that they will only pay for bi-yearly pap smears, most only cover the least effective pap smear, mammogram coverage is inadequate, and women are kicked out of the hospital only hours after giving birth. The "standard of care" changes to make sure the money keeps flowing.

I did not say nor imply that all women who don't go to the doctor are not bright or are unconcerned about their health, and I specifically said that most would go anyway unless they didn't have the money (and not having insurance would be part of that). In other words, I intentionally worded my point to try to make it clear that I understand that there are financial reasons that a woman might skip the doctor. (And I expanded on that point in my post #33.) Sorry to belabor, but I find it distressing when it appears that someone thinks I've insulted them.

And yes, insurance companies have a tendency to be pretty bad, but they don't all limit pap smears to once every two years. It's obviously an outrage that some of them do, but if we're going to win the battle for better health care, we need to be sure take all plan permutations into account. And I'd say that pretty much everyone's health is their lowest concern; the bottom line is the only thing they're really concerned with.

I do think that, from a public health standpoint, studies on this matter should consider whether or not women continue to get regular gynecological check ups, and whether or not there is any increase in undetected cancers or other problems. Without this information, the study is flawed in my opinion. Further, longitudinal studies must follow any change in law along these lines.

I'm not so sure about the cost being increased, however, the pharmacist is not going to get paid anything extra for spending the time to ask these questions, as a physician or midwife would. Pharmacists will face pressure from employers and other consumers to get through these Q & A sessions as fast as possible. With computers at their side, while they may be able to check on all drug interactions and reported allergies, they may not have the time or the education to go down the roads that a Gynecologist or Midwife would be able to, if evidence of illness presented itself, however subtly.

Anyway, I do worry that you may be right. This could diminish the level of health care offered women in the long run.

part of the impetus for this program is that women who need this service do NOT HAVE providers to go to in the first place or cannot afford to go.

They came up with this study idea because we already allow pharmacists to dispense emergency contraception in Seattle, and pharmacists discovered then when asking women what kind of contraception they are using/will use in the future, many responded about their lack of access to care. They requested the morning after pill because they cannot easily get birth control pills.

Hence, this study is offering care to an under-served population. Indeed, it could turn out that by having access to a trained healthcare professional (we pharmacists have 6 years of college and doctorate degrees), a patient may actually become more compelled to get a check-up if the pharmacist educates them on STDs, the link between HPV and cervical cancer etc. Also, part of this program is a blood pressure check. A pharmacist might diagnosis hypertension in someone who doesn't get regular care. It sounds like it might suprise you, but pharmacists are not all money-grubbing, hurried corporate slaves. Most of us take our patient duty seriously and behave like the trained professionals that we are.

Sounds like we're causing more problems with this supposed "solution." What we need to do is figure out how to increase access to providers, not make it even easier for the system to keep women away from providers, while putting a burden on pharmacists that many of them will not want. This is far different than "morning after" pills. Don't kid yourself.

Where are pharmacists going to get the time to do this right? If they have the time now, what are we paying them to do during that time now? If they don't have the time, where is it going to come from? Who is going to pay for it? Or is this just going to shrink the time pharmacists have to do their jobs, increasing the needed speed that they do their jobs at, and thus likely increasing errors? How are pharmacists going to teach women how to do breast exams? Will they have treatment rooms in the back? Who will be the second observer for such education pieces?

And if the parts that I noted in my first paragraph in my post above are not included in the study, then this study is missing something big. It may be a supposed "solution," but if ovarian cancer death rates increase, what's the cost of this "solution."

that's why I spend a few years in graduate school studying public health and health policy. Universal healthcare (or our lack thereof) is what drove me into grad school.

but in the meantime, while I wait for our politicians to "fix" our broken system, I'll fight for any improvements in access, given appropriate safeguards for patients. Empowering more women to prevent unwanted pregnancies is a good thing.

Plus, I'm curious how this is "far different" from emergency contraception. Can you expand on that?

The numbers are vastly different. Pharmacists are going to see far more women to get the pill than they do for the "morning after." Also, as I noted, from a public health perspective, how are pharmacists going to have the time to teach women what to look for, not just in regard to the pill, but in regard to overall reproductive health, including breast health. How are pharmacists going to ensure that a woman whom they suspect might have a kidney problem or a depression gets referred to an appropriate provider? This is a very big screening and education piece for public health. It cannot be taken lightly. Where are pharmacists going to get the time and the training to do all that?

this is not necessarily designed to REPLACE doctors' visits. This is designed to facilitate access to a medication that has been used safely and effectively in this country by millions of women for several decades now.

Pharmacists are not going to be teaching about breast self exam. They are not going to be looking for undetected kidney problems in these women. The onus is on a woman to continue to seek appropriate medical/preventive care. As others stated above, women who currently go to an OB/Gyn will still go for their pap smear and general check-ups. The prescription for OCs doesn't need to be held hostage in order for women to make those appointments.

And, unfortunately, not all women currently go to OB/Gyns (hence the need for pharmacist prescriptive authority), so I hate to say it, but these women are no worse off than before if they get OCs from a pharmacist. They can be advised to go to an MD but not forced to do so. Until we have access to care for all, this is reality.

And please, where are pharmacists going to get the time and training? Is 6-years of college and 6-12 months of clinical internships and a state-approved training program for prescriptive authority for oral contraceptives not enough? The pharmacy profession is interested in doing more than simply dispensing prescriptions - gaining prescriptive authority has been something the profession has actively sought.

You didn't explain where pharmacists would get the time to do it, because they aren't going to do it, though it will replace those visits for many people. How could it not? Just because pharmacists want prescriptive authority doesn't mean their jobs are set up to make such a practice truly safe. And just because they get lots of training, doesn't mean they get the type of training necessary to keep the public health system truly safe in such a scenario as this.

I mean, if the issue is seeing a practitioner, why not give birth control dispensing privileges to FNPs or midwives and take care of the situation more thoroughly? Why is there a need under such a scenario to go to a pharmacist for birth control, if women could get a truly complete check up and their birth control in one spot that way? Sorry, but that just seems more sensible to me from a public health standpoint, especially since you have skipped over most of my main concerns. I really worry that pharmacists don't get the big picture on this matter.

Pharmacists out here are dispening emergency contraception, monitoring patients with diabetes, asthma, cancer etc and adjusting meds when needed. We do it because it's our professional duty. We make the time for what's important. The state of Washington has safeguards to make pharmacist prescribing a safe option in certain situations, such as this one.

Why the pharmacist? Exactly because they are there in your community and you can talk to them free of charge, no appointment needed. How often can someone just walk into an office and see a nurse midwife right then and there when they need to? Sorry, but the issue is ACCESS, and your scenario with FNPs or midwives doesn't solve that problem.

If a program, however well intentioned, creates more problems than it solves, however, that doesn't make it a wise program. I don't think you've truly thought this through. You have ignored every point and question I have asked in order to repeat your mantras. The problems I have shared are very real. Further, it's not like there aren't NPs, midwives, Family Practitioners and Gynecologists out there in the communities. Your post seems to feign that they are all gathered on some mountain top where women must spend days seeking them out. Sorry, but without dealing with the issues I have brought up, this program is dangerous to women's health. You can't just make those issues go away unless you deal with them. It seems to me that this is more about the pharmacists than it is about women's health, and that scares the crap out of me.

sorry, I don't think it's me. Which of your issues have I not answered? You just keep repeating that women should go to midwives or doctors without addressing the real issue about access. Women are coming to Seattle pharmacies for emergency contraception exactly because they don't have providers or can't afford to go to one to get OCs in the first place!

Sure, there are NPs etc in the community. Typically, you need to make an appointment and pay for their services. Why aren't these women going to them now? Nothing is stopping them except perhaps finances, or an inability to take the time off work during office hours. Whatever the reason, a need exists for alternate access to care.

This isn't about pharmacists per se. It is about giving women an improved ability to control reproduction, to prevent abortions, and improve access to a safe and effective medication.

You and I aren't going to see eye to eye on this one. I just wish you'd stop acting like civilization will end if we allow women to take greater control of their bodies.

Just had to point out that if birth control were available from pharmacists, ovarian cancer rates would probably go down, because oral contraceptives tend to decrease the risk of ovarian cancer when used over a long enough period (5 years, IIRC).

But I do understand the point you're making, however much I may disagree with it.

But deaths might go up. And, if the education piece is left out of the picture, what sort of increase in STDs might occur as a result of such a practice? The more I hear on this board about this, the more concerning this possibility becomes.

are getting the disease, unless you're talking about the percentage of ovarian cancer patients whose disease is fatal. But ovarian cancer is a not the disease to include in this argument in any event, because it's often (maybe even usually) not diagnosed until it's basically too late even in women who visit the doctor religiously -- the early symptoms are very vague and often nonexistent.

Not sure what you mean by the education getting left out of the picture. I'd guess that pharmacists would be telling women that the birth control pill doesn't protect against STDs, and that information is usually at the top of the patient info sheet that goes with the pills in bold letters. Yes, I know that people don't always read the info sheets, but there's nothing ANY health care provider can do to force them to.

And I have to say, I'm not persuaded by the idea that making birth control more readily available will increase STD rates; it seems to basically suggest that women will start having more sex if they can easily get birth control pills. (Kind of like the argument that if we have sex ed including condom use, etc., in schools, then teens will have more sex.) Given the rates of unintended pregnancy -- and the info cited above that women getting the morning after pill needed it because they couldn't get birth control -- I rather doubt that the possibility of pregnancy is keeping people from having sex in the first place. I tend to think that it wouldn't necessarily result in women having sex more often, but in their being more prepared to prevent pregnancy when they do.

Of course, this entire argument is just so much speculation on both sides in the absence of hard data from surveys...and I don't see how you could possibly get that data without the sort of pilot study like the one mentioned in the original post.

If they are not seeing health care providers, and many won't, ovarian cancers will be found in later stages than they currently are and more women will die. It's very simple. You eliminate the part of the process that allows for early detection, and the early detection rates go down.

Also, I don't think you realize just how much education goes on in gyn offices regarding STDs. This piece will be lost, and it will be lost at a cost. The evidence of the benefits of such education are very real. Take the educaion away, and the benefits will disappear, leading to increased STD rates. This isn't about women having sex more often, but not knowing how to protect themselves. The gyn office is a primary education piece on this matter, whether you want to believe it or not.

Yeah, it's partly speculation. But it's also pointing out that this study will be flawed if it does not take the concerns I have brought up into serious consideration.

women don't go to OB/Gyns for ovarian cancer screening. There is no accurate screening test that is effective in large populations. The only effective screening test for this population is the PAP smear for cervical cancer.

Most women with ovarian cancer are diagnosed with stage III or IV disease and it is ultimately fatal (unless of course they die of another cause first). Sadly, this is the reality for ovarian cancer.

Plus, ovarian cancer is most common in older women, who are not likely candidates for oral contraceptives in the first place.

The idea that getting OCs from a pharmacist is going to increase ovarian cancer incidence and mortality is just not realistic.

Of course, as someone else posted, use of OCs by women in their reproductive years has been associated with a lower risk for ovarian cancer later in life, which again, could be a benefit to increasing the use of OCs in the population.

So far I have not heard of any backlash.

About time IMHO.

Another link:
http://seattlepi.nwsource.com/health/161705_birthcontrol23.html

"The study, officially kicking off today, will look at how well birth control works at both the customer and retailer ends.

It's the first study of its kind in Washington, a state that is already a pioneer in expanding access to birth control. Washington was the first to allow the sale of emergency contraceptives, or "morning-after pills," over the counter."


JetCityLiberal

why can't we do it for the fellers, too? They don't get their Viagra unless they agree to a full physical every year. I think that women are much better at looking after our health than men are, at least in my family. Women who do not, or cannot be trusted to, or cannot afford to, look after their own health probably should not be getting pregnant anyway, right? For their own sake as well as a baby's. So let them have easy access to contraceptives, at least. Just a thought.

And hey, if holding Viagra hostage won't do the trick for guys, maybe we could hold something else hostage to force them to see their doctors regularly... maybe beer or Monday Night Football??
:crazy: