health

Why doctors don't want women to be able to get The Pill without a script.

The pill available without a script?

By ALYX GORMAN

Imagine if getting your hands on three months worth of a contraceptive pill was as simple as walking into a pharmacy and filling out a brief questionnaire.

That could be a reality in Australia next year if a submission that is currently before the Therapeutic Goods Administration gets accepted.

The amendment proposed would require patients seeking oral contraceptive pills to fill out a short survey, covering “family history of heart problems, hypertension and stroke” and take an in-pharmacy blood pressure test, before being issued with a three to six month supply of the pill.

This might sound like a blessing when it comes to convenience of use but the Australian Medical Association have serious reservations about making the pill available over the counter.

GP and AMA representative Dr Brian Morton explains:

“The oral contraceptive pill is a very safe medication, but it should be prescribed by a GP, with all the quality care that’s needed for women. A simple questionnaire and buying it over the counter doesn’t give women the safety that they need.”

In rare cases, the oral contraceptive pill can lead to high blood pressure, increased risk of clotting and even stroke, and Dr Morton believes that “a subtle assessment of a patient’s risk can’t be done with a questionnaire.”

Related: What really happens to your body when you skip your period. 

He adds that, when a patient comes in to get her pill script renewed, she receives additional medical care. “You check their blood pressure, you find out whether they’ve had a pap smear and maybe do the pap smear at that time. You find out whether they’re self examining their breasts regularly. There’s a lot that happens around the time of prescribing the pill.”

Dr Brian Morton discusses the role of family doctors.

He fears that, by making the pill available over the counter, women will forget things like potentially life-saving pap smear screenings.

Dr Morton notes that taking the pill can be tricky to get right. “There’s a big risk when women don’t fully understand what happens if they miss a pill or have a bout of vomiting or diarrhoea, where it’s not absorbed, or when they take it with medications that are counter-indicated.”

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A doctor can talk a woman through simple questions about using the pill correctly, but in a pharmacy environment, where there is no privacy, finessing the finer points of STI prevention, or when you need to take the morning after pill is potentially awkward.

The issue is further muddied by the fact that selling the pill is big business. On the one hand, doctors do get paid for writing scripts, but, as Dr Morton points out, pharmacists make better profit margins on certain forms of contraceptive.

“A particular type of pill may be more suitable for a patient that another, which a doctor can determine… The conflict of interest is greater with the pharmacist than it is with anyone else, and it’s nonsense to say that a doctor has a significant conflict of interest.”

Related: Amazing news for anyone with endometriosis. 

The TGA told Mamamia that they cannot reveal who made the submission to amend the availability of oral contraceptives, and this lack of transparency worries Dr Morton. “We don’t know who’s asked TGA to look at that, but it’s not the pharmacists, it’s not the doctors, it’s more likely to be a pharmaceutical company. So what’s the driver? Greater profits for the pharmaceutical company. And it may be a generic provider, not “Big Pharma” as it’s so called.”

Sexual Health and Family Planning NSW have similar reservations. A representative for the organisation told us:

Family Planning NSW is supportive of any careful approach to reducing barriers for women accessing contraception. This being said, the application to make the oral contraceptive pill available over the counter cannot be considered without understanding the scope of the proposal – whether this refers to first time prescriptions or repeat scripts is unknown, and would hold very different implications.

There would of course be some practical limitations to dispensing contraception over the counter, including the limited privacy of a pharmacy setting, in which to discuss an individual’s  personal medical needs, or talk through the variety of options available other than the pill.

 There are a range of long acting reversible contraception (LARC) alternatives to the pill now available for Australian women, including intrauterine devices (IUDs), implants and injectables. Overcoming misinformation and being aware of the available options is important for all pharmacists, doctors and women alike!

Submissions regarding the reclassification of oral contraceptive pills will be open to the public until December the 11th. The TGA will announce an interim decision on the 4th of June, 2015.

When we contacted the TGA for comment, they told us that a similar proposal was floated in New Zealand recently, and was ultimately rejected by the New Zealand regulator.

Do you think the pill should be available over the counter?

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