'Morning-after pill' could be as easy to get as aspirin

By Julia Sommerfeld
Seattle Times staff reporter

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The "morning-after pill" could soon land a spot on drugstore shelves, perhaps alongside the condom display, if scientific advisers meeting today recommend making emergency contraception available without a prescription.

Already, Washington women are able to buy the pills from pharmacists without seeing a doctor first because of a state law. Now the company behind Plan B, a brand of emergency contraception, has asked the Food and Drug Administration to go further and make the pills available over the counter nationwide.

Though Women's Capital Corp. touts the success of Washington's unique approach, there is no drug classification that would allow pharmacists to dispense the drug in all 50 states, so the manufacturer is seeking over-the-counter status. Proponents argue such a switch will improve a woman's chances of getting the pills in time to prevent unintended pregnancies after having unprotected sex or if a condom breaks.

Plan B contains two tablets of the hormone progestin in higher doses than those of regular birth-control pills. The sooner after intercourse they're taken, the more likely they are to prevent pregnancy. If taken within a day of intercourse, the pills are 95 percent effective; if taken within 72 hours, they are 89 percent effective.

If a condom breaks on a Friday night, for instance, it might not be possible for a woman to get in to see her doctor for a prescription in time, said Jane Hutchings of Program for Appropriate Technology in Health (PATH), a Seattle-based nonprofit working on health issues worldwide. Hutchings spearheaded the pilot project that made Washington the first state where pharmacists could sell the pills directly to women, starting in 1998.

Washington's experience showed the convenience factor of sales in pharmacies was huge, she said. Because they could go to the drugstore on evenings, weekends or even holidays, 70 percent of women seeking emergency contraception were able to get pills within one day of unprotected intercourse.

During Washington's 16-month trial run in the late 1990s, nearly 12,000 morning-after pills were dispensed, preventing an estimated 677 unintended pregnancies, Hutchings said.

Since 1997, the year before Washington pharmacists began selling the pills, the state's rate of abortion has crept downward from 21.3 per 1,000 women of childbearing age to 19.6 per 1,000 last year.

The success of the program paved the way for four other states — California, Alaska, Hawaii and New Mexico — to follow suit.

"Making emergency contraception available over the counter is a very reasonable next step," Hutchings said.

The morning-after pill hasn't aroused the degree of controversy as RU-486, the so-called abortion pill, which induces an abortion after a pregnancy has been established and is available only through doctors.

Still, many anti-abortion groups are opposed to Plan B, particularly if it's approved for sale over the counter. Dan Kennedy, CEO of Human Life of Washington, equates the morning-after pill — which is thought to work by delaying ovulation, preventing fertilization or, in some cases, stopping an embryo from implanting in the uterus — to abortion.

He poses the hypothetical situation of a teenage girl — possibly having been raped or molested — who would be able to buy the pill off a store shelf without a doctor or even a pharmacist stepping in to find out if she had been abused.

"We seem to be dismantling a safety net all in the name of making these things more available, but at what cost?" he said.

The FDA has already said Plan B is safe to use. The main side effects are nausea and a disrupted menstrual cycle. Because it's used for a very short time, it's not thought to cause the long-term problems such as blood clots associated with regular birth-control pills.

The question in front of the FDA is whether women will take it properly without any professional advice. The panel will issue recommendations today, and the FDA usually follows its advice.

Forty-four members of Congress sent a letter to the FDA last week urging it to deny the request, saying it would make Plan B "as accessible to our nation's teenage daughters as aspirin or hair spray."

Some opponents also worry women will turn to Plan B instead of using ongoing contraception. But Ed Lovejoy, a pharmacist at the Bartell Drugs on Queen Anne, which is thought to dispense more Plan B than any other pharmacy in the state, between four and eight packs a day, said he hasn't seen any hints of women doing this.

"We certainly have had repeat customers, but the cost alone — it's $45 to get it from a pharmacy — would prevent women from using it as a regular birth-control method."

Information from Reuters is included in this report. Julia Sommerfeld: 206-464-2708 or jsommerfeld@seattletimes.com

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