Emergency contraception is under attack by US pharmacists

BMJ 2005; 330 doi: (Published 28 April 2005) Cite this as: BMJ 2005;330:983
  1. Janice Hopkins Tanne
  1. New York

    A growing number of pharmacists across the United States are refusing to fill prescriptions for emergency contraception, even in cases of rape. Some pharmacists won't fill prescriptions for oral contraceptives for moral and religious reasons.

    Karen Pearl, interim president of the Planned Parenthood Federation of America, said, “We're getting more and more reports [of denials to fill prescriptions] from more and more states. This is a clearly orchestrated movement to stand in the way of women getting the birth control they need. Pharmacists are standing in the middle of the doctor-patient relationship.”

    The “conscience clause” trend began several years ago when doctors and healthcare workers were allowed to refuse to take part in abortions (BMJ 2004;329: 476). Some states allow pharmacists to refuse to fill prescriptions, while other states require them to.

    The News & Record, a North Carolina newspaper, reported that some pharmacists were destroying prescriptions, giving patients speeches on morality, and stalling the patient beyond the point where emergency contraception would be effective.

    In Illinois the governor issued an emergency order requiring pharmacists to stock emergency contraceptives and to fill prescriptions quickly. He was challenged by a conservative group. Legislatures in several states are fighting over whether hospitals, including Catholic hospitals, must tell women who have been raped about emergency contraception.

    While Canada became the 34th country to approve the emergency contraceptive “Plan B” without a doctor's prescription on 19 April, the US Food and Drug Administration continued delaying approval, which was expected in January (BMJ 2004;328: 1219). The manufacturer of Plan B, Barr Pharmaceuticals, first sought approval in 2003.

    To protest about the FDA's delay two US senators—Hillary Rodham Clinton of New York and Patty Murray of Washington state—have blocked the approval of Dr Lester Crawford as the new head of the FDA.

    The Democrats introduced federal legislation requiring pharmacies that serve people on the federal Medicare healthcare programme (for elderly people) or Medicaid (for poor people)—which would probably be most US pharmacies—to fill all prescriptions or refer the customer to a pharmacy that would.

    Supporters of emergency contraception say that the emergency contraceptive, a high dose of ordinary oral contraceptives, could reduce the number of abortions. About 1.3 million abortions are performed each year in the United States.

    Opponents of contraception, such as Pharmacists for Life International, say that a human being is created when sperm and egg unite and that because contraceptives may prevent implantation using them is the same as abortion. Other opponents say that emergency contraception promotes promiscuity.

    The American Pharmaceutical Association, which represents more than 50 000 pharmacists, reacted angrily to a New York Times editorial (2005 April 3; sect 4, 12) that said that pharmacists should fill doctors' prescriptions or find another line of work.

    The association recommends “appropriate staffing within a pharmacy, proactively directing patients to designated practices, and working with physicians and other prescribers to establish alternative dispensing methods.”

    Such proposals won't work, said Ms Pearl. Health insurance plans required many women to get prescriptions filled at a particular chain of pharmacies, so their choice was restricted.

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