The "morning after pill" over the counter sales

[relliott]

i was recently reading a newspaper article that was commenting on the rise in emergency contraceptive sales since the morning after pill went on sale over the counter and praising how it had made the service more available to women. It didnt however comment on whether or not the rate of unwanted pregnancies had gone down.

The suggestion that was made in this article that the next step should be to allow advance purchase of the morning after pill (i.e. to have one spare in the cupboard just in case) on the same over the counter basis.

Personally i'm not all that sure that it's a good idea as it would encourage the use of emergency contraception as first line contraception (and yes i know it's about £30 a pop over the counter and is a very expensive option for first line) and then we'll have to figure something else out for emergency use. Surely encouraging sensible use of the existing methods would be a better investment of funds?

I would also be worried about abuse of the system to harmful effect. I have a friend who I shall not name who had been seeing her boyfriend for a long time and they didnt use any kind of contraception. She had been a bit concerned that she had been bleeding at unusual times and gone to see her doctor who couldnt explain her symptoms either. It turned out that her boyfriend who had a friend of a friend in pharmaceutical manufacture had been putting the morning after pill in her coffee, breakfast etc. She only found this out after another person who knew he was doing this told her.

I know that is a rare story, but any item freely available over the counter is available to anyone to use in whatever misguided means they choose. At the moment the sales of the morning after pill are restricted solely to those requiring it in an emergency situation and after they have filled out a questionairre. If it can be bought in advance then there is less strict a control of its distribution.

So, what does everyone else think?

[Devlinator]

encouraging better sexual awareness and a sense of responsibilty would be better. but who is to say that people dont already do this kind of thing?

[lil_kazzy]

encouraging better sexual awareness and a sense of responsibilty would be better. but who is to say that people dont already do this kind of thing?
Hmm yes, good point. They could just go into the chemist and lie.

I personally don't think that it's the greatest idea in the world. It could 'encourage' unprotected sex - "Oh, it's alright, we can have sex without a condom, I'll just take my MAP tomorrow morning".

But then, sometimes people are... too scared to admit that they've done a stupid thing - having one in the cupboard saves them the 'embarrassment' of having to go to the chemist and admit that they had unprotected sex last night. Rather they just have to pop in on their way past and buy one 'just in case'. IMO though, folk that are getting embarrassed about stuff like that shouldn't be having sex anyway, but it isn't an ideal world.

I apologise for my babbling, I had a really really drunken night last night and I'm feeling absolutely awful and not entirely with it.

[elliottsimpson]

I had a really really drunken night last night and I'm feeling absolutely awful and not entirely with it.
isn't it people who wake up in that sort of state and, in addition, find an unexpected fella in their bed who find they might need the morning after pill?

I'm not saying it's right to make this product freely available - but do be very careful where you are and who you're with before you get really really drunk.

[relliott]

That is a good point to remember Elliott (though are you casting nasturtiums about our integrity :) )

All too often you hear stories at university about so and so who had too much to drink last night and cant remember how they got home, or woke up sleeping in a skip/bush/park bench, or are more than a little vague about what went on. I'm almost amazed at the sheer blind trust people put in complete strangers to look out for them and make sure they get home ok! Particularly for the girls I think this is a situation best avoided altogether, and not just becuase it's not befitting of a young lady to be seen drunk in public :). It really is putting your personal safety at risk.

However, I digress..... Yes, this is one of the reasons people go out and buy the MAP, but I still don't see why they can't just go to the chemist and buy it when needed rather than have a "spare" lying about. If it was indeed due to too much drink the night before then a brisk walk to the shops might do them some good :)

The only situation where I can see this being of benefit is perhaps someone who normally uses a barrier method and lives somewhere that the chances of them reaching a doctor/clinic/pharmacy within the 72 hour window is either very low or would be extremely impractical. In that case yes, they tried their best, the method failed and to penalise them for not being able to reach someone is not acceptable.

[relliott]

another thought just came to me...... people also assume that the MAP will always work..... like everything, it's not perfect

[elliottsimpson]

(though are you casting nasturtiums about our integrity :) )
SOZ - I thought I had worded the comment carefully to not suggest anything - although, if you are drunk enough, it maybe just a matter of luck if you wake up in the morning

[elliottsimpson]

I'm almost amazed at the sheer blind trust people put in complete strangers to look out for them and make sure they get home ok! I totally agree - when you get drunk, you leave yourself in the care of a drunk -YOURSELF

[Adam Gilmour]

I'd agree with that one Elliott.......been there quite a few times before and didn't do a very good job! ;p

As for the morning after pill, yes I htink it is a good idea to make it more freely available (in the right circumstances). Having a sexual history taken from a doctor in an emergency situation could be very intimidating to many females whioch may discourage them from seeking advice/medication if they truly needed it!

[Devlinator]

i remember form working in a chemists that at the 72 hour point MAP is onlky something like 50% effective, which is something that people forget. the other issue surrounding the 'just in case' scenario is that people may become complacent, or be too incompetent (due to alcohol) to remember to use anything, and are also putting themselves at risk of STDs.

[lil_kazzy]

I'd agree with that one Elliott.......been there quite a few times before and didn't do a very good job! ;p

As for the morning after pill, yes I htink it is a good idea to make it more freely available (in the right circumstances). Having a sexual history taken from a doctor in an emergency situation could be very intimidating to many females whioch may discourage them from seeking advice/medication if they truly needed it!
Yeah, that's what I was trying to say but couldn't quite string the words together.

[lil_kazzy]

from fpa.org.uk:

If taken within 24 hours of unprotected sexual intercourse, they will prevent more than 9 out of 10 (95%) pregnancies expected to occur if no emergency contraception had been used.
If taken 72 hours after unprotected sex they will prevent more than 5 out of 10 (58%) pregnancies expected to occur if no emergency contraception had been used.

So if people have it at home then they may be able to take it faster and therefore it will be more effective. In theory.

[Devlinator]

true but theres still the whole issue of STDs, which remember are on the increase in our age group.

[andrewbaillie]

I'd agree with that one Elliott.......been there quite a few times before and didn't do a very good job! ;p


so you only do stuff like that when ur drunk?

[crumpet]

to be honest i cant see there being much harm in it being dispensed incase. only if theres been a change in medical history then the woman may not be able to take it but does anyway coz no one asks her any questions. all it does is save the walk to the chemists. it wont save on an embarrissment coz hows the chemist to know if its for today of just incase? what if a girl has sex at midnight, condom bursts? the only options i know of are a+e or wait till morning. would a+e be happy to see you on a busy saturnay night or make u wait about a bit? wouldnt it be better for her to have the pill and take it straight after? as it has always been this drug is open to abuse. i cant see there being more abuse by giving it out before hand. you can trot of to the chemist as often as ur purse will allow what difference is it if its the night before or after? obviously decreasing the price of condoms (also make more freely available) may make a difference but some people will never learn or care!

[Adam Gilmour]

so you only do stuff like that when ur drunk?

Always! :p

[andrewbaillie]

no comment, i know too much about ur opinions on that already!

[VikMcG]

to be honest i cant see there being much harm in it being dispensed incase. what if a girl has sex at midnight, condom bursts? the only options i know of are a+e or wait till morning. would a+e be happy to see you on a busy saturnay night or make u wait about a bit? wouldnt it be better for her to have the pill and take it straight after?

I totally argee with what you said. Obivious taking the morning after pill repeatedly as a form of contraception is wrong (why don't this people just go on the oral contraceptive pill instead - never made much sense to me). But there is circumstances where other forms of contraception has failed (quite common for condoms to burst) and the MAP is required to be used so what is the problem with buying it over the counter encase this circumstance can happen. As for people using it after unprotective sex esp when drunk, they should be more worried about the risk of STIs.

What do people think about free condoms in bars/ pubs? Is it encouraging one night stands or is it helping decrease the number of sti? Interestingly enough I was watching a documentary about the 'Bible Belt' in Amercia (texas etc). They reportly have the highest rate of teenage pregnancies in Amercia. This is because at school they are being taught the only contraception that works is absteince. So therefore typically teenagers go out get drunk once, have a mistaken shag (don't use any contraception because they believe that condoms are useless) and get pregnant. I think education on safe sexual practice is a necessity.

Back to the original topic in my opinion, I think it is a good idea for MAP to be sold because it can cut down on the mental stress to individual (having to wait for the pill, questions asked etc) and the sooner it is taken the more reliable it'll be.
Vicki

[relliott]

Just some extra info on this one:

Part of the reason for the questions being asked is to avoid taking the pill unnecessarily. Increased hormone exposure is a known risk factor for serious medical conditions in later life. By using information based on the timing of an individuals cycle it can be reasoned when the MAP is and is not necessary. This is also true in the case of someone who has had multiple episodes of unprotected sex in the same cycle. Your average intelligence level in some areas would preclude letting the patients figure this out on their own, even if it did generate more cash in sales.

The questions are not designed to put people off, and i don't think anyone has proven that it does put people off seeking help.

As I have said, I have nothing against the MAP being in existence, but I think its sale should be regulated and the first dose witnessed as is current practice.

Should we let everyone buy antibiotics just in case?

[dMcgeadie]

uff.. do you see that they are letting people buy antibiotic eye drops freely out of boots?


oooooh, what would happen in the long run? :D

would a person's eyes fall out, turn purple or just close up forever? :evil

[VikMcG]

Ok back to the comment about the increased hormone levels and risk factors later on in life . The pill and the MAP do have risk factors of DVT and excessive blood clotting compared to normal physiological states. But there is an even greater a risk of excessive blood clotting/DVT in pregnancy (we were taught 30times increased compared to the pill which is five times). Not to mention the other risk - socially and medically which pregnancy can involve.

The risk you are talking about later on in life is more to do with long term use of the oral contraceptive pill and more importantly HRT and not necessarily a patient once using the MAP. Also every woman is at risk of developing breast cancer. Next you will be telling me not to eat red meat incase I develop colon cancer.

MAP over the counter is regulated by qualified pharmacists and like I said before, the sooner the patient gets the MAP the more effective it is. Comparing the selling of antibiotics to MAP is like comparing chalk to cheese. A high percentage of infections are viral and thats the difference between medical and pharmacist training is that we go on history, signs, symptoms and examination to differentiate between when to give antibiotics and when not to. Whereas these clinical skills (esp the examination bit) are not entirely necessary when one needs decide if a woman needs MAP. Also even if a patients is day 5 or 19 of their cycle and prob pass ovulation on day 14, its better to be safe than sorry as each woman's cycle is different ( some have 21 day cycles others have 31 day cycles). At the end of the day, when I do qualify, I would rather px the MAP to a patient than wait 2 months later to do an abortion - but hey thats just my opinion

Finally safe sex education/ using a condom is the best of all.
Vicki x

[relliott]

As I said, i'm not against the MAP

I just don't want people keeping stockpiles of it at home.

[dMcgeadie]

Is that because you dont want to think that these people can treat themselves and put you out of a job, or do you not like hoarders in general?

[relliott]

If the medicine was perfectly safe for people to stock at home it would be available as such. If it was truly believed to be ok by pharmacists it would be on the shelves already.

Since starting this thread however i notice that no further action has been taken on this particular initiative (or at least hasn't been widely publicised)

[Loocy]

The risk you are talking about later on in life is more to do with long term use of the oral contraceptive pill and more importantly HRT and not necessarily a patient once using the MAP. Also every woman is at risk of developing breast cancer. Next you will be telling me not to eat red meat incase I develop colon cancer.



Sorry to push this off-topic, but I've been spending time at a GP's on work experience and because of the fairly recent publicity about the dangers of long-use HRT there were women coming in who were being recommended to stop using it - some had been on it for as much as 20 years. However even after being warned of the statistically increased risk of breast/ovarian cancer some were still adamant they wanted to continue using it - what does everyone think about the doctor's role in this situation? I know that the patient comes first and if they want to keep being prescribed it then there isn't much choice, but it's such an awkward position for a GP to be in, being asked to prescribe something that could end up causing serious illness.

[Adam Gilmour]

Techinically GPS are asked to prescribe things which can end up causing serious illness everyday however. Every medication has a side effect (none are completely safe). So the GP is already put in this position every time they write a prescription (do you give the heart med as it may put the patient in renal failure........do you give the renal drugs as it may exacerbate heart failure........do you give the aspirin as it may cause a peptic ulcer). Same goes for surgeons doing operations (theres a chance we may damage one of your nerves during this operation do you still want us to proceed); for anaesthetists (you may have a severe reaction the anaesthetic). All in al medicince a risky job and therefore patient choice must always come first provided that they are aware of all risks and benefits.

One of the biggest parts of medicine/pharmacotherapy is not treatment but symptom control. Therefore if the risks have been explained to the patient and they still feel it is better to be rid of the symtoms then I feel that is their choice.

[VikMcG]

Is it true that alot of patient problems come from doctors px? Iatrogenic causes

[relliott]

depends on what you are talking about really