Independent Perspective News - Morning-After Pill May Go Over the Counter

The pills are available over the counter in more than a dozen countries. France offers them in schools, to girls as young as 12. But large drug companies shied away from distributing them in this country, to avoid controversy and because they were not highly profitable.

For years, some family-planning clinics would cut up packets of birth control pills to use as morning-after pills. In 1997, the Food and Drug Administration declared the regimen safe, and it took the unusual step of putting out a notice seeking a company willing to produce a morning-after pill.

Roderick Mackenzie, a former drug company executive, took up the offer and founded Gynetics, which in 1998 won approval for the first morning-after pill, known as Preven. The next year, the drug agency approved Plan B, a pill distributed by Women's Capital, formed by women's health advocates.

Without the money to advertise the pill, the companies began urging its use at college health clinics and family planning clinics. Women's Capital did not offer Plan B to retail pharmacies until two years after it was approved.

"We did it upside down," said Sharon Camp, the company's chief executive. "Usually you start with the high-profit prescribers, then it trickles down to the public health sector. We did it just the reverse."

Much of the support has come from pharmacists, who argue that they should be the primary distributors because time is critical in taking the pills and many women cannot get to their doctors in time. In 1998, Washington State took advantage of state regulations that allowed doctors to delegate some tasks to assign to pharmacists the task of dispensing emergency contraceptives. Doctors issue standing prescriptions for the drug, and the pharmacists dispense the pills and monitor the patients. New Mexico, Alaska, and California have approved similar arrangements.

At Ross Valley Pharmacy in Marin County, Calif., Paul Lofholm had been cutting up birth control packets for distribution at Planned Parenthood clinics for years. Now, he says, distributing the morning-after pill has become a "regular business." A store pharmacist remains on call around the clock.

Jerry Karbeling, senior vice president of the Iowa Pharmacy Association, said: "There's a desire, especially from people who are graduating from pharmacy schools right now, to be involved in something more than just handing out pills and bottles. We've been saying for a long time that the pharmacist is the most accessible health care professional."

Still, some controversy lingers. A few large chain pharmacies have refused to stock the drug. The American Life League, a group that opposes both abortion and birth control, says it considers the morning-after pill an abortion drug. In the Maryland House of Delegates, a debate this year over allowing pharmacists to distribute the pills quickly became one about teenage promiscuity and abortion.

But in general, advocates of abortion rights say it is far easier to talk about emergency contraception than it is to talk about RU-486 or abortion. Many people who oppose abortions support birth control as a way to prevent them. The National Right to Life Committee, for example, the nation's most prominent antiabortion group, has said it will not take any position on the application to make emergency contraception available over the counter. Even the American Life League said it did not plan to oppose approval.

The Food and Drug Administration would not comment on the pending application, other than to say a decision would probably be made within 10 months. Some pharmacists and doctors who support the use of the pill have argued that it will be used as regular birth control if made over the counter, particular among teenagers. But studies showed that making it available did not prompt women to use it repeatedly. Of 540 women in one study, Dr. Camp said, 10 used it more than once.

The pills disrupt the menstrual cycle and can cause nausea, which dissuades regular use. So does the price. The morning-after pill typically costs $20 to $30 a dose, more than the cost of a month's supply of birth control pills. While the pill has been most popular among women ages 19 to 29, studies showed it was not widely used by teenagers.

Gradually, it is gaining acceptance. Thomas Purdon, who as president of the American College of Obstetricians and Gynecologists recommended providing advance prescriptions, said some of his colleagues at first opposed this. But the practice, Dr. Purdon said, has become more common. "We're gradually breaking down the barriers."

Sales reflect that. Gynetics said its sales had increased 50 percent last year. Plan B has sold three million doses since it was approved in 1999, with the numbers doubling each year. The Alan Guttmacher Institute estimated that the pills prevented 51,000 abortions in 2000.

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