Home' Australian Pharmacist : Australian Pharmacist November 2016 Contents Australian Pharmacist November 2016 I ©Pharmaceutical Society of Australia Ltd.
Pharmacists around Australia recently found themselves in the middle of a
media frenzy centred on a TV celebrity and emergency contraception (EC).
With the celebrity claiming to have
‘miscarried’ after her husband was
denied the purchase of the EC, the issue
about pharmacists denying access to
EC – the morning after pill – blazed on
And rightly so!
Students and practitioners argued in
social media circles about the fact that
some pharmacists are still stuck in the
dark ages in relation to some dispensing
guidelines relating to EC. But why? The
fact is, despite PSA making some fairly
major changes to these guidelines
in 2011 and again in 2014, some
pharmacists either claim not to have
been notified or simply adopted early
precautions and did not keep up to date
with evidence-based and consumer-
It is time to wake up.
Historically, for those young enough
not to be aware of the recent history
of contraception and reproductive
medicines in the world, EC was
introduced in the 1970s as a Prescription-
Only medicine. Patients would need to
take the whole strip of levonorgestrel.
Later a two-tablet formulation was
developed. Prescription-Only status
remained until 2004. Relatively recently
the one-tablet EC formulation emerged.
As pharmacists would know,
levonorgestrel’s main modes of
1. Altering the normal menstrual cycle,
delaying ovulation; or
2. Inhibiting ovulation, meaning the egg
will not be released from the ovary.
EC has always been controversial, as
was the oral contraceptive pill when
it was introduced in 1960. Even more
so was RU486. The debate was usually
about whether a healthcare provider–
advocating for the sanctity of life, had
a moral objection to EC, and wanted
to exercise their right to conscientious
objection – which was made conditional
on providing ‘continuity of care’ for the
patient. Up until 2004, this debate was
usually about doctors’ choices and their
right to conscientious objection.
In 2004, pharmacists found themselves
front and centre of the debate, after
EC was switched to Schedule 3. Now a
Pharmacist-Only medicine, it was within
the realm of the pharmacists’ duties to
provide the EC on request.
This down-scheduling raised concerns
from the medical profession. In response
to this, and recognising the privilege
and the opportunity to prove to the
world our capacity, PSA developed
guidelines for pharmacists to follow
when providing EC.
At the time, it was declared
inappropriate to supply EC to a
surrogate, particularly male surrogates
and not supply to under-aged
consumers. It was stated that EC was
ineffective 72 hours after unprotected
intercourse. And the consumer would
have to answer a litany of questions
either put to her verbally or she was
asked to fill out a survey-like document.
Dr Betty Chaar MPS is Senior Lecturer and
MPharm Co-ordinator at the Faculty of Pharmacy,
The University of Sydney. Opinions expressed
in this column are not necessarily those of the
Pharmaceutical Society, its Board or staff.
In this climate, some research was
conducted in Australia exploring
views and practices regarding EC.
Findings of these studies suggested
that pharmacists needed training and
that some pharmacists engaged in
condescending behaviour, putting up
barriers for consumers to battle with
before accessing EC, with no provision
of privacy and too many questions to
The demand for revision of dispensing
guidelines became a consumer-driven
necessity. It became clear protocols
needed to be simplified and access to EC
facilitated rather than tightly restricted.
The down-scheduling of the product
was, after all meant to facilitate access to
In 2014 PSA endorsed revised
dispensing guidelines, Guidance for
provision of a Pharmacist Only medicine
– Levonorgestrel. These guidelines and
their footnotes clearly state, among
several other points, that the pharmacist
should not deny EC to third parties;
should not deny purchase of ‘advance
supply’, and should not discriminate
based on age. (See Table 1.)
These guidelines represent the
contemporary needs of consumers,
our professional obligations and our
ethical duties to our patients. If you are
a practitioner reading this article already
practicing according to contemporary
standards – please do spread the word,
and engage in quality role modeling. If
you are a practitioner who is in doubt,
please refer to the guidelines and
change your practices.
Are you across the EHC
BY DR BETTY CHAAR
» ETHICAL DILEMMAS
Links Archive Australian Pharmacist October 2016 Australian Pharmacist December2016 Navigation Previous Page Next Page