From Mr P. Walton, MRPharmS
Responsible supply
From Mr P. Walton, MRPharmS
SIR,—Schering has applied for pharmacy status for Levonelle-2. This will mean that pharmacists who think that the product should be widely available will also have to consider the commercial aspect when it is to be supplied. As patients can go to their general practitioner or family planning clinic to get the product for free, pharmacists such as myself, who work in areas where the vast majority of the population who have to pay for their prescriptions are on low wages, will have a moral dilemma at the point of supply.
I will refuse to say to my patients: "You may have EHC from me now, madam, and pay £15, or you can wait for a doctor's or family planning clinic appointment and obtain the product free. I must warn you that EHC efficacy falls off dramatically with time, and I know that the current waiting time at your GPs is 48 hours." This is a no-win situation which will be seen as a form of blackmail — "pay or get pregnant" — and pharmacists will be seen as the bad guys. We should of course be given a supply function that mirrors other modes of supply.
Some people say that the drug is so safe that it could even be supplied in vending machines. Of course the drug is safe; it is issues surrounding pregnancy that are not safe. EHC requires professional input to be used safely, otherwise we will see increased pregnancy rates where EHC is used in place of mainstream contraception, increased incidence of sexually transmitted infections where it is used in place of condoms, and increased sexual health problems where clients (especially vulnerable youngsters) are persuaded that they may have sex without protection and use EHC later.
If the product is introduced as a P medicine, I would have to think very carefully about whether to supply at all. I am all for increased responsible availability, but I want no part in a supply mode that can later be questioned.
ssPerhaps there is an alternative. Levonorgestrel must be a very cheap drug, and maybe another manufacturer could come into the market with "Responsibelle", a POM version of a levonorgestrel product to be supplied with full support for supply on patient group directions, funded by excessive profits. This would give pharmacists such as myself a method of supply that I am much more happy with. Of course funding for responsible supply could dry up, and leave only the commercial version to be supplied by pharmacists as a P medicine. Every bone in my body tells me that in that situation I will refuse to use my additional training to supply EHC.
Philip Walton Manchester