Should pharmacists be happy or not that emergency hormonal contraception (EHC), what the media calls the morning after pill, is to be available as a pharmacy-only product from the New Year? The change to P status has been the subject of much discussion among the profession, on ethical grounds and about how the the product should be made available.
While Levonelle may be technically changing status on New Year's day an angle the media were quick to latch on to, Schering is not actually planning a public launch of the product before the end of January. This will allow time for training to take place and stocks with the appropriate packaging and leaflets to become available (see p872). In the meantime, pharmacists are being told not to sell existing prescription only medicine packs.
Leaving aside those who did not want to see EHC deregulated at all, one of the biggest areas of contention has been whether Levonelle should be available over the counter as a P medicine (at a cost to the user) or supplied under a patient group direction (on the National Health Service). The successful trials of EHC in Manchester and London used PGDs.
One of the arguments for supply under PGDs is that, because the supply is free of charge, it encourages women (or girls) on low incomes to use the product. However, in the trials, many of those using EHC were not teenagers but 20- or 30-somethings in stable relationships who would have been able to afford the proposed £19.99 retail price. These women, it is argued, would feel that the personal benefits of the using the product outweighed its cost.
To help pharmacists, we publish guidance this week from the Royal Pharmaceutical Society on pharmacy sales of EHC (see pp890-92). The whole area of post-coital contraception is fraught with difficulties and pharmacists will need to be sensitive in the way in which all requests for EHC are handled. Women asking for this product will already be concerned and, although a certain amount of questioning is necessary, they should not be put off asking for it as soon as possible for fear of facing an interrogation.
The sale of EHC has already attracted wide media interest. Once the product is available in pharmacies, there are bound to be attempts to purchase it by journalists or researchers from consumer organisations. Pharmacists should read the Society's guidelines closely and handle each sale carefully.
The product has been reclassified because it is felt that there will be a public benefit from it. For some women, more convenient access to EHC will ensure that they do have a happy New Year.