Norplant, the contraceptive implant effective for five years, has been drawing attention across the state, but county doctors say there is little demand for the prescription among Carroll women.
"We haven't had an overwhelming response," said Dr. Steven Miller, a Westminster obstetrician and gynecologist, who has performed one implant as part of his training at Greater Baltimore Medical Center.
Miller, a Baltimore resident, was certified to perform the procedure a month ago after watching an instruction video and practicing the implant under the supervision of another trained doctor.
The county Health Department, which has not begun implanting the contraceptive, has a 14-person waiting list, said Larry L. Leitch, Carroll's deputy health officer.
The department plans to set up a training program for health officials after July 1, Leitch said.
Some of the 15county ob-gyns are expressing interest in the device, which was approved by the U.S. Food and Drug Administration last December, but onlyMiller and Dr. Sang J. Lee, also a Westminster ob-gyn, have completed training for the 15-minute operation.
The implant, which the manufacturer says is 99.8 percent effective, requires only a local anesthetic and can be done by doctors, nurse practitioners and midwives atany clinic, doctor's office or hospital.
Six matchstick-size capsules are inserted through a one-eighth inch incision in the woman's upper arm. The capsules, which cannot be seen, release a steady trickle of Levonorgestrel, a synthetic contraceptive, into the bloodstream for five years or until the implants are removed.
Norplant is easily removed and fertility is restored within a week, said Dr. George R. Huggins, chairman of the obstetrics and gynecology department at Francis Scott Key Medical Center in Baltimore.
The cost varies from $595 at Baltimore's Planned Parenthood branch to $850 at Baltimore hospitals. Miller said he charges $650.
By comparison, the retail cost of a five-year supply of birth-control pills averages about $1,200.
The state will foot the bill for Medicaid patients as will some HMOs, including CareFirst and the Johns Hopkins Health Plan. Blue Cross-Blue Shield of Maryland, the largest health-care provider in the state, also will provide coverage.
Leitch said the county health department has not finalized its funding plans.
"The (actual) cost of Norplant is about $350," he said. "We will likely charge on a sliding scale of 10 percent to 100 percent based on ability to pay."
The state Health and Mental Hygiene Department said it will use part ofa $93,455 grant from the Baltimore-based Abell Foundation to fund the procedure. State Health Department officials said between $10,000 and $15,000 will be used to pay for women who do not qualify for Medicaid but cannot afford the implant themselves.
Huggins said Norplant has no serious side-effects, but menstrual cycles of nearly 70 percent of the women using the contraceptive are disrupted by irregular timing, spotting between periods, heavier bleeding and missed periods.
Marcia Lipman, Miller's lone Norplant patient, said that while the disruption is a nuisance, she is glad she underwent the procedure.
"I feel safe," said Lipman, an Owings Mills resident. "It makes sex more appealing . . . because I don't have to worry (about pregnancy) any more."
Lipman described the insertion as "uncomfortable," saying her arm was "a little sore" the first week. But, "I recommend ithighly to anyone . . . who gets pregnant very easily and has problems taking the pill."
The 26-year-old mother of two said she had headaches and dizzy spells after taking the pill for a number of years. She said she chose Norplant because she and her husband are not readyfor another child.
Estrogen is blamed for many of the oral contraceptive's side effects. Other contraceptives were not effective, Lipman said.
Dr. Sheldon Segal, who developed the drug for the non-profit research group Population Council, said that the contraceptive will not protect against AIDS and other sexually transmitted diseases.
Segal began research for the implant in 1966, long before people linked "contraception protection with sex," he said.
But Huggins said that was not the drug's function.
"This thing was designed to prevent pregnancy, and it does that very well," Huggins said. "There is not one method that will do everything."
Doctors stress the importance of counseling before choosing to use Norplant.
"These implants are not for every woman," said Dr. Dean Moutos, a fellow in reproductive endocrinology and fertility at Baltimore's Johns Hopkins Hospital. "Women are counseled very thoroughly."
Some human-rights activists fear the implant will be misused.
Although Norplant is in its early stages in the United States, Moutos said thousands of women in other countries have used it.
"It's new to the U.S., but that'sall," he said. "It's been in use for at least a decade overseas."
Huggins said Norplant "is regulated probably more than any other contraceptive on the market."
Wyeth-Ayerst Laboratories in Philadelphia is the only company in the United States licensed to market the implant.
Audrey A. Ashby, a spokeswoman for Wyeth-Ayerst, said the company is not advertising directly to consumers, but has spent nearly$80,000 training physicians in the procedure.
"We've emphasized the training," Ashby said. "We want the product to be one of the birth-control options available to women. Between the doctors and the patient, they will come up with the best method for her."
The company will sell the drug only to a licensed practitioner, Huggins said.
"By law, they don't have to," Huggins said. "They are being very responsible and very careful."