Falling back on Plan B is tough in most states

Contraception: Only five allow pharmacists to dispense morning-after pill without prescription.

March 02, 2004|By Jean Marbella | Jean Marbella,SUN NATIONAL STAFF

About once a week, a woman will come into Peter Lee's pharmacy in need of a Plan B. Because as with anything involving humans, particularly when it comes to sex, Plan A sometimes goes awry.

Lee, soft-spoken and discreet, doesn't know or particularly care what Plan A was or why it failed. Condoms break; a woman forgets to take her birth control pills on vacation; people who should know better end up a drink or two later having unprotected sex.

After a brief consultation with Lee, the woman will walk out with her Plan B -- the brand name of a morning-after pill that can prevent pregnancy if taken soon after having unprotected sex.

Plan B isn't so easy to fall back on in most parts of the country, where it usually requires a doctor's prescription. Although a Food and Drug Administration advisory panel voted overwhelmingly in December to recommend that the drug be approved for over-the-counter sales, the agency has delayed acting on the recommendation. Birth control activists have charged that the FDA is bending to political pressure from conservative and religious groups opposed to wider access to contraception.

But in five states, including New Mexico, where Lee is the pharmacist at Fraser Pharmacy in Santa Fe, state laws allow specially trained pharmacists to dispense the morning-after pill directly to women, selling it to them not so much over the counter as from behind the counter.

As the FDA decision remains stalled -- the ruling was expected in mid-February but has been delayed about three months -- roughly a dozen more states, including Maryland, are considering legislation that would allow pharmacists to directly sell the morning-after pill.

Advocates say streamlining access to Plan B is critical: Although it can be taken up to 72 hours after unprotected sex, it is most effective in the first 24 hours.

"Think of a Saturday morning, trying to get to your doctor," said Lee, whose pharmacy is open or accessible via an answering service on weekends. "This is a safe and effective way of preventing pregnancy, and I think it's needed."

Time is also of the essence when it comes to waiting on federal action, susceptible as it can be to political pressures, said state Sen. Sharon M. Grosfeld, a Montgomery County Democrat who recently introduced legislation on the sale of the morning-after pill in Maryland.

"I don't feel women can wait around until the FDA makes its decision," she said. "The only reason the FDA is delaying its decision, even though the majority of its advisory committee recommended it, is political."

The FDA advisory panel voted 23-4 to approve Plan B for over-the-counter sales, and a host of organizations -- from the American Medical Association to feminist and family planning groups -- has long supported such a move. But last month, the FDA delayed its decision, saying it needed more data, particularly on the drug's use by teen-agers.

In January, a group of 49 House Republicans raised similar concerns that over-the-counter sales of the drug might have the effect of giving teen-agers greater license to have unprotected sex. In a Jan. 9 letter, the group urged President Bush to oppose the advisory panel's recommendation, saying such a measure would increase sexual promiscuity and the spread of venereal diseases among adolescents.

But advocates say that while the morning-after pill does not protect against sexually transmitted diseases, neither do the more common birth control pills that women take on a monthly cycle. In fact, Plan B is just a higher dose of the same hormone used in birth control pills; each dose is composed of two pills, one to be taken as soon as possible and the second 12 hours later.

The most common side effect is nausea, and some women have also experienced a disruption in their menstrual cycles.

There is another morning-after pill on the market called Preven, but the FDA is considering only Plan B for over-the-counter sales.

Proponents say much of the controversy surrounding Plan B comes from the mistaken belief that it is akin to the abortion pill RU-486, a non-surgical means of terminating an existing pregnancy. Rather, the morning-after pill works by delaying ovulation or preventing fertilization in the first place; additionally, it may also prevent a fertilized egg from implanting in the uterus. The morning-after pill has no effect on a pregnancy that is already established.

"It's not like it's some strange new drug," Lee said. "There really isn't much difference between using this and using regular birth control. They work the same way, so what's the issue? This is not abortion. This is a preventative measure -- the pregnancy never takes place."

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