Last November, an online pharmacy began selling emergency hormonal contraceptive (EHC) levonorgestrel for £3. Along with the charity British Pregnancy Advisory Service (BPAS) calling for the drug to be reclassified from a pharmacy (P) to general sales list (GSL) product and placed on pharmacy shelves for self-selection, this made me stop and think. How would I feel about it being on the shop shelf as a pharmacist? And how, as a woman, would I feel about it being more readily available and cheaper?
My first thoughts concerned the price: EHC offered in community pharmacy is quite expensive, so the lower price appears to be quite reasonable to those who wish to prevent an unwanted pregnancy. The cheaper pill is more accessible to those struggling financially.
However, we should not forget the EHC service that pharmacists can provide for free under certain circumstances, under a patient group direction. Through this, a more tailored service is offered to the patient.
The reality of a drastic price reduction was quickly overshadowed by a feeling of anxiety when I considered the option of having packets of EHC on the shelf, where they could be purchased without my knowledge.
The potential for patients to purchase EHC without speaking to a pharmacist threw up several scenarios that made me uncomfortable. For instance, the 12-year-old girl who is frightened, but has heard of EHC and gets her older friend to buy it for her; the male purchasing it for an underage girl he’s illegally sleeping with; and women buying it for when they’re anticipating unprotected sex, but in turn risk the transmission of infections by not using protection.
Emergency hormonal contraception is so named for its purpose: use in an emergency. By making it readily available on the shelf, we risk encouraging unprotected sex to become the norm. As women, we might be more inclined to have unprotected sex if we can just pop to the supermarket and buy a tablet for £3 the next day, no questions asked. The risk of not following administration instructions or taking the medicine inappropriately is too high to trust that women should be able to buy on demand.
Not only are we risking its inappropriate or excessive use, and a lax attitude towards unprotected sex, we are also risking girls and women losing the opportunity for a healthcare professional to recognise the possibility of a safeguarding issue and step in on their behalf.
As a pharmacist, I speak to women of all ages and backgrounds when I provide this medicine. My consultations have ranged from a woman laughing at herself after an awkward, unplanned night on the town to a young girl sat with her mother, looking uncomfortable and scared. The consultations offer us the opportunity to assess the circumstances of the patient, discuss clinical efficacy, provide adequate counselling and signpost to other services if necessary.
Pharmacy is readily accessible to patients and pharmacists are often the last healthcare professionals to speak to a patient before they take a medicine. In the case of EHC, there is simply too much information to process, pass on and discuss to allow the medicine to become available for patients to select themselves.
Reducing the price might make EHC more accessible, but if people can pick it off of the shelf along with their groceries then the seriousness of the medicine, its requirements and the clinical assessment we undertake, including safeguarding, will be lost – putting patients at risk.
Laura Buckley is a locum pharmacist based in Hull