Originally posted on March 15, 2012, on bedsider.org
A small Pennsylvania college made national headlines recently for putting packs of the emergency contraceptive Plan B in a vending machine in their student health center. Imagine the uproar if that vending machine had packs of the pill in it, too. Selling the pill in a vending machine wouldn’t be legal in the U.S., but the idea raises an interesting question about how accessible oral contraceptives should be.
Is it dangerous to sell the pill over- or behind-the-counter?
Doctors have argued since 1968 that the pill can safely be sold over-the-counter (OTC). That means rather than go to a doctor or clinic for a prescription, a woman could go to a drug store to pick up a pack of pills in the same way she can now buy aspirin. Behind-the-counter means a woman would ask a pharmacist for the pill, but she still wouldn’t need a prescription from a doctor. Over 50 drugs that were once prescription-only are now OTC in the U.S., including Sudafed, Cortaid, Advil, Nyquil, Monistat, and Claritin.
The pill doesn’t have much in common with other prescription-only drugs:
- It’s not addictive (unlike cigarettes that are sold in vending machines).
- Taking too many pills might make you throw up, but it doesn’t cause a deadly overdose (unlike the acetaminophen that is on the shelves of every drug store).
- All brands of the pill work without fine-tuning the dose with the help of a doctor.
- Taking the pill for a year results in long-term health benefits, including protection from cancer of the uterus or ovary.
- The pill is for women (or couples) who’ve decided they want to avoid pregnancy—no need for a diagnosis from a health care provider.
There’s a lot of misinformation about the safety of the pill. In fact, women in over 80 countries can already buy it without a prescription—including women just across the border in Mexico.* As medications go, the pill is very safe—safer than having a baby, driving, smoking, or taking daily aspirin. That said, the pill does have risks for women with certain medical conditions; if it were sold OTC, could women correctly decide whether it would be a good option for them? One study in El Paso showed that women who answered 15 questions were pretty accurate in choosing whether the pill was safe for them. The study asked a nurse to decide if the same women could safely use the pill, and compared the answers of the women and the nurse. For all but two of the questions, women and the nurse agreed nearly all of the time (98%).
The questions they didn’t agree on were about blood pressure and migraine headaches, the two most common health conditions that make the pill less safe—both in this study and in real life.
1. High blood pressure. Some of the women in the study didn’t know they had high blood pressure. It becomes more common as people get older, so older women were more likely than young women to have undiagnosed high blood pressure. These women thought they could use the pill, but the nurse said they shouldn’t.
2. Migraine headaches with changes in vision, hearing and motion. Young women tend to experience more migraine headaches than women in their 30s. Only one very specific type of migraine makes the pill less safe, called migraine with aura. (In this case “aura” means changes in vision, hearing or motion.) Women who had migraines without aura sometimes thought they could not use the pill, but the nurse said they’d be able to.
This is where a pharmacist could come in if the pill were sold behind-the-counter. Pharmacists help people take medications safely, and they could check a woman’s blood pressure and help diagnose the different types of migraines. A study in Seattle showed that women liked getting the pill directly from a pharmacist, and pharmacists liked being able to offer it. But there was a catch: zero insurance companies agreed to pay the pharmacists for their time, so women had to pay for the pharmacy consultation out-of-pocket.