July 21, 2006

Unified emergency contraceptive plan being developed

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Jeff Andrews, M.D.

Unified emergency contraceptive plan being developed

Beth Huff, M.S.N., R.N., with an emergency contraception prescription pad.
Photo by Anne Rayner

Beth Huff, M.S.N., R.N., with an emergency contraception prescription pad.
Photo by Anne Rayner

In an effort to assure that there is no barrier for patients requesting emergency contraception, a multi-disciplinary group of physicians, nurse-midwives, nurses and pharmacists has formed a task force to develop a unified approach for making the prescription available to patients at Vanderbilt.

The drug, PlanB, is an emergency contraceptive that can prevent a pregnancy after contraceptive failure or unprotected sex. Frequently confused with RU-486, it is not an abortion pill and will not work if a woman is already pregnant.

PlanB must be taken within 72 hours of unprotected sex and can reduce the risk of pregnancy by 89 percent. But the sooner a woman takes the medication the more effective it is, so it's important that a woman either have a prescription available to fill or be an established patient and able to get in touch with her health care provider quickly.

“Time is of the essence when getting that prescription filled,” said Jeff Andrews, M.D., associate professor of Obstetrics and Gynecology. With Beth Huff, M.S.N., R.N., Andrews spearheaded the task force, which included representatives from Obstetrics and Gynecology, Student Health, Adolescent/Pediatric Medicine, the Vanderbilt Pharmacy and the Nurse Midwifery program.

“If a condom breaks on Friday night, and a woman can't get in touch with her provider until Monday, the chances of the emergency prescription working on Monday are not as good as Friday night or even Saturday,” Andrews said.

“We are making sure that patients who are seen here now — if they are identified for being at risk in the future, for example, if they're using condoms that might break — can get a prescription that they can have filled immediately.”

The task force also established a protocol for established patients to make it easier and quicker to get a prescription over the phone.

PlanB, commonly referred to as the “morning after pill,” is approved by the Food and Drug Administration. Drug development expert Alastair Wood, M.B., Ch.B., who is leaving Vanderbilt to enter the private sector, was a strong advocate for PlanB’s approval (see related story, this issue).

PlanB contains the hormone levonorgestrel, the same hormone in birth control pills. Although it contains a larger dose of levonorgestrel, it works like a regular birth control pill, preventing pregnancy by stopping the release of an egg from the ovary, and may also prevent the fertilization of an egg by preventing the egg from attaching to the uterus. It won't, however, affect a fertilized egg already attached to the uterus — an existing pregnancy.

The company that manufactures PlanB has asked the FDA to make it widely available as an over-the-counter drug. It is already available over the counter in some states, such as California and New York.

“We are eager for the FDA to approve it so we don't have to be directly involved, and a patient can go to the counter, ask for the product, and purchase it,” Andrews said. “But in the meantime we want to have as little barrier as possible for women accessing emergency contraception at Vanderbilt.”

Emergency contraception is controversial. Some advocacy groups claim it is a form of abortion and, like all contraception, it is opposed by the Roman Catholic Church. And some suggest that if emergency contraception is widely available it will promote promiscuity, but actually there's evidence to the contrary, Andrews said.

Andrews said there are even emergency departments in the United States — Vanderbilt is not one of them — that do not provide the emergency prescription to women who are victims of sexual assault.

PlanB received a lot of press earlier this year when the Massachusetts Board of Registration in Pharmacy ruled in favor of three women who filed complaints claiming that Wal-Mart pharmacies refused to fill their prescriptions. It was part of a sting operation against Wal-Mart because its pharmacies had been denying emergency contraception to women who had prescriptions for it.

One of the women taking part in the sting operation was Vanderbilt Chancellor Gordon Gee's daughter, Rebekah, an Ob/Gyn resident at Harvard Medical School. Some of the women whose prescriptions had been denied were her patients. Gee and her colleagues brought suit against Wal-Mart, claiming that what the chain was doing was a violation of the Consumer Protection Act.

After the lawsuit, Wal-Mart reversed its stance and began stocking PlanB, but the company said it will maintain a conscientious objection policy, which lets employees who don't feel comfortable dispensing a medication refer customers to another pharmacist or pharmacy.

Andrews said if a physician, nurse practitioner, nurse midwife or pharmacist at Vanderbilt has an ethical objection to prescribing or filling a prescription for emergency contraception, it is his or her obligation to notify a supervisor so that arrangements are in place to assure the patient can receive equitable care without any difficulty.

Those participating in the task force were provided with the names of area pharmacies where it is easy to fill a prescription for emergency contraception, so that information can be passed along to patients.

“We knew there was some misinformation out there about emergency contraception, that one patient might be able to get it as part of routine medical care and another might be prevented from getting it,” Andrews said. “The most important function of this task force was to make sure that everybody here is on the same page.”