JP at large: Plan B - The opening we've been waiting for?

November 6, 2006

There will be no doctor to hide behind. You are going to be, in effect, the prescriber. You are going to be the one to question the woman about when the event took place. It could be a mother or sister, maybe the father of a girl under 18. You are the one who will counsel about the correct usage.

She will need to know about the possibility of nausea. Most important, you get the chance to serve someone who sincerely perceives that she made a mistake with unprotected sexual intercourse.

In Washington State, seven years ago, we took a weekend of training to be qualified to both prescribe and dispense the morning-after pill. This was before Plan B. We prescribed two Ovral tablets and two promethazine 25 mg. Cash only. No insurance.

Your patient is liable to say something like this, "I hardly know him. It was stupid. I know better. I don't want to take a chance on being pregnant right now. Can you help me? Isn't there a new pill? No doctor's prescription needed?"

You may think that your patient is just a modern-day Jezebel. You may quote scripture. Use all the buzzwords: hell, abortion, baby-killer, murderer. As you watch her back as she leaves the store, will you understand that your company has just lost a patient? Forever!

The profession is still dealing with this push-me-pull-you controversy, and we will have two sides digging in their heels for a long time. There is no doctor involved now. Will we be smart enough to keep the fighting to ourselves? Not plaster it all over the headlines. There is something very big at stake here. Let's not screw it up.

Plan B is the first drug in a third category of drugs, which we have been after for the past 30 years. This is a drug that will be kept behind the counter and sold only with pharmacist oversight. So far, we have been stonewalled at every turn over a third class of drugs.

We wanted the NSAIDs to be in a third class of drugs, kept behind the counter. We begged that the creams and suppositories for vaginal moniliasis be restricted to sale with pharmacist oversight. We know enough to ask the patient the color of the discharge and whether there is an odor.

The night clerk at the 7-Eleven can do actual damage with anecdotal advice: "Oh, try this. My Aunt Hattie had terrible itching. This is good for that."

We know that an untreated bacterial infection could be a disaster. We know that these products belong in a third class. We have been fighting hard for it for decades.

Now we actually do have a third class. There may be only one product in it, but it is finally a reality. Plan B could be the start of something hugely beneficial to the profession. Let's not blow it.

If the American Medical Association has its way, it won't go any further. This national doctor's organization never wants to lose control of anything. AMA has raised the specter of pharmacist diagnosis leading to possible liability.

Well, think! Isn't it about time for a third class of drugs?

Jim Plagakis is a community pharmacist who lives in Galveston, Texas. You can e-mail him at jpgakis@hotmail.com

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You can also check out his Web site at http://jimplagakis.com/.