Post-coital pill
to be easily available

Emergency birth control pills
require no prescription

Women and teenagers 14 and older soon will be able to get "morning after" contraception pills from hundreds of Hawaii pharmacists without prescriptions or appointments.

Hotline To find the closest pharmacy offering emergency contraceptive pills, call a national hotline: 1-888-NOT2LATE (668-2-5283).

Some may offer the service as early as tomorrow.

"It's a great day for Hawaii," said Don Downing, a clinical associate professor at the University of Washington School of Pharmacy. He saw emergency contraception dramatically reduce abortions and unintended pregnancies in his state.

He has helped Hawaii and other states establish programs offering emergency contraception services by pharmacists under collaborative agreements with doctors.

Alaska, California, New Mexico and Maine have programs, and "Vermont is also coming on board," he said.

Downing was here the past three days training pharmacists for the new service during the Hawaii Pharmacists Association's annual meeting.

He said in an interview that he wanted "to rekindle enthusiasm" of those who have waited years for the program and "to remind everyone how critically important access to contraception is and how important this work is that everybody's involved in.

"Access to emergency contraception is a hidden unmet need in the community that affects everyone's lives."

"We are all very pleased to have emergency contraception (EC) access finally being implemented in Hawaii," said Nancy Partika, executive director of the Healthy Mothers Healthy Babies Coalition. The coalition, state Pharmacists' Association and other organizations began working in 2001 to establish the program.

The 2003 Legislature passed a law authorizing it and the state Board of Pharmacy developed administrative rules approved by the governor in December.

"Morning after" pills are birth control pills in stronger doses. They temporarily stop eggs from being released, reducing the chance of becoming pregnant by 75 to 94 percent when used within 72 to 120 hours after unprotected sex or a failed contraception method. They don't interfere with an established pregnancy.

About 300 pharmacists were expected to complete training and be certified for the program the past three days, said Barbara Kashiwabara, Kaiser Permanente's director of pharmaceutical services and chairwoman of the Pharmacy Association's government affairs committee.

Many physicians have volunteered to sign collaborative agreements with the pharmacists and some will be ready to go tomorrow, she said.

A patient requesting emergency contraceptive pills will be asked to complete two one-page forms with a screening checklist and informed consent.

The forms give the pharmacist information about the date and circumstances of unprotected sex or a failed contraceptive method and inform the patient about pros and cons of emergency contraceptive pills.

The patient must sign both documents to get the treatment (two pills) and allow the pharmacist to follow up with phone calls to the patient or referrals, Kashiwabara said.

If a patient is outside the 120-hour window, was sexually assaulted or a sexually transmitted disease is involved, the pharmacist can refer the patient to a doctor or other services, she said. "But it's up to the patient to take advantage of referrals."

Partika said the cost is expected to be under $50, including the pills and the pharmacist's counseling services. Insurance will cover some of it, depending on a person's plan, she said.

Downing said many people who were "on the fence" about the program found they could support it because it reduces abortions. "You do that by increasing prevention access rather than blowing up abortion clinics."

When a pilot project began in Washington in 1998, the goal was to enroll 250 women in 16 months and nearly 12,000 showed up, he said.

"We know, taking very, very conservative estimates, that we averted at least 700 abortions during the pilot study."

Referrals of young women and men into the healthcare system also greatly increased through the pharmacists, Downing said.

Ursula Penrose, Planned Parenthood of Hawaii patient services director, said women going there for an annual exam not only receive a year's supply of contraceptives but are offered an emergency contraceptive pill to keep in case it's needed.

She said the American College of Gynecologists and Obstetricians would like to see all American women have emergency contraception in their medicine cabinets. "It prevents all the issues that surround unplanned pregnancies."

Planned Parenthood of Hawaii provided emergency contraceptives to about 3,000 women the past year, Penrose said. Most often, they're women who practice contraception and the method failed, she said.

"There's a lot that goes with this EC package," she said, pointing out it also entails counseling by pharmacists and referrals to community resources.

In Washington and other states, it has increased business for family planning clinics and health care for women, Penrose said.

Downing said pharmacists are encouraged in training to talk to women about their current contraceptive method and, if it's failing, explore other methods that might be better for them.

He also talked to health care professionals and pharmacists about issues related to adolescent care, such as how to address those who are victims of violence or can't afford the cost of reproductive health services.

Downing urged pharmacists and doctors not to let the fear of liability prevent them from becoming involved. More than 200,000 women have been seen in Washington since 1998 and not one lawsuit has been filed, he said.