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Pharmacists too risky for the pill

A push to allow pharmacists to supply the pill without prescription has been knocked back amid concerns it would increase health risks and encourage misuse of the medication.

In a decision welcomed by the AMA as a victory for women’s health, Health Department Secretary Martin Bowles has rejected a suggestion that prescription-only oral contraceptives be rescheduled as schedule 3 medicines, which would allow women to bypass their doctor to get a new supply.

The proposal was made amid efforts to expand the scope of pharmacist practice, with proponents arguing that, following an initial consultation with their GP, women should be able to get oral contraceptives on demand from a pharmacist, which would be more convenient for them and less costly for the Government.

Under the plan, pharmacists would be able to supply the pill after conducting a blood pressure check and running through a checklist to identify any potential risks or contraindications.

But the AMA condemned the idea, warning that it would put women at risk because pharmacists did not have the skills or training to assess and monitor the health of those taking oral contraceptives.

In a submission to the Therapeutic Goods Administration’s Advisory Committee on Medicines Scheduling, the AMA argued that taking oral contraceptives was not without risk, so their use needed to be carefully considered and regularly monitored by skilled practitioners.

Documented side effects of the pill include blood clots, stroke, heart attack and diabetes, all of which are exacerbated by smoking.

“Assessment and monitoring by medical practitioners of women considering oral contraceptives is essential to ensure risks are minimised,” the AMA submission said. “This requires an initial, and then episodic, medical consultation/s to assess whether it is appropriate to start, continue, change or even cease an oral contraceptive and replace it with another contraceptive option.”

The Association warned that pharmacists had neither the skills nor training to make these decisions, and trying to capture all these considerations with a questionnaire grossly underestimated the complexity of the assessment involved.

The AMA added that a pharmacy was “not the place” for such detailed and sensitive discussions.

In ruling to maintain the status quo, Mr Bowles accepted arguments that pharmacists did not have the training to assess patients, noting that during the first 12 months risks could be particularly acute, and that using the pill might mask more serious health issues including migraine, thrombosis, stroke and cancer.

The Health Department Secretary also raised concerns about a heightened potential for misuse of the medication, including the possibility that women might try to get the pill under false pretences, or use it inappropriately, such as to treat painful heavy bleeding, which could lead to future fertility problems.

Mr Bowles was dismissive of suggestions a checklist could be used as a substitute to assessment by a trained medical practitioner: “The use of a checklist is not considered an adequate alternative to comprehensive medical evaluations.”

He has issued an interim decision that the current listing of oral contraceptives as schedule 4 medicines “remains appropriate”.

Adrian Rollins