MDs to prescribe, dispense controversial abortion pill
Some patients may be at mercy of RU-486 supply, ethical objections of doctors
Controversial abortion drug RU-486 might be coming to Canada, but whether you get your hands on it will be left up to a doctor.
Under Health Canada provisions for the “safe and effective use” of the drug, approved in the country Wednesday, physicians will be left to both prescribe and dispense the product, under the name Mifegymiso.
It’s an arrangement already in place for some medications, but in this case, patients might be at the mercy of local demand and a doctor’s comfort or ethical beliefs.
“I don’t think this is a medication that every doctor will prescribe,” Ashley Waddington, a professor at Queen’s University who specializes in contraception, told the Star.
“I don’t expect people who don’t already provide medical termination of pregnancy to start prescribing it.”
Aside from the ethical objections some may have about the morality of terminating a pregnancy, some doctors, Waddington said, might not prescribe and dispense the drug because they experience little demand for it at their clinic.
Others, she said, might avoid doling it out because of sometimes deadly attacks that have befallen doctors providing abortion procedures or medications to patients.
In the last few decades, there have been dozens of reported death threats, attempted and successful murders, assaults, kidnappings and incidents of vandalism targeting abortion providers in North America.
To ensure no one seeking the drug is outright denied because they can’t find a doctor, Mike Toth, Ontario Medical Association president, said the College of Physicians and Surgeons of Ontario will expect even those doctors opposed to the drug to make an “effective referral” to anoth- er agency or physician willing to provide the service “if clinically appropriate.”
Approval of the drug, Waddington said, would hopefully result in widespread uptake by clinics, making it harder for protesters to retaliate on a smaller pool that have typically supported abortion.
Plus, the drug “can be dispensed without the doctor’s office being identified as a place where abortions are conducted so it might be more discreet,” argued Dr. Shree Mulay, an associate dean at Memorial University of Newfoundland’s faculty of medicine.
Though partially meant to broaden availability of abortions for women and serve those in remote areas, Mulay said ensuring women have access to it is “of course” a concern.
She is not in favour of making it available over the counter as it is in some countries.
But, she said, with good education and information provided to patients, she believes pharmacists could be left to fill doctors’ prescrip- tions for the drug.
However, Health Canada has eschewed that model.
Instead it’s making doctors responsible for much of the drug’s administration and requiring its manufacturer, Linepharma International Ltd., to focus on the “development of an education and registration program for prescribers and a post observational safety study.”
Also part of Health Canada’s stipulations are the creation of a 24-hour patient support line and a requirement for physicians to provide medication information to patients and have them sign consent forms to receive the drug. When Health Canada announced the drug’s approval and the criteria surrounding its regulation Wednesday, it was met with criticism from pro-life advocates, but acceptance from those supporting a woman’s right to terminate a pregnancy.
It took the government more than two years to make their regulatory decision in favour of the drug. It’s a move that comes years after the World Health Organization placed the product on its Model List of Essential Medicines.
“There was some foot dragging by Health Canada, I think,” Waddington said.
“This is long overdue and something to be celebrated, but this should have happened 10 years ago because it has been available in other countries for 25 years.”