Updated abortion pill rule adds to confusion, pharmacist says

A policy that women had to take the abortion pill in front of their doctor was changed in May, but the change has led to confusion for pharmacists.

Former rule required women to take the pill in front of a doctor

Earlier this year, women had to take the abortion pill in front of the prescribing doctor. Health Canada clarified in May that women didn't have to take the pill in front of a doctor, but it has led to confusion for doctors and pharmacists. (CBC)

An old policy that required women wanting to take the abortion pill to do so in front of their doctor may be the reason some pharmacies in Ontario aren't stocking it yet.

Nardine Nakhla, a pharmacist in Toronto and a clinical lecturer at the University of Waterloo School of Pharmacy, says the old rule was based on the product monograph — a scientific document created by the manufacturer of the drug that describes what it does and how to use it.

"We have been trying to get the word out there about what it is that is required both of physicians and pharmacists to be able to provide this to patients," Nakhla told CBC News.

Health Canada approved Mifegymiso, also known as RU-486, for medicated abortions in July 2015 and it became available in January. As of Aug. 10, it is free to women in Ontario under OHIP.

In the first few months of this year, there were two ways for women to take the abortion pill. The first was that a physician could dispense the drug and have the woman take the pill right there, but Nakhla said there are only a few Ontario physicians who also dispense drugs.

The other way was to have the prescription filled at a pharmacy but the pill then needed to be shipped back to the prescribing doctor. The woman had to make another appointment to go take the medication while the doctor watched.

"That definitely affects access because it is adding another step. So the patient will have to go to the physician, then go back to the pharmacy, then back to the physician's office. It's adding a lot of unnecessary work," Nakhla said.

'Still a bit apprehensive'

Doctors and pharmacists expressed their concerns to Health Canada about ease of access. The federal agency then said providers didn't have to go through all those steps to give women the drug.

Instead, Health Canada said they could dispense it to the woman directly — something called "off-label use," meaning they're not following the drug's monograph. That's permitted under Health Canada rules.

That clarification came in May, but Nakhla said she is still hearing of pharmacists who are unaware of the change.

"What I've been hearing out there is that people are still a bit apprehensive about either stocking or dispensing it because they don't feel that they're 100 per cent sure of all the different steps they need to take or what it is that is required versus optional," Nakhla said.

Slow moving but smooth process

Lyndsey Butcher, executive director of the Shore Centre (formerly Planned Parenthood) in Kitchener said Waterloo region currently has about six pharmacies who have the abortion pill in stock or are in the process of ordering it.

She said Ontario doctors now don't have to watch the women take the pill, but some physicians in the province are still requiring it. In Kitchener, women can also go to the Onyx Urgent Care Clinic and physicians there will see patients who are not on their roster.

The Shore Centre also has made arrangements with an ultrasound provider to provide same day or next day ultrasounds for women who want to get the abortion pill. An ultrasound is needed before it can be prescribed.

"The process is moving smoothly and patients in Waterloo [region] are finally able to access the abortion pill in their own community," Butcher said.

Nakhla encouraged any pharmacist hesitant to stock the abortion pill to take a free online course through the Society of Obstetricians and Gynecologists to become better informed.