'Reluctant to prescribe': Local clinic says women wait weeks to access abortion pill

The executive director of the SHORE Centre says women are driving for hours into Waterloo in order to get a prescription for the abortion pill.

The executive director of the SHORE Centres says many family doctors are still not prescribing the pill

"The issue is that many family doctors in Ontario are quite reluctant to prescribe the medication and so they are referring the patients to their nearest clinic, which just happens to be our location in Kitchener," said Lyndsey Butcher, executive director of the SHORE Centre. (Shutterstock)

A local sexual health resource centre says it's experiencing so much demand for the abortion pill, Mifegymiso, that patients often must wait two to three weeks to get it. 

Mifegymiso is the brand name for the combination of two pills that is used to terminate pregnancies—but only up to nine weeks along.

"Because of the timeline for medical abortion, [the wait list] can put them past the cutoff date," said Lyndsey Butcher, executive director of the SHORE Centre.

"So it can be quite disappointing for those patients when they cannot get in in time and have to opt for a surgical abortion."

Family docs can prescribe but aren't

Butcher said the wait list at the SHORE Centre shouldn't have to be as long as it is, because in Ontario, family doctors and nurse practitioners alike can prescribe Mifegymiso.

The problem, Butcher said, is that many care providers are simply reluctant to do so, and will instead refer patients who request the pill to their nearest clinic that provides abortion—which, in many cases, winds up being the SHORE Centre.

"The patients who are coming in who are referred by their family doctor, they're creating a wait list for those that truly are in need, who have no other clinician who can provide this medication to them," said Butcher.

In total, Butcher said the clinic has received 500 medical abortion patients since Nov. 2017, including many who drive in from small towns up to two or three hours away.

Throughout the Waterloo-Wellington Local Health Integration Network, there have been 951 Mifegymiso prescription claims since August 2017, according to the Ministry of Health and Long-Term Care. 

Mifegymiso is the brand name for the combination of two pills — one containing mifepristone and the other misoprostol. It is used to terminate early pregnancies. (Linepharma International)

The SHORE Centre isn't the only clinic in Waterloo Region coping with high demand for Mifegymiso.

In Kitchener, Onyx Urgent Care also offers the pill through its sexual health clinic, and operations director Cait Desilets said demand has grown "staggeringly" since they began offering the pill in August 2017, although they do not currently have a wait list.

Dr. Michael Kam, who is chief executive and a physician with Onyx, said he also thinks many family doctors remain uncomfortable with prescribing the abortion pill, and that discomfort can be a particular issue for those who work as part of large family health teams.

"You need to have not only a physician who's willing to prescribe it, but staff who are also comfortable with it," he said.

"So as a result they're finding it easier to refer to us, and because we've got everything implemented and in place we're able to then expedite the whole process."

Adjustment period still in place

Dr. Jeff Sisler says that many family physicians are still getting used to the idea that they don't need to refer patients elsewhere to receive an abortion. (Submitted by Jayne Johnston, College of Family Physicians of Canada)

Part of the problem could be that doctors are still falling back on old referral habits from when abortion was mainly a surgical procedure, according to Dr. Jeff Sisler, executive director of professional development and practice support at the College of Family Physicians of Canada.

"Historically there has been a reliance on these clinics to provide that care," said Dr. Sisler, noting that the abortion pill has only been available by family doctor prescription for a few years.

Still, he said he's noticed interest by family doctors in learning more about abortion services, and said that over time, he believes more and more doctors will begin to offer the pill by prescription.

For her part, Lyndsey Butcher said she would like to see more doctors getting up to speed on Mifegymiso—and is even willing to help them, if that's what it takes.

"We can share all of our patient education materials and support them through the first few prescriptions that they provide, we're happy to help them build up their capacity to offer this to their patients," she said.

"At the end of the day, the family doctor, it's their responsibility to support the patient through this."