Abortion pill can now legally be prescribed in Canada, but is still unavailable
Some doctors argue restrictions on abortion pill will limit access to those who require the drug most
While doctors across the country can now prescribe the home abortion pill Mifegymiso, the drug isn't expected to be available in Canada until the fall.
Last year, after a lengthy drug approval process, Health Canada agreed to allow doctors to begin prescribing the drug, more commonly known as RU-486, as of July 1 this year.
But doctors have told CBC News that they currently do not have a supply of the drug and are concerned that rules put in place by Health Canada governing how doctors prescribe the drug are complicating the process.
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Health Canada's rules require doctors to complete an online training course on the drug. The rules also say that unlike with most drugs, where a doctor gives a patient a prescription and sends the patient to a pharmacy to collect the drug, doctors will be required to dispense the drug to patients themselves.
That unusual move has some women's health specialists arguing the process will be too difficult for family doctors in rural and remote communities who do not have experience maintaining the supply and distribution of pharmaceuticals.
"Most family physicians we've spoken to don't have any mechanism to sell drugs to their patients," said Dr. Wendy Norman of the Society of Obstetricians and Gynaecologists of Canada.
"You also need to buy, stock, store and maintain a stock — that is, recognize when something's about to be out of date and change it over. And this is outside the expertise of physicians. We don't have training in this, speaking as a family doctor myself," Norman added.
Doctors unprepared to dispense drug
Norman said the rules will likely mean that only large family practices in big cities will have the expertise required to prescribe Mifegymiso, which can be used to terminate a pregnancy up to 49 days after conception.
"All of these communities where abortion is not currently available, and where women are having to travel long distances and leave their families, and leave their jobs, the situation won't change," she said.
Another problem is that some provincial colleges of physicians and surgeons don't allow doctors to dispense drugs, so doctors in those provinces would have to get special permission to prescribe and dispense Mifegymiso.
The Federation of Medical Regulatory Authorities of Canada wrote to Health Canada in May with its concerns.
"Dispensing by physicians is not normal practice (and could be a conflict of interest) and has the potential to create additional barriers for patient access," Fleur-Ange Lefebvre, executive director and CEO of FMRAC, wrote to Health Canada.
In reply, assistant deputy minister Anil Arora wrote, "The submission to Health Canada relied on data provided from the use in other jurisdictions, where considerable restrictions are in place, including having patients access the drug directly from their physician."
Distribution rules could change
Federal Health Minister Jane Philpott said she is aware of the concerns.
"We are committed to making sure that this medication is accessible. But with any medication, particularly new ones, it is important that the prescribers have the appropriate competence, that they are well-informed as to the nature of the medication, and what it's effectively to be used for, what concerns to watch out for," she said in an interview with CBC News.
Philpott also said the restrictions on how the drug is distributed could change.
"They can always be adjusted along the way with appropriate evidence and reassurance that the system is functioning appropriately, she said. We have to balance accessibility with making sure patients are safe, and these medications that do have some concerns to make sure they are taken safely, and that no unnecessary harm will be done."
An email response from the Canadian distributor for Mifegymiso, Celopharma, did not provide an explanation for why the drug will not be available until November.
"Celopharma is working very hard along with providers across the country and leading advocates to open the restrictive distribution of Mifegymiso in Canada," spokeswoman Paula Tenenbaum wrote.
"We hope that the conversation will continue, and leaders will continue to place pressure on the government to make sure that this happens, and as such, making Mifegymiso available in those rural areas that need it most."