Plan B reality: available or not?

Most every pharmacy in our community has a “sex” section. Condoms hang here in tidy boxes. Lubricants hawk security, friction and fruity flavors. Jellies found here are not for your toast. Perhaps you’re here to browse. To assert your sexual responsibility with your pocketbook. To giggle. Or you might be running in, crazy-eyed and blushing, scanning for the item that may calm the rising tide of panic within you. A pregnancy test. A home HIV test kit. Or to grab the Plan B emergency contraceptive pill. Plan B One-Step’s friendly pink, purple and green packaging blends in well with the other items, but its price tag - $39 to $49 - stands out amongst the $6 crowd. The package contains one pill only. And, if taken within 72 hours of sex, it can safely prevent pregnancy. A federal law in April 2013 mandated the pill be available over the counter – meaning on store shelves – to all persons of “childbearing age.” Even so, area pharmacies sport different interpretations of “access to all.” In Oakland County, you might have to ask the pharmacist for Plan B. One pharmacy we visited did not stock it at all. It might be put away in a security box, out of convenient access. Or it might be right there on the shelf, as easy to buy as a box of sinus medicine. Here’s our look at Plan B’s impact in our community. Planning is part of preparation. Do you know the location of the nearest exit? The closest defibrillator? Do you have a family plan in case of a fire, tornado and food shortage? Where is your nearest Plan B emergency contraception? No matter where your personal politics fall on the conception or abortion spectrum, most people agree on one thing: when you’re dealing with a time-oriented sexual intervention, every minute matters. That’s why there are prayer vigils outside clinics and ardent advocates ushering people inside the doors. Legal – and moral – distinctions are made in months, in weeks, and in Plan B’s case – hours. A woman has 72 hours after sex to take emergency contraception to be reasonably assured of its effectiveness, though its effects can last up to five days later. It’s a tight deadline, and research shows that the more hurdles there are between a person and the ability to gain its intervention, the less likely its purchase and use. This puts every step in purchasing the emergency contraception under a microscope. Seemingly small distinctions play a large role in the debate – on both sides of the issue. How easy is it to get Plan B in our community? How do people feel about its placement in our pharmacies? What is it anyway? Dr. Renee Horowitz doesn’t advocate for Plan B’s use as regular birth control, but supports the pill’s designed use for sexual accidents. “Anyone can have a mishap. A condom can break. A diaphragm can slip,” said Horowitz, a Farmington Hills-based OB/GYN specializing in sexual health. “It’s designed for a slip-up and it’s a good, safe tool if it is used responsibly.” She still fields calls to her office for emergency contraception, as many people don’t realize that they have non-prescription access, she said. “I explain that they should be able to walk into any drug store, find it on the shelf, pay for it and follow the directions on the box,” Horowitz said. Having failsafe birth control – especially in long-term partnerships – can actually improve sexual health, Horowitz said. “If we’re not worried about getting pregnant, we can enjoy sex more,” Horowitz said. “People who are partners for a long time may not want to have sex because of pregnancy worries. Having the ability to access emergency birth control helps us have a healthier sex life.” But children, who are too young and impressionable, misuse emergency contraception, and sexual predators misrepresent Plan B to convince young children to engage in risky sexual behavior, said Barb Yagley, the vigil coordinator for 40 Days for Life Southfield. Part of her group’s mission is to evict Planned Parenthood from Oakland, Macomb and Wayne counties in order to protect children, teens and women. “Having this access is fraught with abuse,” Yagley said. “It’s open season for child predators. They use emergency contraception to convince young girls to have sex with them.” Unscrupulous predators may leave out important facts about Plan B – facts such as that it does not shield users from sexually transmitted diseases, sexually transmitted infections, and HIV transmission. She is also concerned about the health impacts of “super powerful” hormones on young bodies. “We’re seeing these children taking a steady diet of these pills and we don’t know yet what kind of havoc it is wreaking on the body,” Yagley said. Health impacts of Plan B made headlines last month when European regulators added a warning to the morning-after pill that it may not be as effective in heavier women. The pill’s European version, called Norlevo, will sport a warning to its label stating that: “in clinical trials, contraceptive efficacy was reduced in women weighing 75 kg (165 pounds) or more and levonorgestrel was not effective in women who weighed more than 80 kg (176 pounds).” The Food and Drug Administration (FDA) has commented only that they would investigate the issue. The most recent research by the Center for Disease Control and Prevention places the average weight for an American woman at 166 pounds and an American man at 195 pounds. Both European and American versions of the morning-after pill contain the same active ingredient in the same amount – 1.5 mg of levonorgestrel. Levonorgestrel is a form of progestin, a synthetic hormone widely used in birth control pills. Progestin is the patentable substance that mimics the body’s naturally occurring progesterone, a hormone made in the ovaries that balances out estrogen, maintains insulin and prevents cystic diseases. While other forms of emergency contraception contain other ingredients, Plan B’s levonorgestrel is considered “a second generation” progestin and is the most-widely distributed type of birth control pill worldwide due to its minimal side effects. That said, it still commonly causes “abdominal pain and cramping, irregular periods, bloating and spotting,” according to the Mayo Clinic. Like birth control pills, emergency contraception prevents pregnancy by stopping ovulation or making the lining of the uterus “inhospitable” to a fertilized egg. The latter impact upsets the pro-life camp, which compares emergency contraception to the “abortion pill,” known as RU-486 or mifepristone, which induces medical/chemical abortion in pregnant women within 49 days from the first day of their last menstrual period. Groups have also stated their concerns that emergency contraception can lead to a false sense of security, giving rise to risky sexual behavior and increases of sexually transmitted diseases and infections. A pro-life media group, Lifewatch, cites a Washington state-based study where more widespread use of the morning-after pill led “led to a statistically significant increase in STD rates (gonorrhea rates), both overall and for females.” Yagley believes that young girls are most vulnerable to these risks and personally believes that emergency contraception should be used only with “informed consent.” Yagley said that she prays for those who undergo medical abortion, and personally attends and organizes prayer vigils outside Oakland County clinics where the procedures are performed. “I’m praying for these children, their parents, and the entire community that allows this to happen,” Yagley said. The emotionally charged nature of the issue gives rise to demarcations in odd places. President Barak Obama’s administration, while supporting over-the-counter availability for some, made motions to impose age restrictions on Plan B under an operating principle that young people would find instructions “too complicated,” especially multi-pill contraceptive options. The generic and multi-pill versions of the pill retails for $10-20 less than Plan B One Step, which carries an average national price tag of $48. The FDA ruled in 2008 that Plan B One-Step could be sold over the counter to women over 18 without a prescription. Then, prompted by cases ruling that age limitations were arbitrary, the restrictions were removed by U.S. District Judge Edward R. Korman in New York, who called the age restrictions “politically motivated” and “scientifically unjustified.” Korman’s April 5, 2013 ruling allowed the sale of the pill to any woman “of childbearing age.” Obama’s administration filed for a stay of the ruling, citing concerns that young women would not understand how to take the pill. Months later, the filing was dropped, leaving a strange situation in place. The generic two-dose version of the pill stays behind the counter with an age restriction, and Teva Pharmaceuticals was basically granted a government-sanctioned monopoly with the exclusive right to sell the drug without a prescription to individuals 17 and under. In our community, the price of the pill varies as does its placement and accessibility. Practices even vary store to store within the same franchise. At Walgreen’s on Woodward in Birmingham, Plan B was on the shelf, but the franchise allows some leeway on this issue, said Emily Hartwig, Walgreen’s Corporate Media Relations spokesperson. “In some stores, the product will be placed in lock boxes on the shelf. These locations are determined strictly on an individual store’s past experience with retail theft,” she said. “All of the products, regardless of the lock box, will have anti-theft sensor tagging.” Additionally, pharmacists and employees with moral qualms about selling Plan B may “step away” from the transaction, she said. “We allow pharmacists and other employees to step away from completing a transaction to which they have a moral objection,” Hartwig said. “Our policy also requires the employee to refer the transaction to another employee or manager on duty who will complete the customer’s request.” At the CVS on Old Woodward in Birmingham, Plan B retails for $49.99. Additionally, CVS carries the cheaper alternative for “Next Choice" contraceptive with a card that a shopper could bring to the pharmacist for an over-17 years old identification check. “To comply with the FDA, in August we made Plan B One Step available as a non-pharmacy item and carry it either in the family planning or feminine care sections of our stores,” said Michael J. DeAngelis, CVS’s Pharmacy branch Director of Public Relations. However, Plan B was more difficult to find at smaller, private pharmacies. In Bloomfield Hills, the Medical Park Pharmacy did not carry it at all, but the pharmacist said that she could “order it and have it within a day.” At Mills Pharmacy & Apothecary in Birmingham, it was behind the counter with a price tag of $47. Same scenario at Sav-On Drugs at Maple and Telegraph – you can buy it, but you have to ask. That said, all three of the above pharmacies are small, with their “family planning” or “sex” sections offering a slim selection of items in all areas. The Rite Aid at Maple and Telegraph carried Plan B on the shelf in a lock box. These findings are fairly typical, said Jo Ellen Green Kaiser. As the executive director of The Media Consortium, she collects pharmacy reports in an investigative project called “Where’s Your Plan B?” The website publishes a national map with community-generated findings focused on the placement and accessibility of Plan B One Step. The variability seen in our region is common of what is being reported in Midwestern states with broad interpretations for “on the shelf.” “We found that ‘on the shelf’ in practice means that women still have to ask someone for assistance in order to buy the drug because stores keep it locked up due to theft concerns,” Kaiser said. “In middle America, we found a large number of stores were not complying – they had Plan B at the pharmacy and required ID.” But most of the time, pharmacists and clerks seemed to be acting out of inertia and misinformation as opposed to policy, she said. “For example, some store clerks told reporters that they kept Plan B at the pharmacy because they still had old supplies of Plan B One-Step that were labeled ‘prescription only.’ As they sold out of the old supplies, they would move the drug to the shelf,” Kaiser said. Some segments of the population are currently without any access whatsoever to emergency contraception, namely those in immigration detention, women on reservations and prisoners, she said. Lori Lamerand is also concerned about the young women she sees at the health centers within the Planned Parenthood system. Many have been slipped date rape drugs, she said, and while the situation itself is devastating, emergency contraception does provide a certain comfort. “I met a young woman who wasn’t sure if she’d had sex or not because she’d been drugged,” Lamerand. “It was incredibly disconcerting for her not to know if she was part of an intimate act like that.” Most of the women who ask for Plan B in the health centers are ages 19-25 and are trying to either shore up a birth control failure or who have had sex unexpectedly, Lamerand said. She is the president and CEO of Planned Parenthood Mid and South Michigan “Our clients trend toward the better educated. They know they have options,” Lamerand said. “Sex is so complicated and we prepare people so poorly in this country. Anything we can do to give them tools to manage whether they want a child or not, or not at this moment, is really an important thing.” But should young kids who don’t really know what they want have easy access to Plan B? One Walled Lake big sister, who requested to remain nameless, made this comment. “My sister is 16-years-old. She is mostly responsible, but she is still 16- years-old and doesn’t really understand consequences. Having Plan B on the shelf is an invitation to misuse the drug and to reinforce irresponsible behavior.” Still the $48 price tag would most likely curb most teens’ ability to use Plan B as regular birth control, she said. No matter who you are – your age, your beliefs or your community – the journey to the sex section of the pharmacy when you’re under stress is a horribly uncomfortable process, said Brittany Batell, a 23-year-old college student from Dexter. She watches individuals and couples agonize over emergency contraception in her duties as a store manager in the University of Michigan’s Safe Sex Store. “There is often a good deal of worry and anxiety, tension between partners, embarrassment about going to a pharmacy to pick it up, and difficulty with the cost of it (emergency contraception).” Batell said. “It is not a pleasant experience, and it is not one that people typically want to repeat.”$1”