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Liberate ‘The Pill’

Dr. Richard Grossman

Do you think that a medication that kills more than 3,000 people in the U.S. annually should be available without a prescription, even though it has health benefits? What about another medication that has many health benefits but doesn’t increase the risk of death?

The first drug mentioned above is aspirin and can easily be bought without a prescription. The second is “the Pill,” or oral contraceptive pills, which require a prescription to obtain. In the past, women needed a yearly Pap smear, which meant a visit to a doctor (or other health care provider) with the expense and embarrassment of a pelvic exam. As the amazing safety of the pill has been recognized, laws have been changed to allow women to purchase their OCPs in some states from a pharmacist with minimal hassle – and they can keep their clothes on!

Perhaps you noticed that the first paragraph of this essay was making an unfair comparison. The people who die from aspirin are usually older than the women taking oral contraceptives. Furthermore, the study that found no increased mortality among women who had taken OCPs found that there was an increase in deaths from breast cancer – but that was counterbalanced by a decrease in ovarian cancer and other causes of death.

When OCPs first became available 60 years ago they were quite different. Then the level of estrogen included was more than twice what it is now. More than 50 years ago, my wife and I visited a college classmate in the hospital where she had been diagnosed with a blood clot – from OCPs. It took years to recognize that estrogen in OCPs increases the risk of clots – the more estrogen, the higher the risk. We now know that pills with less estrogen are safe, but still effective.

Fortunately, there are already several ways OCPs can be bought without an examination. They include Planned Parenthood, where answering a questionnaire and blood pressure check are all that’s needed. In Colorado and some other states, a pharmacist can prescribe them. Also, there are internet sites that provide prescriptions and sell OCPs inexpensively. Why not reduce the restrictions and make it easier and less expensive to get OCPs?

The “Oral Contraceptives Over-the-Counter Working Group” advocates for OCPs to be available without prescription. They have worked for years to reduce hurdles for women. They have looked at pills’ safety record in other countries, where one can purchase OCPs without a prescription. Social scientists have been developing easy-to-understand wording to go with the pills because no provider will be available to tell the woman how to take the medication.

Well, England has beat us to it! This month, progestin-only pills will be available without a prescription, after a brief consultation with a pharmacist. Because POPs have no estrogen, they are safer than the usual combination OCPs and can be used by many people who should not take estrogen.

Making contraception more available is not just a matter of convenience. Studies show that access to contraception increases young women’s chances of graduation from high school. Facilitating access to safe OCPs can help change teens’ lives for the better.

Richard Grossman, M.D., is a retired obstetrics-gynecology physician who lives in the Bayfield area. He has written this column for The Durango Herald for 26 years.

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