Hand It Over

In one giant step for feminism, California is making waves as one of the nation’s pioneers selling birth control pills over the counter. But is it safe?
BY: Sara Smola

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News outlets across the nation exploded with reports when California joined Oregon in allowing women to purchase birth control pills over the counter at a pharmacy, eliminating the need for a doctor’s visit by going directly to the source. Though the pharmacists will be required to abide by safety protocols, required procedures are a bit hazy at this point—and still in legislative development—but are thought to be as simple as filling out a health questionnaire and having your blood pressure taken.

Signed into law back in 2013 by Governor Jerry Brown and set to take effect in Spring-Summer of 2016, the decision to allow oral contraceptives to be obtained over the counter is leaving some medical professionals concerned for the safety of their patients. Dr. Emil Avanes of Harmony Health MD in Glendale ensures his patients are properly screened for potential risks and aware of the side effects, taking into account each patient’s medical history whereas dispensing oral contraceptives over the counter encourages a ‘one-size-fits-all approach.’ “We see healthcare going in this direction which is something I’m vehemently opposed to—that we can somehow deliver healthcare through cookie cutter approaches. No physician would say, ‘We should limit access to women,’ but at the same time, it’s important to have someone who is in the daily practice of [prescribing] these medications,” Dr. Avanes warns.

Popping a pill every day seems basic enough, but without properly educating people, we can’t assume the drugs will be used correctly. When used as recommended, cough syrup is an effective medication, but it can turn into a deadly drug when dosages are abused. Should someone misunderstand how the medication affects them or how to properly take it—perhaps a teenager taking it for the first time—the results can be detrimental. “It’s the practical aspect that really concerns me because I sense that what will happen is, just like Advil, you know when you have a headache? It’s a fairly simple medication with fairly low side effects; why would you have to have a prescription to grab Advil for headaches? But you don’t know how many people come to the office and say ‘I just took 20 Advil because I have this horrible headache.’ Some folks just don’t know, don’t read, don’t take however many you’re supposed to take and that’s what I’m concerned about,” says Dr. Avanes.

One of the law’s selling points is that with fewer restrictions on birth control accessibility, unwanted pregnancies could drastically decrease. DoSomething.org reports 3 in 10 American girls will get pregnant at least once before the age of 20. From this, DoSomthing estimates roughly 750,000 teen pregnancies per year. But, by focusing on the surface issue, we may be ignoring a deeper one—the lack of safe sex education and not just pregnancy prevention. “The rate of teen pregnancy is extraordinarily high and I don’t think that we should put our teens in that position because what I fear for the younger population is that we’re not discussing the whole different side of sexual intercourse which is all of the sexually transmitted diseases. So, that is something that we [doctors] do all the time in the conversation when someone asks for oral contraception. The pharmacy is not going to talk about that. Are we going to have an epidemic of genital herpes? Or, are we going to have an epidemic of some other sexually transmitted disease now that people are accessing it and not worrying, ‘Oh well, I’m not going to become pregnant, might as well not use any protection.’ One of the reasons people use condoms is to prevent pregnancy, right? But now we’ve removed that. We haven’t educated people,” Dr. Avanes explains.

Additionally, the side effects of oral contraceptives have the potential to be life threatening. These include an increased risk of blood clots, especially if you’re overweight, a smoker, sit for long periods of time (such as sitting on a long plane flight) and particularly if someone in your family has exhibited a tendency to clot. In a doctor’s office, there are tests (including pelvic exams and pap smears), there are conversations to be had before the doctor ever writes the prescription. According to the professionals, there are many things to take into consideration to ensure the patient will not be at risk. It’s all too common to find a harried pharmacist in the midst of fulfilling prescriptions who hurries us out with medication in hand. There is rarely time for a conversation of one’s entire medical history at the pharmacy window, much less that of your entire family.

While the majority of candidates for birth control may display no undue risk, most physicians remain concerned. The problem is, without at least a minimal, informed discussion with a qualified medical professional, the possibility of risk can’t be properly assessed. Dr. Avanes cautions, “We shouldn’t send a mixed message of ‘Well, you’re young, there’s probably nothing wrong with you.’ It is important to have a yearly checkup. [Oral] contraceptives can raise blood pressure. I can give you the example of a 45-year-old lady who comes into my office with a blood pressure of 170 over 95. Now, a perfect candidate for OTC [oral contraceptives] but at the same time, I would highly recommend against it for her. But what if she just walks in and grabs OTC from the pharmacy? We’re putting her at risk for developing more complications and that’s the major fear among physicians.”

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