Study shows OTC access doesn’t increase EC use

If emergency contraception (EC) is made available over the counter (OTC) in the United States, will it lead to more unprotected sex and increased use? Results from a just-published analysis of British use of the drug indicates that it will not.1

EC has been available without prescription across Britain to women age 16 and older since January 2001. The new study, an analysis of data of contraceptive use in women ages 16-49 from 2000 to 2002, shows that making EC available OTC has had no discernible effect on use, either in terms of number of uses per year for individual women, or in terms of overall numbers of women using the method, reports Cicely Marston, PhD, lecturer in social science and public health at Imperial College London and lead author of the analysis.

"The drug has an excellent safety profile, and timing is crucial for its effectiveness: The longer it takes to obtain it, the less likely it is to work," she observes. "Because over-the-counter provision has not had negative effects, and because of the potential gains in terms of convenience and rapid access, EC should be made available over the counter as soon as possible in other countries, including the USA."

To conduct the study, researchers analyzed contraceptive use data collected by the Omnibus Survey, a multipurpose survey performed by the United Kingdom’s Office for National Statistics in London. There was no significant change in the proportion of women using EC, researchers found. In 2000, 8.4% of women surveyed used the method, compared to 7.9% in 2001 and 7.2% in 2002. The researchers also saw no significant change in contraceptive use among the women over the course of the study, and they recorded no significant uptick in the proportions of women having unprotected sex or using EC more than once during a year.

Scientists did note one change: When access was broadened, fewer women obtained EC from physicians, while a greater proportion bought it over the counter.1 EC sells OTC in Britain for approximately $36 to $46.2

United States awaits FDA ruling

Barr Pharmaceuticals of Woodcliff Lake, NJ, is awaiting a decision from the Food and Drug Administration (FDA) on its request to take its levonorgestrel-only EC, Plan B, over the counter, says Carol Cox, company spokeswoman. If the request is approved, Plan B will be sold without a prescription for women ages 16 and older, while prescription status will be maintained for women ages 15 and younger. (Editor’s note: On Aug. 26, 2005, the FDA again postponed its decision on OTC sale of Plan B. The agency called for 60 days of public comment on whether and how drug stores can enforce an age limit on OTC sales of the drug. To check what states are doing to increase EC access, see the update box.)

A new analysis of use of the EC Hotline web site, (www.NOT-2-LATE.com), jointly operated by the Office of Population Research at Princeton (NJ) University and the Association of Reproductive Health Professionals, shows that women are in need of information when it comes to EC and other reproductive health matters.3 Women often are reluctant to ask for advance prescriptions for EC pills, and providers rarely offer them without being asked, according to the findings.

When women have a condom failure or fail to use contraception, they may not know about EC and, even if they do, they may face hurdles in finding a provider who can prescribe EC pills and then locating a pharmacy to get the prescription filled, researchers note. Unprotected intercourse often occurs on weekends or holidays when access to medical providers is limited, they state.3

References

  1. Marston C, Meltzer H, Majeed A. Impact on contraceptive practice of making emergency hormonal contraception available over the counter in Great Britain: Repeated cross-sectional surveys.BMJ 2005; 331:271.
  2. Bissell P, Anderson C. Supplying emergency contraception via community pharmacies in the UK: Reflections on the experiences of users and providers. Soc Sci Med 2003; 57:2,367-2,378.
  3. Wynn L, Trussell J. The morning after on the internet: Usage of and questions to the emergency contraception web site. Contraception 2005; 72:5-13.