Pharmacy Staff Frequently Misinform Teens Seeking Emergency Contraception

Release Date: December 19, 2013 | By Katherine Kahn, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

KEY POINTS

  • Many teens face barriers to obtaining emergency contraception due to misleading or incorrect information from pharmacies.
  • Pharmacists often cited institutional or personal beliefs as reasons for not stocking or dispensing emergency contraception.
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Despite the fact that emergency contraception, also known as the morning-after pill, has been available since 2003, many teens still face barriers to obtaining the medication, a safe and effective way to prevent up to 74 percent of pregnancies following the failure of birth control or after unprotected sex.

A new study in the Journal of Adolescent Health finds that pharmacy staff frequently give teens misleading or incorrect information about emergency contraception that may prevent them from getting the medication. 

“I was having lots of teenagers telling me weird things about emergency contraception prescriptions,” says lead study author Tracey Wilkinson, M.D., a pediatrician at the Children’s Hospital of Los Angeles. She says that pharmacies might refuse to fill a prescription, confiscate a written prescription or even deny that an electronic prescription had been sent.

This led Wilkinson to investigate just what was happening at pharmacies when teens tried to purchase emergency contraception. Female researchers, posing as 17-year-old teens, called over 940 pharmacies in Nashville, Philadelphia, Cleveland, Austin, and Portland, Oregon and asked pharmacy staff basic questions about emergency contraception, including its availability, age requirements and confidentiality.

At the time of the study, the emergency contraception brand Plan B One Step was legally available to any person 17 years of age or older without a prescription, but was kept behind the pharmacy counter for purchase with a photo ID. Other brands of emergency contraception, including a generic form, were available by prescription for all teens and women. 

“About 20 percent of the pharmacy staff said that, because the callers identified themselves as teens, the callers couldn’t get [emergency contraception] at all. That’s completely incorrect,” says Wilkinson. “Of the remaining 80 percent of respondents, about half of them got the exact age requirement correct and half of them did not.” 

Additionally, the study found that pharmacy staff often cited ethical reasons, such as institutional policies and personal religious beliefs, for not stocking or dispensing emergency contraception. Pharmacy staff often inaccurately told callers a parent or legal guardian would need to accompany the teen to pick up the medication, or that an older friend or boyfriend couldn’t buy the prescription for them. 

The federal laws governing the dispensing of emergency contraception have changed since the study was published—and have become even more confusing, says Wilkinson. As of July 2013, Plan B One Step is now legally available over the counter to anyone of any age, and no photo ID is necessary. Other brands are either available to teens 17 or older at the pharmacy counter without a prescription, or to teens of any age with a prescription. One brand is available only by prescription, regardless of age.

Cora Collette Breuner, M.D., a pediatrician and member of the Committee for Adolescents of the American Academy of Pediatrics says, “Every time I go into a pharmacy, I see if Plan B is there without age restriction. And half of the time—or maybe even 80 percent of the time—it’s not. That’s against the law.”

Breuner says that one of the best ways for teens to avoid problems at pharmacies is to get an advance prescription for the generic form of emergency contraception from their pediatrician or clinic and get it filled. 

Wilkinson echoes this advice: “I try to emphasize that teens should have emergency contraception at home, just like they have Tylenol for a headache—don’t wait until you need it to try and go get it.”

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

For More Information:

Reach the Health Behavior News Service, part of the Center for Advancing Health, at (202) 387-2829 or hbns-editor@cfah.org.

Journal of Adolescent Health: Contact Tor Berg at (415) 502-1373 or tor.berg@ucsf.edu or visit www.jahonline.org

Wilkinson TA, Vargas G, Fahey N, et al. “I’ll see what I can do”: what adolescents experience when requesting emergency contraception. J Adolesc Health. 2013.

 

Tags for this article:
Teen Sexuality/Pregnancy/Contraception   Inside Healthcare   Prescription Drugs   Patient Engagement   Communicate with your Doctors   Make Good Treatment Decisions   Get Preventive Health Care   Women's Health   Reproductive Health/Contraception   Children and Young People's Health  



Comments on this article
Please note: CFAH reserves the right to moderate all comments posted to the Health Behavior News Service. Any inappropriate postings will be removed.

Reggie says
December 22, 2013 at 6:10 PM

Thanks, Jesus

W PARIS says
December 22, 2013 at 7:22 PM

IT seems this article in its terms of service needs the PLAN B ONE STEP.

Original says
December 22, 2013 at 8:14 PM

“Every time I go into a pharmacy, I see if Plan B is there without age restriction. And half of the time—or maybe even 80 percent of the time—it’s not. That’s against the law.”

What a sad country America has become. We call ourselves a democratic country but force companies to provide certain services against their will. Home of the brave but certainly not land of the free.

Dumb says
December 22, 2013 at 8:22 PM

Right, because I'm sure there wouldn't be a stink if the pharmacy decided it didn't want to carry insulin, or heart mediction *eye roll*

Steve says
December 22, 2013 at 8:27 PM

The wording on that is a bit loose, I wonder is the author meant that they check for plan B in general and it's not there, or its there and it has an age restriction.

I think the second one is what was meant. You cannot say that a law saying they are not allowed to have an age restriction on Plan B is un-American. If anything putting an age restriction on it is un-American. You wouldn't see any pharmacy put an age restriction on condoms, or tampons or candy bars, or deodorant. If their is no age restriction then their is no age restriction.

More Original says
December 22, 2013 at 9:07 PM

Original, how stupid can you be. There is no such thing as absolute freedom. How about the *freedom* for a person to have access to the medication they want? Which freedom is more important, that of a citizen, or that of a company? Regardless, what you are doing is further justifying the government providing health services, so that everyone has the freedom to have access to the medicine they want, you know, freedom and all. And it is unfortunately that there are areas where if one pharmacy doesn't carry something, there isn't another one nearby. It's a limitation of capitalism, which often needs to be countered by a democratic government stepping in to fill the gaps. Welcome to real freedom, not your ignorant, selfish, utterly pathetic view of it.

Michelle says
December 22, 2013 at 9:19 PM

The whole concept of keeping Plan B around is dumb. Women should be educated and keep an extra month of generic birth control and know the proper dosage which is the EXACT same thing as Plan B, but at a much lower price (usually around 25% of the cash price).

john_smith says
December 22, 2013 at 9:29 PM

the study, and its reporting on this website, are extremely valuable to us as a society because laws are meaningless if they are not being followed. any legislature can pass a law in an hour, but can they verify that it is being followed? and if the police don't care, then who does? this is one of the most fundamental functions of the press---to inform us about HOW our laws are being implemented. and it's something that armies of bloggers can't do. some things take plain old fashioned shoe leather, and this is one of them. cheers for whoever organized this multi-state study, if we don't know how companies are acting, then the laws that are supposed to govern their behavior don't matter much.

Elle says
December 22, 2013 at 9:33 PM

To Michelle: Plan B and birth control are not the same. Plan B contains a much higher dose of progestogens, which stops ovulation. Birth control has lower amounts of estrogens or progestogens in order to minimize side effects.

Edd says
December 22, 2013 at 9:53 PM

To Michelle : Not every woman takes birth control pills either, and you can't get them in case of emergency as you need a prescription for them.

Nellie Whan says
December 22, 2013 at 10:36 PM

I sue start suing the crap out of any of these pharmacies who pull this crap. I am really getting tired of the misinformation being spread out there on Plan B. It does not induce abortion, all it does is stop a female from ovulating to prevent a pregnancy. In fact if you are already ovulating or have already become pregnant the Plan B pill can do nothing. Your shit out of luck. If you are a heavy set woman then the Plan B pill does not work for you either. I expect pharmacists to be educated on this, if they are not then they have no business in the pharmacy biz.

CaffinatedOne says
December 22, 2013 at 11:10 PM

" but force companies to provide certain services against their will."

Companies aren't people and as such, don't have "will". If a public company chooses to provide pharmaceutical services, then said company has to follow the laws, rules, and regulations that apply.

Joe says
December 22, 2013 at 11:12 PM

Pharmacy staff don't have to stock the pill. It's not a law. It is 100% legal for pharmacists to not stock or dispense pills due to personal beliefs.

Sarah says
December 22, 2013 at 11:25 PM

I think this article was unfair towards the profession of pharmacy. The article sites one "study" and one physician's anecdotal "experience". In defense of the pharmacy profession (of which I am a member), there are currently no laws that mandate that pharmacies carry or dispense Plan B or other behind the counter emergency contraceptives. In addition, calling a pharmacy and speaking to staff members doesn't mean you're speaking with a pharmacist, or even a technician but rather an untrained cashier. I personally don't believe that my own moral opinions should bias my practice but I realize other pharmacists feel differently. With that said, it is very difficult to hand out Plan B like condoms. It makes me nervous when I CAN'T counsel the patient on the proper use because her partner comes in for the medication. The thoughts that go through my mind are, "was this consensual? Is she okay? Who is this guy? What if it's child abuse?" I mean seriously plan b and condoms are NOTHING alike. There are side effects of taking plan b. Unfortunately some people use it as their only form of birth control, which means they aren't trying to prevent sexually transmitted diseases - I'd like to talk to these people and see if I could help. Too often pharmacists are labeled as obstructionists when in reality we're just trying to help the patient.
Yes, I know pharmacists that for moral reasons do not dispense emergency contraception, but most pharmacies in my state (TN) have a policy regarding this that states we have to post where the nearest pharmacy is that does carry plan B. I would much rather someone take plan b then end up a teen mom or in a position where they feel abortion is their only option and I would say in my experience this is how the majority of pharmacists practice as well. Talk to your pharmacist. We'd love to hear from you.

Ross says
December 22, 2013 at 11:40 PM

I agree with Sarah. I am also a pharmacist and have no issue with Plan B but feel a lot more comfortable when the patient who is using the medication is present so they can be counseled on the correct use and possible side effects. If the doctor cited in the article is upset about the outcome of her study, she should use that information and help local pharmacies to increase access to emergency contraception. I am sure there is at least one local independent pharmacy who would love to help their patients in this way.

loveslife says
December 22, 2013 at 11:42 PM

same thing they do with pain medicine. They think they are doctors. smh.

Brian says
December 22, 2013 at 11:48 PM

The doctor in this article is quoted as saying it is illegal for pharmacies to have an age limit for plan B and its generics. What law is this?

Brian says
December 22, 2013 at 11:48 PM

The doctor in this article is quoted as saying it is illegal for pharmacies to have an age limit for plan B and its generics. What law is this?

Taylor says
December 23, 2013 at 12:34 AM

while i'm sure this isn't always the case, if a drug sits on my shelf for more than a few months, which Plan B does in my location, it gets sent back. nothing to do with morals or personal decisions. Its inventory control. We do this with every drug in every class. with over a million dollars of drugs in inventory, and dropping insurance reimbursements, an independent pharmacy simply can't afford to keep every single drug in stock hoping that it sells one day. If it sold, or if i was asked for it more often than once or twice a year, I'd keep it in stock. simple as that for my store.

Brian says
December 23, 2013 at 2:24 AM

@Loveslife As a pharmacist, I can tell you that we don't just "think" we are doctors, we ARE Doctors. It's a Doctor of Pharmacy, Pharm.D.

tjw says
December 23, 2013 at 2:48 AM

This is so sad. Why is the US so f'ed up?

Nathan says
December 23, 2013 at 3:34 AM

I hate the way drugs become irrationally criminalized/hated.

Dekoder.ring@gmail.com says
December 23, 2013 at 10:05 AM

All this talk of "freedom" and everyone is missing the point. The Government revoked the freedom of the general public and granted a monopoly to pharmacists. If the pharmacists don't want to accept that they do not have their personal freedom because they were granted this monopoly, the pharmacist is using Government restrictions to infringe on the buyer's individual freedom. If the pharmacists want complete personal freedom they should be lobbying the Government to abolish all drug schedules and allow the free unrestricted commerce of a good (drugs) the way a free market would allow.

Dekoder.ring@gmail.com says
December 23, 2013 at 10:40 AM

And to add to that... This is why we should have an unrestricted free market on goods (drugs) while pharmacists provide service (consulting). Pharmacists should not be tasked with restricting the citizenry's freedom.

http :// m.theage.com.au/world/emma-sloan-dies-in-ireland-after-pharmacy-refuses-to-give-her-epipen-20131223-2ztn9.html

Steph says
December 23, 2013 at 3:50 PM

http://www.jahonline.org/article/S1054-139X(13)00523-5/abstract

Read the actual study. If it was 'gee, we don't have it, sorry, we're not asked for it often' that would be one thing. In fact, the study says 'ethical terms' were used to explain the lack of availability.

James says
December 23, 2013 at 4:05 PM

@ Dekoder.ring@gmail.com

What?? Drugs are restricted for the patients safety. If a doctor prescribes 25 mg of a drug, and the patient feels like it isn't working, you're saying they should be allowed to buy 50 mg or 100 mg without consulting the doctor? What if they're getting medication for their children?

It's not about restricting freedom, it's about protecting against ignorance. Drugs are restricted so patients can't obtain harmful doses without approval from someone who has studied the drugs.

Could you imagine how profitable it would be to freely let patients get addicted to pain medications? It would be freedom alright, and drug companies would love it. It would also devastate lives.

Mike says
December 23, 2013 at 5:37 PM

@elle what do you think they used to use before Plan B came out? Its called the Yuzpe Regimen.

Mike says
December 23, 2013 at 5:45 PM

This study was conducted in 2010. There was an age limitation on EC. This was mandated by the FDA. They do not do put limits on it for no reason. They make decisions based off of science. When a new drug comes out, they just do not give it out to everyone. They do not know the long term effects of the drug. The truth is, the suit that lifted the age limit was proposed by 'Watson.' The manufacture of PLAN B!

Juli says
December 29, 2013 at 1:41 PM

To original, Joe, Sarah, & other numnuts;

If your religious beliefs prevent you from doing your job, then perhaps you should GET A DIFFERENT JOB.
You do not have the right to destroy another individual's life or interfere with their *personal* decisions because you are a bunch of egomaniac, sanctimonious control freaks.

And to Sarah, the buyer has a right to privacy & may not want your interference or moral judgment, *plus* did it occur to you that she probably was councelled already by her *doctor*?

Jennie says
January 2, 2014 at 6:45 PM

@ Juli
First, I think you can express your opinion here without calling other people names (e.g. "numnuts")

Second, those commenters are simply saying that they would prefer patients having been counseled and are even concerned about sexual abuse, etc. as it's most likely the girls who has someone else buy Plan B for them is probably under 17 and in some states considered statutory rape if it's not consensual. If you work in the health care field, you would know that a surprisingly large number of patients have misconceptions about medications and often misuses them without realizing.
They are also making the point that it's not illegal to not stock Emergency Contraception (EC) in it's inventory, especially if it's is OTC (over the counter) status. It's like saying it's illegal if a pharmacy doesn't feel like selling Tylenol or aspirin (also OTC status.) You can't find Tylenol here, go elsewhere that has it. Even though some pharmacies don't stock EC, a lot of others do. Get it there. Pharmacists' job aren't to hand out birth control like candy. They are there to prevent medication errors, catch doctors' mistakes (hey, we're all human!) and to properly counsel patients on correctly and safely using prescription medication. So just because they are hesitant to dispense EC or PREFERS (not mandate) and feels better that patients get educated, doesn't mean they should go "get a different job."

And to Sarah's defense: Yes, the patient has rights and privacy, but that's not even the issue here. If EC is now over-the-counter, the "buyer" or the "buyer's representative" no longer needs to go through a doctor anymore to obtain it. So them already being counseled by their doctors is pure assumption. You can't even assume that to be true even in cases where patients are prescribed medication by doctors. Doctors are often very busy and may not have time to counsel or may have left something important out by mistake.



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