Plan B eases morning after worries

Now readily available at the Student Health Service is the prescription drug treatment, Plan B, which prevents pregnancy in a woman who has had unprotected intercourse.

However, the treatment is most effective when started within 72 hours of the event, warned Kathleen McAuliffe, physician with the Student Health Service. The treatment is inexpensive, reliable, safe, may be obtained on short notice and will not abort a fetus if a pregnancy has already been established through previous intercourse.

“It used to be the only thing you could do is wait until your period came, and hope,” she said. An old form of morning-after contraception had been around for 20 years but few people knew about it. In those days, physicians did not provide a lot of sex education due to moral constraints and also there was some fear that these older forms of treatment might result in deformed fetuses.

This older type was a pill combining forms of estrogen and progestin. This was actually part of a birth control pill. The patient took four pills at a time and had to do that twice. One objection was that so much estrogen made some patients sick to their stomachs. Also, there were potential side effects of blood clots, making physicians leery about prescribing it.

There also was an estrogen-only treatment which required taking 20 pills twice but it cost about $60. Those earlier treatments were “off label,” meaning they were not approved by the Food and Drug Administration.

The most recent answer is Plan B, a treatment produced in Hungary by Gedeon Richter. It is one pill which the patient takes twice. The proprietary name is levonorgestrel. Each pill contains .75 mg of the drug.

“All it has is the progestin, so it has no risk,” McAuliffe said. It is inexpensive, $9.15 for two pills. There also is an injection treatment, depoprovera, which is not preferred over Plan B.

Plan B has proved so effective and safe, McAuliffe said, that the American Medical Association has recommended that it be offered over the counter. She expects that to happen any time.

A new combination estrogen and progestin pill is also available under the name Preven. Instead of taking four pills at a time, the patient takes one. It functions as a combination birth control and morning after pill.

“It is the first combination treatment that was approved by the FDA just for emergency contraception,” she said. But it is Plan B that is safe, effective and there is no reason it couldn’t be available over the counter, in McAuliffe’s opinion.

The morning-after treatment is much more effective the sooner the woman uses it. “We can’t recommend it after 72 hours, but the sooner you use it the better, the doctor said. There is evidence that it will work after that time but it becomes less and less effective as time passes.

Some pharmacists in Washington state are authorized to do a 15-minute consultation with a patient and then dispense Plan B. This is called collaborative prescribing. In this state, any such authorization must be related to a specific patient name.

McAuliffe said that in the last Oregon legislature there was an effort to have that same option in this state but it was defeated. It was opposed by pharmacists on certain moral objections.

The PSU health service does pretty much what Washington does. The student comes in, she doesn’t need an appointment and is able to receive the treatment quite readily.

Another method the health service provides is when a woman comes in for an annual exam and uses condoms or a diaphragm for birth control, she can receive a prescription to have Plan B at home in case the condom breaks. A packet has a shelf life of about two years. Studies have shown that if a woman has such a packet at home, she is twice as likely to use it as a woman who has to visit a clinic to get a packet.

The health service wants women to rely on some standard method of birth control and not depend on a morning after treatment as an habitual method to avoid pregnancy.

When Plan B first was introduced, the health service was dispensing about 40 packets a month. That has diminished to the point that in March, 15 packets were dispensed.

The idea of a morning-after pill first surfaced in this country with news of a European drug, RU486, also called misoprostel. McAuliffe said at low doses it’s a very effective contraceptive with very few side effects if used within the first 72 hours. It got its bad name because if used at higher doses within seven weeks of pregnancy it will induce an abortion.

The health service does not dispense it because plan B is effective and, as for the abortion aspect, “we don’t do abortions. There’s no advantage to having both of them.”

Misoprostel originally attracted attention on college campuses because it was seen as a way to make abortion more readily available. However, it would require the campus to have surgical backup and PSU does not maintain such backup nor does it perform abortions.

“Only about one percent of the women in larger communities who should know about Plan B do know about it,” McAuliffe said.