In July 2015, the “gold standard” abortion pill mifepristone was approved for use in Canada. The drug is taken to terminate pregnancy in the first 50 days and is a less invasive alternative to surgical procedures. Especially for women living in more rural areas of Canada — where abortion services are not easily accessible — the introduction of mifepristone will have a considerable impact.
Health Canada has, however, imposed strict regulations on how the drug can be prescribed and dispensed. Dr. Wendy Norman, an associate professor in the department of family practices and a chair in family planning research, and Dr. Judith Soon, an assistant professor in pharmaceutical sciences, advocate for pharmaceutical dispensing of mifepristone in BC and hope to create a Canada-wide model. Ubyssey Science sat down with them to talk about mifepristone, Canadian women’s access to health care and the importance of interdisciplinary work in the healthcare profession.
What is mifepristone and why is it important?
WN: The exciting news is this pill means that all of a sudden you wouldn’t need to go to an abortion clinic. Eighty per cent of women will choose to have their abortion this way rather than by surgery if it is available to them. We’ve been conducting research across Canada on where abortions are provided and right now, 96 per cent of Canadian abortions are surgical. The advent of mifepristone gives us a chance to help women better and closer to home. But the way the regulation was handled in Canada is defeating the purpose.
JS: What happened is that Health Canada has brought in some unnecessary and unusual constraints on the way this product will be prescribed and dispensed. This promises to really slow down the entire process and decrease access — especially in the rural and remote areas.
WN: Health Canada has said if you want to be a doctor offering this to your patient, you also have to dispense it. This is the only drug family doctors or obstetrician/gynecologists would ever be prescribing that they’re also supposed to dispense. In BC, physicians cannot dispense unless they get special permission, which can take months.
What does this mean for women in BC?
JS: British Columbia is pushing the agenda for all of Canada. In 2000, British Columbia was the first province where pharmacists were able to dispense emergency contraception. We’ve been working in this sensitive, confidential area for a long time. Health is actually a provincial issue, not a national one. Health Canada is the agency that can approve the drug, but it’s the provinces that actually have the ability and the responsibility to make sure patients have access. They’ve formally announced that they will allow physicians to prescribe the drug and the pharmacists will — as is usual and customary — dispense it. It sounds like Health Canada is actually interested in this province-based approach as a workaround for the entire country.
Why should students in Canada, and more specifically UBC students, care about the regulation of mifepristone?
WN: Well, I think this is part of normal healthcare delivery. It’s such an exciting advance — it really helps to be able to ensure health for women and for their families. Particularly for UBC students, if they’re not yet ready to be parents, they have safe effective options that are available closer to home.
We’ve got hundreds of students at UBC studying pharmacy and I think that they should be looking forward to having fulfilling and challenging professions as highly respected members of the healthcare team. Links within the healthcare profession are a really important part of how safe care is delivered.
What is regulation like in other countries and what might that mean for Canada’s approach to regulating the drug?
WN: Canada is geographically very different from almost every other country where mifepristone has been approved. Women live all over the country, but abortion services are only widely available within our biggest cities, mostly along the US border.
JS: Australia brought this drug onto the market in 2012, and the physician prescribes it and the pharmacist dispenses it. This quite closely follows what we are hoping for. It’s very exciting to see that in Australia, many of the physicians and pharmacists are out in the rural and remote areas, providing this drug. We don’t have to think we are inventing a new system. We are utilizing something that’s already been proven for four years now. We’re ready. The drug’s ready. Let’s go.
Would you like to add anything?
WN: I would like to stress the importance of interdisciplinary care. At UBC, we’ve got so many people studying health professions and I think it’s so important for them to understand they each have a vital role to play. Cases like this one really show us that the broad scope of training and expertise students acquire is important to our health system.
This interview has been edited and shortened for clarity.