Seven million pills the day after dispensed in ten years



The free dispensation of the so-called morning-after pill (PDD) is this Saturday in Spain ten years, a time in which more than seven million doses of this emergency postcoital contraceptive method have been acquired in pharmacies, without a prescription. It should not be used as usual.

These are the data provided to Efe by the consultancy Iqvia, which has broken down the figures of the evolution of the free sale of the pill the day after from September 28, 2009, when it began, until May of this year.

The average annual units that have been dispensed in pharmacies since 2010 to the present have been about 700,000, an amount that was not known before.

This is reflected in the data of another consultant -IMS Health- in the months before and after the free sale: in the first six months of non-prescription sale (between October 2009 and March 2010) about 480,000 units were sold, triple of those dispensed between October 2008 and March 2009.

ACTIVE PRINCIPLES OF THE PDD

The PDD contains two active ingredients that prevent or delay ovulation and in most cases prevents pregnancy, but never interrupts it.

The first to be dispensed without a prescription was levonorgestrel, of which there are currently two brands (Norlevo and Postinor) and eight generics, and should be taken as soon as possible after having had unprotected sex or when protection has failed.

It is best to do it in the first 24 hours, although it can take up to 72 hours, but its effect decreases the longer it is delayed.

The second began to be dispensed without a prescription in 2015: it is ulipristal acetate, which is marketed under the name of Ellaone, and is known as the “five days later” pill because it is up to five times more effective than the day later in the delay of ovulation.

Specifically, different medical studies have shown that it is three times more effective than levonorgestrel if it is administered in the first 24 hours, and twice if it is given in the first 72.

The appearance of Ellaone has caused that the sale of levonorgestrel has diminished and that they are more matched in their sales figures. Thus, in 2015, 449,000 units of Norlevo and 98,000 of Postinor were dispensed against 39,000 of Ellaone.

Figures that have been matched more in 2018: from Norlevo 171,000 were dispensed; Postinor 108,000, and Ellaone 200,000.

IT IS NOT AN ABORTIVE PILL

The gynecologists experts in contraception affect this anniversary in which the morning after pill "is a hormonal medicine, which does not interrupt pregnancy".

The president of the Spanish Contraception Society (SEC), Paloma Lobo, maintains that it is not anti-implant because what she does is delay ovulation: "It is not an abortion pill and in fact if the woman has started to ovulate, she could get pregnant If it were abortive there would be no pregnancy in women who have taken it, and yes there are. "

"It is a plan B for not having to resort to voluntary termination of pregnancy, which is a major failure," says Lobo, who maintains that it is "the last chance when everything has failed to protect" and underlines the importance of immediacy because "it takes more effect as soon as you take it".

AWARENESS OBJECTION

Since the free sale, announced by the Socialist Minister of Health at that time, Trinidad Jiménez, the way to acquire this emergency contraceptive "has changed a lot," according to Lobo, because women go directly to the pharmacy "for immediacy and also for privacy, "and fewer people go to health or planning centers.

But not all pharmacists want to sell it and they accept their right to conscientious objection. In 2015, the Constitutional Court (TC) endorsed the right of a pharmacist in Seville not to dispense it and that he had been punished with a fine of 3,300 euros for refusing to supply it in 2008.

But the pharmacy professionals are a minority who do not want to dispense it for their religious beliefs or for not agreeing with the free sale, as Carlos Fernández Moriano, of the General Council of Pharmaceutical Colleges, has told Efe.

"They are specific situations and are a minority and the pharmacist, although not dispensed by their beliefs, will inform you where you can get it if asked and most pharmacies dispense these medications," he says.

Pharmacists also have a guide that details the general rules for dispensing emergency contraceptives, unifies criteria on the protocol of action and provides answers to the most frequent ethical-legal considerations.

Bethlehem Squire

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