Local Pharmacy Promotes Naloxone to Save Lives on Overdose Awareness Day

Today is Overdose Awareness Day. This annual awareness day aims to reduce the stigma of drug-related overdose, prevent overdose-related death, and remember loved ones injured or lost to overdose.

Opioid-related overdoses and overdose fatalities are a growing epidemic in the United States and in San Diego. Opioids, including prescription opioid pain relievers and heroin, killed more than 28,000 people in the U.S. in 2014 alone. Home naloxone decreases overdose-related fatalities. Naloxone is an antidote to opioids and when given, reverses the effects of opioid overdose immediately. California and some other states have expanded access to home naloxone through pharmacist prescribing and dispensing.

Naloxone on Overdose Awareness DayThe Pharmacists Clinic is committed to saving lives by offering naloxone to patients. We offer overdose education and home naloxone kits to all patients who have a personal opioid overdose risk or a loved one at risk. Some of the risk factors for overdose are: history of overdose, history of opioid misuse or abuse, chronic prescription opioid use with complex medical problems, or taking long-acting opioids. Patients can choose to get naloxone to use at home as an injection, nasal spray, or auto-injection device. Our clinical pharmacist, Dr. Sally Rafie, will review the signs of an overdose, how to respond, and how to administer naloxone in case of emergency with each patient.

According to Dr. Rafie, “many patients underestimate their risk of opioid overdose or that of their loved ones. My goal is for my patients to have this available just in case. There’s no judgment or consequence to keeping this life-saving medicine on hand in case of emergency.” Anyone can book a quick appointment and walk out of the pharmacy equipped with a naloxone kit.

If you take opioids, here are some tips to help ensure you and your loved ones are safe:

  • Do not mix opioids with alcohol, other pain medications, anxiety medications, sleep medications, or street drugs. Mixing opioids with other substances is a leading cause of opioid injury and death. Talk to your doctor and pharmacist about other meds you are taking, and let them know if you have any changes in your meds.
  • Keep out of reach from children, other people, and pets. This medication can hurt people if taken by accident.
  • Get rid of any opioid medications that you no longer need.  The safest way to get rid of unused meds is by taking them to a drop off location. If you are unable to take them to one of these places, you should flush them down the toilet or the sink to prevent others from taking them accidentally.
  • Talk to your doctor about carrying naloxone (Narcan) with you in case of emergency. You will need someone else to give you naloxone, so tell your friends or family members where you keep it and how to use it. In an overdose, naloxone can reverse opioid side effects and save your life.
  • Take only as prescribed. Taking more than your doctor told you can lead to injury and in some cases, death. If you feel that your medication is not meeting your pain needs, talk to your doctor to discuss other options that may work better for you.
  • Do not drive or use heavy machinery after you have taken opioids until your doctor says that it is safe. Opioids can cause confusion and sleepiness, which can affect how well you do these activities.
  • Talk to your doctor if you have been taking opioids for a long time and you think that you no longer need them. Your body can get used to the medication. Your doctor may help you prevent withdrawal symptoms such as anxiety, sweats, trouble sleeping, loss of appetite, nausea, and fatigue.

For more information:

5 Ways to Make the Most of Your Pharmacist

With tax season just behind us, it’s that time of year where we ask, “Did I get everything I could out of my return?” or “Did I maximize my investments?” These are important financial questions but the same questions can be asked about our own health. Each year we complete our taxes and reflect on the financial decisions we made over the past year. We should be doing the same for our health care decisions, “Am I getting the results I’m looking for from my lifestyle changes?” or “Am I taking my medications correctly?” We get so busy wrapped up in the day-to-day activities that it can be hard to take care of ourselves. And at the end of a long stressful day, a fast-paced doctor’s visit might be overwhelming. Most of us only address recent health problems, like infections, injuries, or emergencies and we often neglect our ongoing health issues.

We live in a society obsessed with quick fixes and convenience, yet many overlook one of the most accessible resources — our local pharmacists. According to Gallup polls from the past several decades, pharmacists are consistently rated as one of the most trusted professions. People turn to their local pharmacist for many different reasons — advice, health education, and help managing complicated diseases. But are we taking advantage of all the benefits our local pharmacists have to offer?

talk to the experts pharmacists services

Your pharmacist can provide 5 key services for you:

  1. Preventative Care: Pharmacists are an access point for screening services for a variety of diseases. They also help you figure out if you would benefit from immunizations. With easy access in most communities, it makes your local pharmacy a one-stop shop for many of your healthcare needs.
  1. Medication Management: A lot of patients have chronic diseases and a pharmacist plays a vital role in helping with medication adherence. It can be as simple as helping to program cell phone medication alarms, pre-record talking medication vials for the visually impaired, or assisting patients in organizing their medications in a weekly pillbox organizer.
  1. Medication Review: Pharmacists play an integral role as the final check between the physician and the patient. Sometimes you might feel like you’re stuck playing a game of telephone and many of the details may get lost in translation. Pharmacists can take a comprehensive look at their your medications, evaluating new medications and how they interact with ongoing medications to help make managing all the recommendations from recent hospital stays, regular office visits, and specialty clinic visits easier for you.
  1. Counseling: Pharmacists work with you to help you understand your diseases, the role of your medications, and side effects to look out for. This increases your ability to consistently take your medications and helps optimize long-term health. Your local pharmacist is also an expert on over-the-counter products for health issues that can be taken care of with self-care, so they can help you answer questions like “How serious is it?” and “When should I see a physician if it doesn’t get better?”
  1. Collaborative Care: Pharmacists work in partnership with physicians and other healthcare providers to help manage medications for chronic conditions — think high blood pressure, high cholesterol, and diabetes — and reduce hospitalizations that can lead to unnecessary costs such as lost wages, caregiver fatigue, and expensive medical bills.

So the next time you visit your local pharmacy, make sure you are taking full advantage of all the things your pharmacist can do for you! After all you put time and effort investing in your health, make sure you’re maximizing your return.


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About the Author: Sarah Ross is a fourth-year pharmacy student at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences.  After graduation, she will be completing her PGY1 pharmacy practice residency at Scripps Mercy in San Diego.

 

(Article image credit: Mai Le)

Hormonal Birth Control Now Available Directly At Pharmacies in California

Like our neighboring state to the north, pharmacists in California can now prescribe and dispense birth control directly to women.  Now this warrants a happy dance!  Women now have another choice in how they get their birth control.  They can either go see their primary care provider, Ob/Gyn, family planning clinic, or go straight to the pharmacy.  At the pharmacy, women will have their choice of birth control pills, patch, ring, or injection.  All thanks to a state law passed back in 2013.  So why the delay?  It took 2 and 1/2 years to develop and approve the protocol because of the multiple rounds of revisions.

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Is this safe?  What about the pap smear?  A pelvic examination and a pap smear are not necessary to initiate hormonal birth control.  They are important for other health reasons.  Women will need to complete a health history questionnaire and have their blood pressure taken at the pharmacy.  This helps the pharmacist figure out which methods of birth control are safe.  If the pharmacist finds something concerning in your health history or if you want a long-acting birth control device like the implant or IUDs, then you’ll be referred to a provider who can help with that.  Ultimately, the goal is to improve access to medications where there is a public health benefit.  After the visit, the pharmacist will send a note to your primary care physician to fill them in — unless you don’t want the pharmacist to do that of course.

Interested in getting your birth control directly from your pharmacist?  Give them a call first to find out if they are providing this service.  Just because pharmacists CAN provide this service doesn’t mean they WILL.  California pharmacists want to participate but they are worried about time constraints at the pharmacy that prevent them from taking the time to do this.  Over time, more and more pharmacists will provide this service.  When you call the pharmacy, ask when would be a good time to come in for this service.  Pharmacies have “rush hours” and the pharmacist will be able to give you more time if you  come in when it’s slower.  Some pharmacies may even make appointments for this service.  In California, women of any age can access this service from a participating pharmacist.  No age minimums and no ID checks.  This service is completely confidential and no information can be shared with your parents or anyone else!

What’s this going to cost me?  If you go to the pharmacist for your birth control visit and fill your prescription, the prescription costs will be covered by your insurance the same as if it was written by a different provider.  Unfortunately, insurance companies aren’t paying pharmacists for the visit like they pay physicians and the long list of others who can provide birth control, including nurse practitioners, physician assistants, nurse midwives, and even nurses.  So you may have to pay out of pocket for the visit and submit the receipt to your insurance company and hope they reimburse you (if you try this, please let us know if this works or not!).

Is this a good idea?  This is an enormous step forward in increasing access to birth control.  Hopefully women will appreciate having more choices in where to get birth control.  Next steps?  Ideally more states will pass similar laws expanding access with pharmacist prescribing — Tennessee is already moving forward with legislation and many other states are considering it.  There is also growing support for over-the-counter birth control pills.  

Want to consult with Dr. Sally Rafie, PharmD, BCPS about your birth control and get a prescription?  Fill out the contact form and let her know how to reach you.

My Pharmacist and Me: How California Pharmacists Can Help Protect Patient Privacy

As pharmacists prepare to step into the ring of providing sensitive family planning services to their patients, it is important to brush up on patient confidentiality strategies, especially as they pertain to teens.

But wait…isn’t that what HIPAA is for?

Well yes… but wait there’s more! Once the statewide protocol for pharmacy access to hormonal contraception gets approved in California, pharmacists are likely to see teens pursue this option as a confidential, convenient way to get effective birth control. As a pharmacist, you should know that in the State of California, minors are allowed to obtain birth control without parental consent. In fact, you legally cannot discuss any family planning issues with a minor’s parents without the patient’s written permission. While you should encourage teens to keep open communication lines with their parents, you need to respect their decision if they choose to keep their sexual health a private matter. Knowing that they can trust their pharmacist to keep their healthcare private is VERY important to teens and they would benefit from being assured that you will keep their information confidential.

How does the ACA affect patient privacy?

The Affordable Care Act not only expanded insurance coverage for young adults through their parent’s plan up to age 26, it also provided complete coverage for birth control for women. This brings up an important dilemma, patients may now have expanded coverage for birth control, but they may be afraid to access it because of privacy concerns. While you have provider-patient confidentiality laws to adhere to, the insurance companies do not have to keep it confidential. This means that if your patient uses her insurance to cover her birth control, but her parent or spouse is the policy holder, then the insurance company could send billing information that reveals services obtained to that policy holder.

keepitconfidential birth control pregnancy test STD teen insurance pharmacy pharmacist

How can I make sure my insurance company keeps my health information confidential?

In California, a law was passed that allows dependents to fill out a Confidential Communications Request form to prevent insurance companies from sending potentially revealing information to the policy holder. Instead information specified in the form will be sent directly to the patient by either email or an alternate mailing address as requested by the dependent. More information for patients and providers can be found at myhealthmyinfo.org.

How can pharmacists help?

This is an important counseling point for pharmacists to review with patients.  Cost can become a big barrier to access when patients do not feel comfortable using their insurance and have to resort to paying out of pocket.  Since this is a new law, pharmacists can help spread the word and direct patients to the website for more information and the form.  Pharmacists should always be aware of their state laws regarding serving minors and confidentiality.


Courtney HeadshotAbout the Author:  

Courtney Miller is in her second year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. 

What California Teens Need to Know About Pharmacy Access to Birth Control

ProviderGuess what California! Having safe sex is about to get a whole lot easier for you in the next few months! We think that increasing access to highly effective forms of birth control is the best way to help prevent unplanned pregnancies and the lawmakers in California agree! A law was passed that is getting ready to rock how you get your birth control in a big way. Starting towards the end of 2015, your local pharmacist can start providing you with more effective forms of birth control in the pharmacy (the pill, the patch, the ring, and the shot)!

This means that you would be able to get your birth control without worrying about making a doctor’s appointment or clinic visit. (Side note: Getting checked out by a doctor regularly is really important! ESPECIALLY, if you are sexually active. It just shouldn’t prevent you from getting effective birth control!) Now if you need birth control you are going to have choices – the doctor’s office, your local family planning clinic, or your local pharmacy!

Who can get birth control at the pharmacy?

First of all, all you ladies out there can use it! Women of all ages — including teens — will be able to use this service. You also don’t need to have insurance or an ID card to get birth control. In California, minors can consent to medical care for the prevention or treatment of pregnancy without parental permission. In fact, legally the pharmacist cannot disclose any information to your parents without your written permission. Of course we know that your parents had sex at least once (hey, you’re here right?) so they probably know a thing or two about sex and birth control. So if you feel comfortable you can always chat with them about any questions you might have and they are welcome to come along to the pharmacy. We know teens like their privacy too; so just know if you don’t want to tell them, we won’t either!

How does pharmacy access to birth control work?

So here’s how it works. It is kind of like when you go get a flu shot from the pharmacist (if you don’t do that you totally should!). You fill out a health screening questionnaire and get your blood pressure taken to make sure that it is safe for the pharmacist to give you birth control and that’s it! The pharmacist will review your questionnaire and talk you about which methods of birth control would be safe for you to use. Then you can discuss how each method works and pick which you like best. The pharmacist will then provide you with birth control supplies just like you would get with a doctor’s prescription and you are good to go.

Keep in mind that not all pharmacies will be providing this service right away. It’s always a good idea to give the pharmacy a quick call to find out if they do before you go in.

How much will this cost me?

There will probably be a small service fee for the screening. This is different than the cost of the medication. If you do have insurance, you will most likely be able to get your prescription filled with no copay. (Thanks Obama!) If you are under your parents insurance, the insurance company might send your parents documents about what you got from the pharmacy. If this is something that you want to keep private, consider filling out a “confidential communication request” for your insurance company. See www.myhealthmyinfo.org for more information and a copy of the form.

What if I don’t live in California?

Basically, this new law is very exciting in the word of birth control. Hopefully once the other states see how much it has helped in California they will follow suit! So if you don’t live in California keep your eyes out changes to come!

What are some trusted sources for more info about birth control methods?

If this gets you excited about birth control, check out these helpful links to help you learn about different methods! These are really cool resources for teens and they break down all the pros and cons of each method. Bedsider includes videos from guys and girls talking about the experiences they’ve had with each method. On their website you can also sign up for text reminders for clinic appointments or to remind you to take your birth control pills, patch, ring, or shot. Planned Parenthood has an interactive quiz to let you know which methods might work best for you. They’ve even got info just for teens.

How can I get my questions answered?

Check out our new resource page just for teens!  If you have any other questions about your sexual health or anything pharmacy related you can submit your question anonymously. Your question will be answered by Dr. Sally Rafie, PharmD, who is a pharmacist and is very passionate about sexual health and how pharmacists can help!


Courtney HeadshotAbout the Author: Courtney Miller just finished her first year of pharmacy school at the University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences. She is from the central valley which has the highest rates of teen pregnancy in California so this topic is very close to her heart!

Look For These 5 Features When Choosing A Pharmacy For Your Birth Control

When it comes to picking a pharmacy for your birth control — whether you are buying something over-the-counter or filling a prescription — we are inundated with choices.  There are probably as many pharmacies in your neighborhood as there are coffee shops.  Everything from your corporate chain pharmacies (think CVS or Walgreens) to grocery store pharmacies (Vons, Ralphs) to big box pharmacies (Costco, Walmart, Target) to independent pharmacies (YourStreet Pharmacy, Sally’s Drugs).  There are a couple of other options too.  We can’t forget about mail order pharmacies and online pharmacies.  So how do we pick one?

There are a couple of features to look for.  These can be applied to other medications beyond birth control too.

#1 – Privacy  

Is there a private area where you can discuss your confidential medication and other health issues with the pharmacist?  We have all overheard awkward conversations between the pharmacy staff and the person in front of us in line.  The dividers on the counter don’t cut it.  It doesn’t have to be this way.  Some pharmacies are making the effort to have a private room or at least a private cubicle to meet with you.  

Target Pharmacy Counter

(Photo credit: Random Retail via Flickr)

Does the pharmacy guarantee your personal health information will not be shared with family members or others without your permission?  There are laws protecting your personal health information but that doesn’t always mean you’re safe.  A lot of people send their loved ones to the pharmacy to pick up their medications or ask a question, so the pharmacy is used to sharing information.  But if you want your records to stay private, ask about their privacy practices.  

#2 – Knowledge

The pharmacy exists for two reasons.  One is to get you the medication supplies you need.  The other is to make sure your medication will be safe and effective for you — essentially serving as a second set of eyes on your doctor’s prescription.  Birth control is not one-size-fits-all.  Pharmacists add an important layer of safety to the risky business of using medications.  You want to be sure your pharmacist is knowledgeable about birth control and everything that goes with it, like the menstrual cycle and sexual health.  

Birth control is amazing.  It prevents unwanted/unplanned pregnancies and does wonders for some mood disorders, making periods lighter and less painful, getting rid of acne, and so much more.  It’s not without its side effects.  As with all other medications, it’s a balancing act of the risks and benefits.  In most cases, the benefits outweigh the risks.  But you want to be sure your pharmacist warns you about the risks –there are some rare yet serious complications.  Many women give up on birth control because of more benign side effects like spotting, hair growth, decreased sex drive, weight gain, etc.  A pharmacist who knows birth control can use this information to recommend a different birth control formulation that will give you less grief and helps you plan if/when you want a baby.

#3 – Service

What services does the pharmacy provide that might add value to you as the patient or client?  Check if they can auto-refill your prescription.  Some pharmacies may be able to call/text/email you when your prescription is ready for pick up or when you’re due for a refill to see if you want them to process it.  Ask if the pharmacy can reach out to you when you are due for vaccines or other preventive health check-ins like STD testing.  

Perhaps you’d like to make an appointment to discuss your birth control or other health/medication issues with your pharmacist.  If this is an available service, does the pharmacy have an online scheduling option?

Is your pharmacy willing to go to bat for you?  This may mean playing phone tag with your doctor to get your prescription just right.  Or spending time convincing your health insurance company that you need this method of birth control or whatever medication and that the insurance company should pay for it (so you don’t have to).  See if your pharmacist has collaborations with other nearby health care providers and refer you as needed for related services like a pap test, pelvic exam, or breast exam (note: these are not needed for birth control, but help screen for cancer).

#4 – Convenience

Is the pharmacy convenient for you?  And I included you because we are each looking for something different.  Would it more convenient if the pharmacy was near school, near work, or near home?  Would you prefer they are open on weekdays or weekends?  Mornings or evenings?  Don’t forget to consider the parking situation.  

In this century, it’s not just about getting to the physical location anymore.  Does your pharmacy send you through an automated phone maze or is it easy to get through to someone who can help?  Can you email or text your pharmacy?  Do they accept refill requests online?

Now think about what the pharmacy can offer you to make it even easier.  Do they offer delivery or shipping services?  A small fee could well be worth the added convenience.  Your time and effort is money…and there’s the cost of gas too.

Does the pharmacy have other items that you can conveniently grab or have delivered/shipped?  Maybe you want to pick up a Mother’s Day card (hint hint, it’s just around the corner).  Or you’d like to pick up a thoughtful gift for your roommate.  Or you just need to stock up on the basics — we all need to brush our teeth  and use deodorant right?

#5 – Trustworthiness

This is somewhat of a catch-all for for the remaining things you should be looking for.  First, is the pharmacy legitimate and licensed?  Your neighborhood pharmacy will be but what about the anonymous people operating the online pharmacies.  Are the pharmacists licensed with their state board of pharmacy?  Does the pharmacy have a license/permit?  Are they getting the medications from a trusted wholesaler or could they be off-market?  The integrity of a medication cannot be trusted if it touches an off-market wholesaler.  You do not want to be fooled by counterfeit medications.  There’s a fantastic book on this topic.

Why isn’t cost on the list?

Medication prices are controlled much higher upstream and the pharmacies may not have much input on the matter.  The drug wholesalers set prices and insurance companies dictate how much the pharmacy gets reimbursed for dispensing prescription medications.  Oftentimes, pharmacies are actually losing money on some of the prescriptions they fill.  When the pharmacy’s costs and reimbursements are controlled by these outside factors, so is the cost to you — the patient.  Your copay will be the same regardless of which pharmacy fills your medication.*  So you can let the other features listed above help you pick the pharmacy that meets your needs.

*Some health insurance plans have lower copays when using their mail order pharmacy.  So a 3-month supply may be given for the price of 2-monthly copays.  Some health insurance plans may have “preferred” pharmacies so using a non-preferred pharmacy could cost a bit extra.

We would love to hear about your experiences with different pharmacies.  Please add comments below!

Expert Interview: Dr. Veronica Vernon

vernon veronica pharmacist womens health choose controlMost people are familiar with the roles of physicians and nurses, but don’t always know what pharmacists roles are. Dr. Veronica Vernon is a clinical pharmacist specializing in women’s health and shares a little about what she offers her patients.

How did you become interested in women’s health?

Through high school, I struggled with some gynecological issues, and this really sparked my interest in learning more about women’s health. During pharmacy school, my interest grew as I discovered more about the differences in how medications work in men and women and how to treat women’s health conditions. I noticed that many practicing pharmacists and fellow classmates were uncomfortable discussing women’s health issues. I desired to further grow my knowledge in order to meet a need I saw in my community.

Who benefits the most from having a women’s health pharmacist caring for them?

I see patients by myself sometimes and other times with a doctor. The gynecologist refers patients to me who have menopausal symptoms, side effects from birth control, premenstrual dysphoric disorder, and those who are pregnant or want to be. The patients who have multiple chronic illnesses or complicated medical issues seem to be benefiting the most from having me work with their doctors. I treat high blood pressure, high cholesterol, diabetes, and low thyroid function as well.

Pharmacists are an integral part of any women’s health care team, since we understand how medications can work differently in women and we are the medication experts. Discussing your medication use with a pharmacist is extremely important to make sure that you are not experiencing any side effects and the medication is optimally working. We can also help prevent and manage chronic illnesses. I always discuss how to live a healthy lifestyle with all of my patients. My favorite part of my job is helping women lead healthier lives.

Do you think other hospitals or clinics should hire a women’s health pharmacist?

I firmly believe other VAs, health systems, and clinics should hire a pharmacist focused on women’s health. I have been able to spearhead initiatives, such as providing emergency contraception to our female veterans and the use of methotrexate for ectopic pregnancies, in our health system. I also lend my services to the smaller VA hospitals in our region that do not have the resources to hire their own women’s health pharmacist.

I can see patients using a video conference system (similiar to Skype) and assess their symptoms and manage their issues virtually. I enjoy this more than a phone call since the patient and I can actually see each other without having to be in the same room.

I serve as a resource to all of our providers in my VA faciltiy and provide quarterly education sessions each year on women’s health topics. This allows my facility to improve the overall quality of care provided to female patients.

What are your top 3 tips for women based on what you’re seeing among your patients?

  1. Women should make sure they are getting regular check-ups (including pap smears if indicated) and talk with their doctor regarding ways they can prevent chronic conditions, such as diabetes, high blood pressure, and high cholesterol.
  2. Women should find a healthcare provider with whom they feel comfortable voicing their concerns. Many women are embarassed to bring up gynecological-related symptoms, such as pain during intercourse or vaginal burning or itching, but these are important issues to discuss with your healthcare provider.
  3. Women should keep an updated medication list with them at all times (I recommend keeping one in your purse or wallet) and know why they are taking each medication. Being well-informed about your health is empowering and allows you to take control of your health instead of your letting your health control you.

What do you wish you could do for your patients?

I would really enjoy starting a prenatal class for our patients who are pregnant. I think meeting with a pharmacist throughout their pregnancies would be extremely beneficial. I think my patients would like the support system that could be formed through this class. I would want to bring in other healthcare professionals, such as nurses and dieticians, who could support my patients.


About the Expert: Dr. Veronica Vernon, PharmD, BCPS, BCACP is a board-certified pharmacist practicing at the Richard L. Roudebush Veterans Affairs L Medical Center in Indianapolis, Indiana. She is also an Adjunct Assistant Professor of Pharmacy Practice at Butler University.  Dr. Vernon is a North American Menopause Society (NAMS) Certified Menopause Practitioner.  Female veterans who would like to make an appointment with Dr. Vernon should call (317)988-4917. 

Birth Control in 2014: The Goodies and The Bullies

Reflecting back on what happened with birth control in the last 12 months, there were many goodies worth celebrating…hooray! Unfortunately, there were some big time birth control bullies too…boo! Here’s a quick reflection on the most notable of each.

Birth Control in 2014 Goodies Bullies Choose ControlGoodies

1. More women using highly effective methods. We saw a big jump in the use of highly effective methods of birth control, also known as long-acting reversible contraceptives (LARC). Among women using birth control, only 2% were using LARC in 2002 but that’s up to nearly 12% in 2011-2013. Both teens and adult women alike are now choosing these methods over other options more than ever before. Most women still use the pill, which is very effective if taken correctly and consistently, followed by condoms. LARC comes in at 3rd favorite. We are all on the edge of our seats to see if this leads to fewer unplanned pregnancies and abortions.

2. Generic versions of Plan B One Step approved. The FDA approved several generic versions of Plan B One-Step. This means more options when it comes to emergency contraception. The brand Plan B One-Step product is still on the shelf, so now women can choose between spending $50 on that or go with one of the less expensive generic products ($40 for My Way, Levonorgestrel, Take Action, or Next Choice). The least expensive product (AfterPill) is available online for $25 a dose. This is a great option for anyone who wants to keep a dose at home in case it’s needed later.

3. Birth control being developed for men. Men have been limited to vasectomies and condoms for pretty much ever. That list may grow much longer to include pills, gels, injections, and even implants in the future. Indonesia is studying a natural compound as a birth control pill for men. While no new methods hit the market in 2014, we’ve got lots of great options in the works. In the meantime, an elastic prophylactic (better known as a condom) will have to do for most.

4. Californians can get birth control at the pharmacy without a prescription. California approved a law that expands pharmacists’ scope of practice to include providing some birth control methods directly to patients without a prescription. That means women in California will be able to get the pill, patch, ring, and depot injection at their local pharmacy soon. The protocol is being finalized now and this new service should be available in the next few months. This is a BIG DEAL! California will be the first state with this expanded access, which is the closest to over-the-counter. More to come on this when we get closer to this being a reality.

5. More support for over-the-counter access to the pill. The American College of Obstetricians and Gynecologists just released an expert opinion on access to birth control reinforcing their statement of support for over-the-counter birth control. Many other professional associations and advocacy organizations are behind this expanded access too. Want to know more about over-the-counter birth control? Check out the Free the Pill websiteTwitter, or Facebook page.

6. Improving consumer and healthcare provider knowledge of emergency contraception. Senator Murray along with her consponsors introduced the Emergency Contraception Access and Education Act of 2014. If passed, two things would happen: First, hospitals* would be required to give sexual assault victims medically accurate information about emergency contraception and promptly offer emergency contraception regardless of the victim’s ability to pay for this service. Second, there would be educational programs about emergency contraception directed at both the public and healthcare providers. Ask your senators to support this bill. *This would be required of hospitals receiving federal funds.

There have been lots of efforts to increase awareness about emergency contraception methods and availability. I helped create a guide to access to emergency contraception for pharmacists and other pharmacy staff members. Bedsider.org has awesome resources like this chart comparing methods of emergency contraception.

Bullies

1. Corporations can have religious beliefs. And impose those beliefs to restrict the health care options of their employees. But only when it comes to birth control and abortions. This doesn’t make any sense but the Supreme Court of the United States made it so. Tens of other companies are now following in Hobby Lobby footsteps to fight the birth control benefit of the Affordable Care Act (ACA). This GIFs-planation explains how we went from celebrating the birth control benefit — a major goodie — to being bullied by “religious corporations.”

2. Republicans support over-the-counter birth control for the wrong reasons. Their reason: so it’s no longer covered by insurance. But birth control will need to be covered by insurance to be sure there’s access. Since the Affordable Care Act benefit kicked in, we’ve already seen a shift in women using more effective methods that were cost-prohibitive before (see goodie #1). Over-the-counter birth control would make it much more convenient for women (see goodie #5) but insurance coverage means ALL women can benefit. Dr. Dan Grossman, MD, MPH explains the issues in this LA Times Op-Ed.

3. Counterfeit birth control. Untrustworthy retailers began selling emergency contraception on Amazon.com this year. The unbelievably low price was the first red flag. We don’t know whether these products were counterfeit, stolen, or illegitimate for some other reason. But we can’t trust them either. RH Reality Check published a great article warning buyers to beware. The FDA also has posted information on the dangers of buying medications online and warning consumers to be wary. As if there aren’t enough barriers to birth control without adding this to the list.

I’m glad to see there are more goodies in my list than bullies. I’m optimistic about what 2015 will bring and hope you’ll join me by using your voices and votes to promote progress.

Radio Interview About Pharmacists & Birth Control

Last week, I had the pleasure of being interviewed for a radio program about the different areas where pharmacists provide clinical services.  The host of Health Update Radio, Dr. Gerry Graf, is a retired pharmacist himself and was very interested in pharmacist roles with family planning and birth control.  The program aired live last Monday, September 5, 2014.  The portion of the show where I am interviewed can be found in the video clip below.

We talk about why family planning is important for women of all ages from menarche (when a young woman begins menstruating) to menopause.  Some of the topics we discussed include all the different methods of birth control, considerations in women with medical conditions, access and privacy in pharmacies, and contraceptive coverage under the Affordable Care Act and Hobby Lobby decision.

You can access the full program featuring Drs. Steven Atallah and David Ha discussing their roles in trauma care and infectious diseases care on the WS Radio website.

Ask Dr. Sally: Took the Wrong Pill

We received our first question from a reader today!

Just realized I took my pill today (Wednesday) but I took the wrong day’s pill (Friday).  What now?  Are they pretty interchangeable at that part of the month?  I take a generic version of Yaz.WrongBirthControlPill

Let me alleviate your concerns!  Yaz is a combination birth control pill, which means there is a combination of both estrogen and progestin hormones.  This is the most popular type of birth control pill and a minority of women use progestin-only pills.  Among the combination birth control pills, there are many different formulations.

Yaz has 24 “active” pills, all with the same doses of both hormones, and 4 hormone-free or “placebo” pills at the end of the pack.  The two active pills are the exact same.  So in this case, the fact that the wrong day was punched out and taken does not make any difference.  It’s just important to remember this and continue taking one active pill a day until you are back on track later this week.

For women taking other birth control pills, the response to this question would depend on the formulation.  Some pills have different doses of hormones every week or sometimes the dose changes after just a couple days.  Your pharmacy, doctor’s office, and community or family planning clinic are resources if you find yourself with a contraceptive mishap.  When asking a question, be sure to let your pharmacist, doctor, or other clinician know which birth control pill or other method you are on…know the medication name!  This way, you’ll get an answer specific to the medication you are on…and this goes for all medications, not just birth control.

Thanks for sending us your question.  Don’t be shy to ask your pharmacist any questions about your birth control pills or other birth control methods.  We look forward to answering many more questions!