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Times Union (USA), June 2, 2004

State at center of 'morning-after pill' fight

Albany Bill would allow pharmacists to dispense emergency contraception without a prescription

BYLINE: Erin Duggan; Capitol Bureau

The battle to make emergency contraception readily available to women has shifted from the federal government to New York and other states, where it is marked by confusion, politics and conflicting definitions of pregnancy.

Advocates contend the high doses of birth control pills could prevent as many as 1.7 million unintended pregnancies and 800,000 abortions in the United States each year, while opponents say preventing a fertilized egg from attaching to the uterus is tantamount to abortion.

In May, the federal Food and Drug Administration kept the emergency contraception drug, called Plan B, as prescription-only. In doing so, the agency went against its own advisory panel, which had recommended reclassifying it for over-the-counter sales.

Now scientists, doctors and groups advocating for and against increased access to the pills are watching New York. A bill to give pharmacists the ability to dispense emergency contraceptives (also known as the "morning-after pill") without prescriptions passed the Assembly in February and is currently before the Senate.

The bill is sponsored by Nancy Larraine Hoffmann, an Onondaga County Republican. But Hoffmann, a former Democrat, faces a primary challenge for her Senate seat by a more conservative Republican.

Sarkis Harootunian, Hoffmann's chief of staff, said Hoffmann believes the pills are contraception, not abortion, and stands by the bill regardless of political pressures.

"Her positions are her positions," he said.

Emergency contraception is as confusing as it is controversial. Many women don't know drugs like Plan B and Preven are available by prescription, and even fewer know how they work. Emergency contraception is not RU-486, a pill that aborts a fetus.

The emergency contraception drugs are a dose of birth control hormones, which do one of three things whether taken daily or in higher dosage as emergency contraception. The hormones prevent the ovary from releasing an egg. If an egg is released, the drugs make fertilization much harder, and in the few cases when fertilization does occur, the drugs prevent a fertilized egg from attaching to the uterus. The drug does not, however, interfere with a pregnancy.

"Without implantation, by definition, there is no pregnancy," said Dr. Paul Blumenthal, director of contraceptive research and programs unit at Baltimore's Johns Hopkins University.

That is where the scientific debate ends and the political debate begins.

"They call it emergency contraception, but it's abortion," said Joseph M. Scheidler, national director of the Pro-Life Action League. "It's very possible and very likely in many cases that the egg has been fertilized. And that is a new life."

The bill that passed the Assembly, sponsored by Amy Paulin, D-Scarsdale, allows doctors to write prescriptions that are not patient specific and to give them to pharmacists who would dispense them at their own discretion.

While the drugs would be as easily accessible as over-the-counter medications, they would be much easier to obtain than they are now. Today, women must see a doctor to get a prescription, and find a pharmacy to fill it -- which can be difficult on weekends and holidays. Emergency contraception is meant to be used within 72 hours of unprotected sex.

"Women have better access to pharmacists than to physicians," said pharmacist Boris Mantell, chairman of the board of the Pharmacists Society of the State of New York. The group is one of about 80 organizations in the coalition of the New York City-based Emergency Contraception Access Campaign, which is pushing the Senate to pass the bill.

Mantell said pharmacists would decide for themselves whether to accept the non-specific prescriptions from doctors and would likely undergo additional training on emergency contraception.

"Pharmacists would undergo some sort of review, to make sure they are up to date on any criteria and make sure this is a safe and proper way to do it," he said. "But I'm confident it can be done."

The idea isn't unique to New York -- several states including California, Washington, Maine, New Mexico, Alaska and Hawaii already have approved similar legislation.

Describing the positions Hoffmann is evaluating, Harootunian inadvertently summed up the tug-of-war between science and politics: "The College of Obstetricians and Gynecologists supports it, the Conservative Party opposes it."

Mike Long, chairman of the state Conservative Party, said his party's platform explicitly opposes emergency contraception. He said the drug encourages reckless behavior.

Whether the Senate will move on the bill in its last scheduled weeks of session is unclear. Mark Hansen, a spokesman for Majority Leader Joseph Bruno, R-Brunswick, said Bruno's office is "still reviewing it."

At a news conference Tuesday at the Capitol with emergency contraception advocates, Rochester Democratic Assemblywoman Susan John, a co-sponsor of Paulin's bill, seemed fed up with the politics competing with science in the debate over accessible emergency contraception. Also at the conference was Dr. Vivian Lewis, an obstetrician-gynecologist who served on the FDA panel.

"This is important to women of all ages, races, classes and across the state," said John, who says she was contacted by a married mother unable to get emergency contraception. "Women live in fear of pregnancy. It's internalized, and it's always a fear. Despite your best efforts, you know it's always a possibility."

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