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Morning-after pill: we can't turn pharmacists into police officers

THE Irish Medicines Board has licensed the "morning after" contraceptive pill for sale over the counter in pharmacies without prescription. It's a massive step forward; or it should be.

Apart from anything else, the move will reduce the price of the emergency contraceptive pill from €45 to under €10.

But already the caveats are emerging, the quagmire is starting to bubble, and the seedlings of uncertainty are being carefully nurtured to ensure doubt, equivocation, and an "Irish solution to an Irish problem" which, once again, will probably leave an undignified lack of answerable certainty for pharmacists as much as for women who fear they may be unintentionally pregnant. The morning-after pill in Ireland comes in the form of two brand named drugs called NorLevo and Levonelle. Until now, Levonelle has had a more than 90 per cent market share. And until now, both have only been available on prescription from a doctor.

In 2007, HRA Pharma, which manufactures NorLevo, applied to have its product made available over the counter without prescription.

The Irish Medicines Board (IMB) asked for more information, and the company withdrew its application. But for the past month, the pharmacy chain Boots has been selling both drug brands over the counter under a protocol drawn up by its own medical doctor, which Boots believes is a permitted interpretation of Irish law. The IMB disagrees, claiming there is no provision in Irish law for "patient group directions". (If that is the case, the lack of provision of such directions points to yet another failing in our laws concerning the availability of contraceptive and, indeed, other drugs.)

But when Boots (hardly a company of questionable or underhand reputation) last month began selling the two brands of morning-after pill over the counter, with a consequent rush of demand, the manufacturers of NorLevo returned to the IMB with an application for an over-the-counter licence.

They received it last week. So now the drug which had cornered more than 90 per cent of the market (Levonelle) has no over-the-counter licence, while its rival (NorLevo) has. Both, of course, are available on prescription.

To quote the late Oliver Hardy, were he in the unlikely situation of addressing the IMB: "Another fine mess you've got me into." And you can add to that: another fine mess that's been sorted for us by the hated Sassenach: Boots is a British company. But to do justice to the IMB, it can point back to the legislation which has created so many oddities of interpretation.

If two such organisations as Boots with its international reputation for probity, and the IMB which allows or disallows the sale of every drug available on the market, can have such different interpretations of the law, then that law is dangerously ambivalent .

We can no doubt expect self-styled "pro-family" and "pro-life" groups to begin a long process of agitation against the new licence. They will claim, no doubt, that it encourages promiscuity.

Just as such groups fight against the right of very young women to receive contraceptive advice in confidence, without their parents or guardians being informed. What they really mean is that they want legislation in place which will ensure that any woman indulging in extra- or pre-marital sex (that is, Catholic-unsanctified sex), whatever her age, suffers for it.

And therein lies another problem: in Ireland, the legal age of consent to sex is 17; the legal age of consent to medical treatment is 16. So what does a pharmacist do if a 16 year old walks into the shop, says she was raped/the condom broke/ or she was just too drunk to ensure her boyfriend used a condom? Legally, she was breaking the law by having sex with her boyfriend. She was also, of course, breaking the law by being drunk. (That's not even contemplating the horror of rape.) She has committed a crime: in law, the pharmacist should report her to the gardai, but should also provide her with emergency contraception. If she's 15, the pharmacist should report her to the gardai, refuse her contraception, and notify the nearest Magdalen home.

What in the name of all that's unholy is a pharmacist supposed to do? The Pharmaceutical Society of Ireland (PSI) has done its speedy best. Following on the granting of a sales licence for NorLevo, it issued interim guidelines on Thursday evening.

The guidelines point out that under the authorisation for the sale of NorLevo, there is no age limit for patients using the product. You get the impression that the PSI wishes that was all it had to say. But it goes on to point out that under legal guidelines it is "usual" for parental guidance to be sought for medical procedures, treatment, or provision, for people under the age of 16. The guidelines then point out that the age of sexual consent in Ireland is 17.

The Pharmaceutical Society still doesn't go under: where appropriate, the guidelines point out gamely, "pharmacists need to assure themselves of the age of the patient, and having regard to the age and circumstances of the individual patient, and any child protection issues arising" they should consider referral to a "medical practitioner . . . other agency or authority."

The granting of a licence for the sale over the counter of emergency post-sexual intercourse contraception at a reasonable price after proper consultation between the pharmacist and the patient should be the gateway to ensuring a massive drop in the numbers of accidental or unwanted pregnancies.

We all know that immaturity, responsibility, and passion make uneasy bedfellows. But the new availability, without embarrassment, effort, or 25 per cent of an unemployed person's dole money, should mean that we have made enormous social progress. It might be pushing it, but it's possible even to say that there is no longer any justification for someone to have a child in an unplanned pregnancy, whether they're 14 or 40.

Except, as usual, we've screwed it up, as we seem to screw up everything to do with sexual health in this country.

As things stand, we're trying to turn pharmacists into police officers.

When will we wake up and accept that a 15 year old stands closer to having her life and prospects blighted by pregnancy and childbirth than does a 25 year old?

When will we pass laws that recognise that sexual function should be a health issue for the State, and only a health issue? Only where violence, exploitation, duress, and perversion are involved, has the State a legitimate function to intervene under criminal law.

Sunday Independent