The practice of online prescribing and buying medicines on the internet is expanding and it can play a positive role in providing care for our ever growing population. However, concerns have been raised at the news that some women are buying emergency hormonal contraceptive (EHC) pills from overseas websites that deliver to customers’ homes with no questions asked. Some are even available for purchase via eBay for as little as £5. This highlights key issues that are affecting patients and professionals alike.
EHC (commonly called the “morning-after pill”) is currently available via sexual health and contraceptive clinics, GPs, pharmacies and registered online pharmacies. Under these providers, the pill is only prescribed after a professional assessment, with respect to a sexual, medical and drug history (i.e. patient safety is priority).
The patient obtaining EHC from a non-regulated website is, often unwittingly, removing themselves from this safety net. Like any medicine obtained from an unregulated source, it is impossible for the patient to ascertain if the drugs are safe or effective. Overseas shipping means the tablet may not arrive in time and the lack of professional overview means that patients with certain medical conditions and those taking other medicines are at risk of harmful drug effects and interactions.
Women accessing EHC in this way also miss out on the benefits of a professional consultation. This provides a great opportunity to discuss the types of emergency contraception available (for example, many women are unaware that an intrauterine device can be inserted up to five days after unprotected sex, is more effective than EHC and can remain in place for up to ten years afterwards). A consultation also allows discussion about long-term contraceptive needs, sexually transmitted infection testing and sexual concerns. There is also an opportunity to identify vulnerable groups, such as the very young, who are at risk of sexual coercion.
What we must also acknowledge is why people are accessing EHC in this way. Some may be purchasing pills online to avoid the embarrassment or anxiety of visiting a clinic, while some may not even realise free EHC is available, even from some pharmacies, which offer EHC under a patient group direction. These points highlight the need for mandatory sex education in UK schools so that young people are aware of their contraceptive needs and choices.
This situation additionally reflects how some women are resorting to these methods because of reduced access: budget cuts are meaning clinic closures and the loss of preventative services. The Family Planning Association’s 2015 report ‘Unprotected nation’ predicts an additional £8.3bn spending because of unintended pregnancies over the next five years. That is in the midst of the UK already having the highest rate of teenage pregnancy in western Europe.
All professionals providing EHC should warn patients of the risks and pitfalls of obtaining the tablet online from overseas suppliers. Additionally, professionals who do not prescribe long-term contraceptives or provide sexual healthcare should be aware of their local services in order to direct patients towards appropriate ongoing care.
Specialist registrar in sexual health and HIV
King’s College Hospital, London