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    Pharmacist on the spot

    I used to have a friend who claimed The New York Times was the best pharmacy journal out there, and he subscribed just for that reason. All the big drug companies are major Fortune 500 corporations trading on the New York Stock Exchange, and with the ins and outs of healthcare always on everyone’s minds, his plan was to learn most of what he needed to know about the profession by keeping tabs on the business and health news printed in the nation’s paper of record.

    I thought of him the other day as I browsed the paper’s website and came across an article that resonated right to the heart of modern pharmacy practice. Here’s the gist: In reaction to the passage of restrictive new abortion laws in the state of Texas, more women were expected to cross the border into Mexico, where Mexican pharmacists sell an “abortion pill” over the counter.

    That pill is misoprostol, known to most of those reading this as the anti-ulcer medication Cytotec. That it can be used to end a pregnancy has been an open secret in the medical community for years, but it was the following quote that really caught my eye:

     “When asked how women should use the pills, some of the pharmacists said they did not know and others recommended wildly different regimes that doctors say could be unsafe.”

    These words would strike horror into the heart of any pharmacy academic or leader north of the border. Evidently the Mexican Pharmaceutical Association is even less effective than its U.S. counterpart is at addressing the needs of the profession.

    Key roles

    I bring this up not to start a debate in these pages on the abortion issue, but to point out how one story in a mainstream paper neatly tied together most of the issues facing pharmacy today.

    It illustrated both the role of pharmacists as the most accessible healthcare professionals and the importance of our role as educators and guides to proper medication use.

    If the article also had talked about the imposition of flu shot quotas and the pressure to meet assembly-line metrics in the filling of patients’ prescriptions, it would have covered in one fell swoop every challenge we face.

    Here’s the beef

    I also bring up this subject so you can be ready.

    The passage of laws making abortion access harder to obtain in parts of this country will not let up any time soon. This means that between striving to meet that shot quota and the “prescriptions filled within 15 minutes of label print” metric, you may very well be faced with a question from a scared and vulnerable young woman about a pill she got from the local flea market to “bring her period back.”

    No matter where you stand on one of this country’s most divisive issues, I doubt that you would want any young woman to put herself in harm’s way through incorrect use of that medication. This means that we’ll have to come up with a better answer than “I don’t know.”

    And it will have to be a better answer than “Call your doctor,” since for some of these patients, talking to a doctor might be as big a challenge as flying to the moon.

    Ready or not

    Welcome to the world of “beyond count, pour, lick, and stick.” Whether you’re ready or not, it’s coming to your counter, in ways you may not have expected or been trained for.

    For all the talk of fancy prescription MTM and cookbook immunization protocols, sometimes our value arises from the fact that the pharmacist is the only contact who might prevent a medication-induced disaster. 

    You can’t measure it or put a quota on it, but it’s the most important thing we do.

    Make sure you’re ready.

    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]

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    • Anonymous
      Perhaps the reason pharmacists do not know the protocol for misoprostol is that this procedure requires medical supervision. It is not a one pill, one day regimen. This procedure has been dangerously over-simplified here. Assistance might be needed to remove products of conception which to my knowledge pharmacists have no training in performing. "See your doctor" is the most prudent advice we can give. As I further recall, some misoprostol induced abortions result in infections which would require prescribing of antibiotics and possibly hospitalization. I am happy to consult on correct drug use all day long and correct use of misoprostol requires appropriately trained medical personnel. Period.