Pharmacists are being trained to dispense abortion pills, despite a prohibition put in place by the Food and Drug Administration (FDA). The online course for pharmacists and pharmacy technicians is being provided by Advancing New Standards in Reproductive Health Center (ANSIRH) in collaboration with Dr. Sally Rafie, a consultant for GenBioPro, the generic manufacturer of the abortion pill. ANSIRH, founded by abortionist Felicia H. Stewart, is a program within the University of California San Francisco’s Bixby Center for Global Reproductive Health, which trains abortionists. Read much more about ANSIRH here.
Currently, under an FDA abortion pill safety requirement (REMS), women may only obtain the abortion pill with an in-person visit to a certified prescriber of the drug. To become certified, prescribers must have the ability to accurately assess the duration of a pregnancy and diagnose an ectopic pregnancy. The REMS safety regulations require providers to sign the manufacturer’s prescriber agreement and they must stock the drug, since it currently cannot be dispensed in a pharmacy. However, using the COVID-19 pandemic as an excuse, the Biden-Harris administration’s FDA has allowed the pills to be dispensed online, by approved prescribers.
ANSIRH claims that “pharmacists have limited involvement in abortion care, primarily due to the FDA’s dispensing restrictions on mifepristone,” adding, “Dispensing of mifepristone by trained pharmacists could improve access to medication abortion by enabling people to bypass geographic, financial, or insurance obstacles to clinic-based care and to receive abortion care earlier in pregnancy.”
However, pharmacists clearly do not meet current FDA prescriber requirements with the ability to properly assess pregnancies or diagnose potential issues. Therefore, what is at the root of this effort is increased access, not safety.
“Pharmacist dispensing could also help to increase the number of clinicians willing and able to provide medication abortion by enabling them to avoid the associated costs and logistical challenges of stocking and dispensing the medication in their facilities,” ANSIRH claimed. “Mail-order dispensing of mifepristone could increase access to medication abortion particularly for individuals who live in parts of the country with few abortion providers and where few pharmacies may agree to stock the medication.”
ANSIRH online abortion pill course for pharmacists
ANSIRH’s one-hour online course was developed for pharmacists and pharmacy technicians in collaboration with presenter Brooke Griffin, PharmD, abortionist Daniel Grossman, and the aforementioned Dr. Sally Rafie, “with an overview of medication abortion, and reviews current and future roles for pharmacists in its provision.”
The course is expected to “discuss the potential ways in which pharmacy professionals could be involved in provision of medication abortion…” What is interesting about the graphic below is that it places pharmacists in the role of abortion procedure follow-up. At the bottom, the graphic suggests, “Call patient in 1 week to assess therapy and wellbeing. Discuss contraceptive options, if patient interest.”
Rafie is also a former pharmacist consultant for Planned Parenthood of the Pacific Southwest, and founded the organization Birth Control Pharmacist with help from a grant by Society for Family Planning. Birth Control Pharmacist (BCP) recently published a resource to “help clinics and mail order pharmacies collaborate to provide medication abortion care/Rx while the FDA is allowing exceptions to the REMS dispensing restrictions,” according to a tweet from the group.
The BCP pharmacists checklist states, “Avoid pain medications like ibuprofen and naproxen,” then suggests abortion clients call if “[p]ain [is] not responsive to pain medicines or diffuse/severe abdominal pain.”
Despite claiming medication abortion is “safe,” ANSIRH’s online course handout tells pharmacists to “evaluate for other contraindications” such as “suspected ectopic pregnancy,” “Hemorrhagic disorders,” and “Chronic adrenal failure,” to name a few. It also recommends they “review RH status.”
These recommendations seem to go far beyond what a pharmacist is trained to do.
“Mifepristone and misoprostol are contraindicated in case of ectopic pregnancy because treatment believed to be ineffective,” one slide warns, adding that “Medication abortion may be used with pregnancy of unknown location, but must follow closely to confirm completion.”
“Patients at high risk of ectopic should have ultrasound…” the ANSIRH course states.
Again, exactly how pharmacists will oversee what is typically done by physicians was not specified.
“All patients with a successful medication abortion have some bleeding,” one ANSIRH slide states. “Uterine infection is rare, but may occur. Mifepristone has boxed warning regarding serious and sometimes fatal infections.”
ANSIRH’s slide presentation warns pharmacists to tell abortion clients to “Call if… bleeding… soaks 2 full-size pads per hour for 2 consecutive hours… Patient has minimal bleeding, does not believe passed pregnancy, or has continued pregnancy symptoms after 7 days.”
“Ongoing pregnancy occurs in 1-3% of patients, depending on gestational age,” claims ANSIRH. “Incomplete abortion occurs in 2-5%.” What ANSIRH does not state is that the later in gestation, the greater the likelihood of an incomplete abortion.
The modules then describe “major complications” such as hospitalization, surgery, blood transfusion and death.
Pharmacists instructed to refer abortion pill complications to ER
When it comes to abortion pill complications, which no doubt will arise, ANSIRH tells pharmacists to simply refer the women to the nearest emergency room.
“Clinician discusses with patient to go to Emergency Department (ED) in case of signs of serious complication. Patients encouraged to bring Medication Guide with them to ED or if they see a different clinician.”
In 2019, pro-abortion ER doctor Dara Kass confirmed that eight percent of abortion pill patients end up in the ER. “Recently published results of the Gynuity pilot project showed that 8 percent of their patients who received abortion medication sought follow-up care at a local urgent care clinic or emergency department,” Kass told Vice News.
Eight percent is no small number and may represent 27,000 possible emergency or urgent care visits in one year, based off the most recent data (2017) showing 339,640 medication abortions were committed nationally out of 862,320 total abortions reported.
Pharmacy abortion pill access is simply one step in the goal of unrestricted over-the-counter abortion drugs, in which minors and adults can access the dangerous regimen without any involvement with medical professionals except when something goes awry.
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