Why is the “gold standard” of abortion drugs not available in Canada?

Bottles of mifepristone, an abortion-inducing drug, which is not available in Canada.Charlie Neibergall/Associated Press

In Canada, there are approximately 100,000 abortions a year, most of them performed surgically in clinics or hospitals. Access to the procedure varies considerably across the country. Wait times are short in larger urban centers, although they can still take several weeks, but options are extremely limited in Atlantic Canada and many rural communities. Even women in small towns often have to travel hundreds of kilometers to reach a clinic.

Medication abortions, experts say, are a way to improve earlier access to abortions and protect privacy, as patients could potentially see their family doctor and not need to visit a clinic – an important option for women from ethnic or religious groups who oppose abortion.

Currently, for medical abortions, Canadian women only have access to methotrexate, a chemotherapy drug, administered orally or by injection, which terminates pregnancies. It can only be used during the first seven weeks of pregnancy.

Another drug – mifepristone – is considered the “gold standard” drug for medical abortion. The World Health Organization has declared it an “essential medicine” and, according to statistics cited in a recent editorial in the Canadian Medical Association Journal, it is now used in around 60% of abortions in Europe and 20% in the United States. . .

Taken orally, mifepristone blocks the production of progesterone which prevents the pregnancy from continuing. In other countries it has been approved for use for up to nine weeks.

Both drugs are taken with misoprostol, which causes contractions and bleeding similar to a miscarriage. But having a medical abortion using methotrexate can involve a much longer process – patients usually wait three to seven days before taking the second medication. According to Dr. Wendy Norman, an assistant professor at the University of British Columbia’s faculty of medicine who specializes in family planning, only about 60% of women will have completed the abortion within a week, and some patients may wait several weeks. . In up to 10% of patients, women will undergo surgery, either because the pregnancy is still growing, to manage bleeding, or because of the long wait.

In comparison, mifepristone is generally much faster acting, making it easier for doctors to monitor patients. The second drug, misoprostol, is usually taken within 48 hours, and research shows that two-thirds of women who have a medical abortion using mifepristrone will have a complete abortion within four hours of taking misoprostol. and 90% during the day.

Mifepristone is the preferred option, medical experts say, because it works faster, has been shown to be more effective and is less toxic. (In fact, as the CMAJ editorial pointed out, the World Health Organization does not recommend methotrexate for abortions due to the high risk of serious birth defects if the pregnancy continues.)

Concerns were raised about medical abortions around 2000, Norman says, when there was a cluster of cases in which women died from infection – antibiotics are now prescribed as a precaution. Some groups have raised concerns that the use of medical abortion may isolate women when they have abortions and prevent them from receiving advice or support.

As CMAJ pointed out, the problem is that Canadian women only have access to the second best option. “There’s no evidence to suggest it’s not a very safe drug, and we have a lot of evidence to suggest it is,” says Dr. Sheila Dunn, director of research at the Family Practice Health Center of the Women’s College Hospital in Toronto and co-author of the CMAJ editorial.

Norman agrees: “There is no scientific basis to justify denying the benefit of this drug to Canadian women. It is beyond logic and scientific evidence to try to explain the decisions that are made.

According to Dunn, Health Canada received an application for approval of mifepristone in October 2012. “Results are pending,” the editorial states. “It is important that this submission does not fail.”

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