Manitoba pharmacists will soon have ability to prescribe birth control, HIV medications
Pharmacists in Manitoba will soon be able to prescribe birth control, the province's health minister revealed this week in an announcement that came as a pleasant surprise to the industry.
Health Minister Uzoma Asagwara told the legislature Wednesday that granting pharmacists the means to assess and prescribe contraceptives is a "very reasonable expansion of scope for pharmacists in Manitoba."
The minister added in an interview the government is moving "very quickly" on the changes, which will take effect "in the coming days and weeks."
"We're trying to get it out the door as quickly as we can for pharmacists across the province who have been asking for this for years," they said.
Pharmacists will also be able to prescribe HIV medications beginning this summer, a government official said.
Manitoba, Ontario and the three territories are the only places in Canada that do not currently allow pharmacists to prescribe birth control.
Emergency contraceptives, such as the Plan B pill, are currently available without a prescription from pharmacies.
"Right now in Manitoba, pharmacists do not have the ability to practise at their full scope, the way that they should," said Asagwara, who pledged "to go even further" in granting pharmacists more prescribing authority.
Pharmacists Manitoba welcomes change
Members of the industry association Pharmacists Manitoba were in the legislature to watch question period Wednesday, after they were informed that Liberal MLA Cindy Lamoureux would ask questions about pharmacists' scope of practice.
In her first question, Lamoureux asked if the government planned to "enable and empower pharmacists who directly assess and prescribe contraception."
The question prompted a sometimes rare occurrence in question period: a direct answer to the question posed.
"The short answer to that question, for the member of Tyndall Park, is yes," Asagwara said.
Britt Kural, the pharmacy practice adviser with Pharmacists Manitoba, said she was "pleasantly surprised" by the response.
"We had no idea that there was going to be something right around the corner," said Kural.
The pharmacist said she believes she and her colleagues will be able to prescribe products like daily oral birth control pills, hormonal injections and IUDs, but the province hasn't provided those details yet.
Currently, a patient must go to a doctor's office or a nurse practitioner to receive a prescription for birth control, and must then visit a pharmacist to pick it up.
This regulatory change will save patients from seeing a doctor or nurse practitioner.
"Quite often pharmacists are a first point of care for many people in Manitoba, because they don't have access to a primary care physician or a nurse practitioner, especially in rural and remote communities," Kural said.
She couldn't estimate what kind of uptake pharmacists will see, but said her profession is eager to help.
Women's Health Clinic executive director Kemlin Nembhard said any step toward making prescription birth control more accessible is worth celebrating.
The change will make contraceptives easier to access for people without a family doctor, or for young people who worry about their parents finding out, she said.
While Manitoba's NDP government has been offering free prescription birth control since October of last year, Nembhard said some hurdles to accessing these contraceptives persist, such as the requirement to have a health card. It's one of the reasons the clinic runs a free birth control program, funded entirely through donations.
"It would be great for us to get funding through the province to support that program," Nembhard said.
Kural said Manitoba's pharmacists would like to further expand their prescribing authority. Some options could include prescriptions to treat the minor ailments pharmacists are already assessing, such as strep throat, ear infections and cold sores, Kural said.
Any such move would require regulatory changes from the province.
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She adds she was told she would need to isolate while she waited for surgery, as her surgeon specialized in head and neck cancer surgeries and could not risk falling ill. So, Harris isolated. She said she didn't leave her house and didn't have anyone come over for a visit, because she didn't want to ruin her chance of getting surgery. Her daughters even transferred to online schooling, the mother adds. 'I missed everything for weeks and weeks, years and years,' Harris said. At the start she says the communication between her and health-care staff was 'pretty amazing,' but as time carried on, the quick responses apologizing for the wait turned to requests to stop calling for updates. 'It was just really demotivating,' Harris said. 'All I'm doing is filling up an inbox or a voicemail inbox that's probably overflowing (…) like I'm just adding more burden into the healthcare system.' By 2024, she finally got the call with the surgery date. But after the procedure happened, Harris recalled waking up to hear the procedure became 'too risky.' 'He said he kind of pushed (the bone) to the side (but) he couldn't remove it because it was too close to my carotid artery and cranial facial nerves, and it was just too risky to remove from that approach,' Harris said, adding she was told the bone was left in her neck. 'I never heard of that happening before.' 'It wasn't even about the pain anymore' She returned home to Windsor after a couple of days, to ensure she'd be well enough. But Harris says five or six days later after the operation, she started coughing up blood. Harris says she immediately called the paramedics because she couldn't tell if the blood was coming from her surgical site or from her stomach, and they swiftly brought her to the emergency room. But says she waited hours on the gurney, 'throwing up a litre of blood,' while she waited to be admitted to a room. 'Staff was walking by me and everyone was—healthcare workers are all very empathetic and compassionate, but they're just so severely understaffed,' Harris said. Harris says she spent about three nights at Windsor Regional Hospital, profusely bleeding off-and-on throughout her stay and, at one point, pulling out blood clots 'the size of ping pong balls' from her throat. 'I was covered in blood, just covered. I was so mad. It wasn't even about the pain anymore,' Harris said. She says during her time there, she never met with an appropriate surgeon, adding she was repeatedly told doctors don't want to treat another surgeon's patient after an operation due to liability concerns. So, she was airlifted back to Sinai in Toronto, had CT scans there, and was discharged on Dec. 18. Karen Harris Karen Harris being airlifted to Toronto. Harris says she last saw her surgeon in February this year, where they requested more imaging and confirmed they would carry-on with her surgery again, but this time trying a different approach. She says she still hasn't heard back. Why is there a delay to get a surgery? Ontario's surgical backlog grew to more than 245,000 procedures amid the COVID-19 pandemic but has steadily decreased in recent years, as the province has poured millions of dollars into tackling the backlog. That, however, is of little comfort to patients like Harris. Isser Dubinsky, a retired clinical physician who had worked in emergency medicine and previously consulted in the development of the wait-time strategy in Ontario, said there's a variety of factors that come into play while waiting for a procedure. 'There's the wait-time to see your family doctor who has to come up with a diagnosis that requires surgery, there's the wait-time from when the family doctor sees or can arrange a referral to a surgeon, and then there's a wait-time from when after that patient sees the surgeon until they get access to surgical care,' Dubinsky said, adding each step is 'integral' to the problem. Outside of a shortage of family doctors, Dubinsky says they're not providing the same number of in-person office hours as they had before the pandemic with several patients being met online, mitigating against their ability of conducting physical exams and potentially leading to 'reasonable skepticism' from the surgeon when they don't have all of the given information they need. 'There's also a huge amount of fractionation of family medicine,' Dubinsky adds, as some family doctors don't fit the traditional role of what a family physician is. 'There are family doctors who only practice psychotherapy, there are family doctors who largely practice emergency medicine (…) and so on, so the number of family physicians who are providing what you or I might have thought of as comprehensive primary care is diminished.' Then when it comes to getting from a family physician to a surgeon, Dubinsky says surgeons will want to know what the patient's imaging has shown, which means various tests need to be arranged before a specialist will see them. Once tests have been completed and a patient is off to see a surgeon, Dubinsky says they follow clear guidelines for what an appropriate time is to wait for a procedure to be done—which is gauged on a patient's symptoms and physical findings. Dubinsky also says time is wasted in the operating rooms, which can stem from a doctor showing up just 15 minutes late. 'Let me give you the arithmetic example of your average community-sized hospital in Ontario that has six operating rooms functioning. If each of those six operating rooms starts 10 minutes late every day, that's an hour of time that's wasted every day, that's five hours a week, that's 260 hours a year. That's enough time to do 100 hip or knee replacements,' Dubinsky said, adding on top of that, surgeons have allocated operating room time, which can vary per doctor. A spokesperson for Ontario's Ministry of Health says the province has 'some of the shortest wait times' across Canada, with nearly 80 per cent of people receiving their procedure in the clinically recommended amount of time.
