Secret trade in abortion tablets: Chemists selling drug without demanding doctors’ presciptions


Tribune Staff Reporter

THE illegal sale of a drug obtained without a prescription but used to cause abortions has been uncovered by The Tribune.

At least one pharmacy visited by a Tribune investigator in the Over-the-Hill area was happy to hand over the drug - Cytotec - even though it should only be given after a doctor’s prescription is received. Health Minister Dr Duane Sands said he has received anecdotal reports about the sale of the drug.

The Tribune’s investigator went to a pharmacy and told the pharmacist he needed the drug for his girlfriend who was five-weeks pregnant and wanted an abortion.

The pharmacist told him he had none in stock at the time, but immediately referred him to another pharmacy where he was able to buy five of the pills for $20 each. At no point was he asked for a prescription.

In fact, the pharmacist gave The Tribune’s investigator the names of two doctors he should contact should the girlfriend have any problems after taking the pills.

In a recent interview, Dr Leon Dupuch, the immediate past head of Princess Margaret Hospital’s Department of Obstetrics & Gynaecology, expressed alarm at the number of women coming to the hospital after an attempted abortion goes wrong, a problem he tied to Cytotec use.

“Women and girls arriving in the hospital’s emergency room very often are bleeding excessively and many end up requiring emergency surgery,” he said. “On occasion, a potentially viable baby is delivered with remnants of these pills – which, having been inserted in the mother’s vagina and failed to dissolve – are stuck to its feet, limbs and torso.”

The Tribune could not obtain statistics on the number of failed abortion attempts dealt with in the public healthcare system.

Use of Cytotec for abortions is not a new or recent development in the Bahamas even though it is illegal without a prescription. The drug is used for managing heavy bleeding after birth and other purposes but should be used in a controlled environment and under the supervision of a qualified physician, Dr Dupuch said. The World Health Organisation says misoprostol––which is sold under the brand name Cytotec––can be used to safely induce an abortion but recommends a clinical follow-up to ensure complete abortion has happened.

Gina Archer Carey, chairperson of the Bahamas Pharmacy Council, said she is unaware of any formal complaints being made about the dispersal of the drug without a prescription. She said medical professionals who are aware of a problem are obligated to report it.

“We have no issue of sending someone in to find out what is going on,” she said yesterday. “It’s illegal. If we find that this is happening, we would refer the matter to the police. When you give persons these things without a prescription, you are putting their lives at risk. That’s not something we take lightly. I would love to have a complaint so we could address it because that’s really disturbing.”

Nonetheless, policing the sale of such drugs is difficult, Dr Sands said yesterday, because those who obtain them are not forthcoming about how they got them even when complications develop.

“Victims are unwilling to confess on the record as to where they would’ve gotten the medication from,” he said. “The issue of whether there is a protocol that exists to deal with this is difficult because it’s hard to act in the absence of a complaint. It speaks to some of the weakness in the legislation. As health minister, I cannot ignore an anecdotal complaint that emanates from such a doctor who has clearly raised the alarm. If there is one case where illicit use of a drug may have resulted in injury then as awkward and uncomfortable as it is, we are obliged to listen and to act on it. If there is evidence that there is a pharmacy or pharmacist who is acting outside of the law then we don’t have the volition to give a nod and say, we ain’t worried about that today.”

Some health professionals say cultural conservatism is the root of the problem, that the illegal procuration of such drugs is inevitable in a society where women do not have legitimate ways of ending unwanted pregnancies. Some observers emphasise the disparities that exist, with legal abortion easily accessible to Bahamian women who can afford to get them abroad.

Dr Sands said it is not among the Minnis administration’s priorities to address abortion legislatively, calling the issue political kryptonite. He said his ministry has generated a list of “flagged pharmacies” that warrant greater inspection and evaluation. Among other things, officials are concerned about questionable practices like the delivery of generic medications alleged to be brand name drugs, he said.

“Illegal numbers before it was legalised was the worst kept secret of all,” he said. “It’s illegal, wink wink, it doesn’t really happen, wink wink, and then the discussion took on a surreal turn when there was an opinion poll/and the public said we don’t wish to legalise and regulate numbers and the administration did something different. When you start talking about abortion, you really talking about an emotive issue. You have to acknowledge there are things that are happening which are indeed illegal.”