Medication for abortion or miscarriage management unavailable at most Hamilton, Ontario pharmacies, survey finds

A medication commonly used for abortion or miscarriage management is only available at six percent of Hamilton, Ontario pharmacies, according to a McMaster University-led survey.

Over 200 pharmacies were contacted as part of the survey, with pharmacies citing low patient demand, cost and a lack of familiarity with the medication as the top reasons the medication—known as mifepristone/misoprostol—was not in stock.

The findings, published the Journal of Obstetrics and Gynaecology Canada, point to barriers to access the medication, which was approved for use by Health Canada in 2017 and is listed by the World Health Organization as an essential medication.

"In our clinical experiences, it is difficult for prescribers and patients to locate a pharmacy that has the medication," said Giuliana Guarna, a fifth year obstetrics and genecology resident at McMaster University and lead author of the study. "Patients face significant psychological hardships while undergoing management for both medication abortion and miscarriage, and delays in care further exacerbates these hardships."

To conduct the study, researchers undertook a mystery caller survey of 208 pharmacies in Hamilton between June and September 2022. Nearly 40 percent of pharmacies cited low patient demand as the reason for the medication being unavailable, with cost (22 percent), lack of familiarity with medication (13 percent), supplier issues (nine percent), training requirements (eight percent), and medication expiry (seven percent) cited as the remaining reasons for not carrying the medication.

Over half (55 percent) of pharmacists were willing to order the medication, but cited arrival times of one business day to weeks.

The authors note that when used for medical abortion, Health Canada indicates mifepristone/misoprostol must be taken by 63 days gestational age, or 70 days gestational age per the Society of Obstetricians and Gynecologists of Canada. A lack of availability or delays with the medication arriving to a pharmacy could render a patient to be ineligible for its use.

"This study clearly demonstrates a need for further advocacy and education in order to ensure mifepristone/misoprostol is accessible to the patients who require it," said Dustin Costescu, associate professor in the Department of Obstetrics and Gynaecology at McMaster University and principal investigator of the study.