Opill, the first ever over-the-counter birth control pill, hit store shelves late last month-- this, as a result of the Food and Drug Administration approving its use without a prescription last year.

Another over-the-counter medicine the FDA approved in 2023 that is also now available at local pharmacies is NARCAN, an emergency treatment that reverses opioid overdose.

Christina Madison is a Clinical Pharmacist and Founder and CEO of The Public Health Pharmacist, she joined Nevada Week to discuss these monumental moves in medicine as well as other trending health topics, including the side effects that the popular drug Ozempic may have on weight loss.

Okay.

Opill, how big of a deal is it?

(Christina Madison) Well, this is for those of us who work in reproductive health and reproductive justice, it's just incredible news.

So when the FDA chose to decide to go ahead and have the OTC status indication for Opill, which is a contraceptive product, be over the counter, it was so big.

And now that it's available on the shelves and also available for order online, this is such a big deal for people that, you know, may not have access to the traditional healthcare system, want the privacy of being able to just go and get the product on their own.

There's no age restrictions.

There's no gender restrictions.

So it really is, you know, a big deal for reproductive health and reproductive rights.

-Who does this matter most to.

When you talk about people who don't have access to the traditional health care system, who are these people?

-So I would say anyone who maybe is uninsured or underinsured, and then, you know, there's still a lot of people that don't have a primary care physician or maybe don't have access to an OB-GYN.

Or maybe they do want to go to see an OB, but it's a two-month wait to go to get seen.

And we know that that two months is the difference between having, you know, contraception and having an unintended pregnancy.

And so again, this is really just to provide an access point, an equitable access point for people who may not be able to get in to see either their OB-GYN or their primary care physician to get these types of services.

-So Opill now on shelves in Nevada?

-Yes.

-How affordable is it?

-So it depends on how many of the pill you'd like to get.

So it comes in a one pack, which is $19.99.

You can get it in a three-month supply or six-month supply.

And so there's a slight discount if you get it in, you know, bigger supply, but that's the price point at this point.

And then also, CVS has specifically said that they will assist you with processing it through insurance.

However, this is over-the-counter.

You don't have to go see the pharmacist if you just want to pay outright.

If you want to try to see if it's covered through your insurance, you'd have to go to the pharmacy counter, and they could try to process it to see if you can have a zero copay, which is also really great.

-In your opinion, how affordable is it for someone who does not have insurance?

-So $19.99 a month, I thought that this was a fair price, considering the fact that it is, you know, 28 pills in the pillpack.

However, for someone who is deciding between food and rent and a bunch of other things, I do think that it may be a little bit cost prohibitive for some folks.

But again, if they do have insurance or even if they have Medicaid, that is something that we can use to help process it so that we can get it at a zero copay for them.

- The Washington Post is reporting that birth control misinformation is on the rise.

Have you witnessed that?

-Oh, my goodness.

Have you not been on TikTok lately?

So that is definitely been a challenge.

There are a ton of people creating content with no medical licenses and no healthcare degrees that are talking about the side effects associated with contraception.

And you see a lot of women listening to that.

And that's where they're getting their news.

And they're either choosing to not get on contraception, or they're stopping their current contraceptive product, which is a little scary.

Because we've had these products since the '60s.

They're safe.

They're affordable now because of the Affordable Care Act, zero copay, it's preventative care.

I think the side effects have really been overblown.

So obviously, we know there are some things that taking a hormone can cause, you know, some-- a little bit of tummy upset.

-Which is what birth control is.

-Which is what birth control is.

We know that, you know, it can sometimes cause a little bit of weight gain.

But typically, that is something that happens throughout your cycle anyway.

And, you know, so mood changes.

These are all things that we know and are expected, and we can do things like taking it at night to lessen some of these side effects.

And so I think a lot of the information that's been talked about is rooted in fact, but it's been completely overblown and not so much to the point where someone should discontinue their product.

-When I was researching this, I even saw a TikTok video that said, "Can it cause cancer?"

-Oh, my goodness.

So hormones alone do not cause cancer.

These are things that your body naturally produces.

So we're basically just pushing the pause button on your menstrual cycle by giving you hormones that you take by mouth, instead of something that your body already creates.

We're regulating your hormones by doing this.

And a lot of times, people take them for noncontraceptive benefits.

-Why do you think this misinformation is on the rise?

-I think because social media just, it amplifies negative narratives.

And then also because we have seen after the Dobbs decision and because we're seeing a lot of misinformation in general around abortion medications, medical abortion medications and abortion care, that this was just a natural segue to the next thing to attack as part of the reproductive justice movement.

-And I'm sorry I cut you off, but you were talking about other uses of birth control that are not related to reproduction.

-Yeah.

Typically, a majority of people who are on it, it's usually for hormonal regulation.

And then also to help with things like PMS or PMDD, which are different menstrual-related disorders that can cause challenges with your mood and your, really just your ability to do activities of daily living.

-The accessibility of birth control in Nevada prior to Opill, what was it like?

-So accessibility for contraceptive services was great.

But again, having this over-the-counter product is just another fantastic access point.

I will say that here in the state of Nevada, pharmacists are allowed to prescribe contraception to folks at the pharmacy without an additional prescription from another provider, which is great.

We're one of about 20 states in the country that allow for pharmacists to provide this type of service.

So we are definitely very lucky in the fact that we have these additional access points for people if they can't go to their OB or primary care provider.

-Okay.

And that was in place prior to the Opill.

-Yes.

-Okay.

So they were already able to prescribe birth control without a prescription.

And then according to a Nevada Current article, pharmacists in Nevada will soon be able to prescribe medications that are supposed to help with opioid addiction.

-Yes.

-So that was part of a legislative process this past session, passed unanimously; however, there are arguments both for and against it.

Will you familiarize our viewers with those arguments.

-Yeah, so medication-assisted treatment, or MAT, is something that we currently use for substance use disorder.

And so, again, I really want to emphasize that this is a disease and it requires treatment.

And so when we think about ways that we can improve access to medication-assisted treatment, really bringing in the pharmacy and the pharmacist, which also I mentioned we could do contraceptive services, is really just something that I think is a great way to improve the normalization of these types of services.

Part of the reason why we need an additional access point is because we don't have enough providers that are offering these types of services.

And for people who are really struggling with opioid addiction or even alcohol dependency, these could be life saving medications, because naltrexone and buprenorphine are the two main medications that we know that can really help with someone who's struggling with addiction.

-The argument against pharmacists prescribing this?

-Yes.

So the argument is, is that these are controlled substances that, you know, there could be some challenges with mismanagement, also that we are somehow, you know, telling these people that they can continue to use and that we're giving them a license to keep having challenges with their substance use, which is not the case.

And again, the other argument is that pharmacists already have too much to do, so why would we give them something else to put on their plate.

But I think that that's not the case.

I think that there are certain pharmacists that are highly qualified, work in mental health, work in, you know, psychiatric pharmacy that are very skilled and can do this and are already doing it, but they're doing it under what's called a collaborative practice agreement, which is where they work with a physician, and they're able to help with providing these types of services.

So I think, again, we're just alleviating a barrier to allowing more people to get access to something that is extremely needed, especially as we've just seen, a new report just came out that our increase in our opioid overdoses in the last six months have been on the rise.

And even with the availability of over-the-counter NARCAN and access to fentanyl test strips, we have to do something else.

-Before we talk about that, for someone who's watching who may think, I am addicted to opioids and I might go try and get this prescription, do you recommend that they use it all by itself?

Or how important is it to seek treatment in addition to that?

-Yeah.

So when we talk about medication-assisted treatment, it's a complement of services.

So it's not just the medication itself, it's typically also included with something called cognitive behavioral therapy and counseling.

And then we also typically ask that those individuals join a opioids anonymous group or some type of substance use counseling group that is a peer support system as well.

So it's usually that whole system approach together, not just the medication alone.

And so with pharmacists, again, the debate about whether or not we should do it or not, is that we may not have access to those other, what we call, wraparound services.

But really the key here is that we want them to come in and get that medication because that's the foundation, but then we can also provide them with referrals to some of these other systems as well.

-Okay.

You brought up the drug overdose deaths, certainly a significant issue within Clark County.

Thanks to the FDA's approval last year, NARCAN, the nasal spray that's used to-- well, what does it do?

-It's an opioid reversal agent.

So basically, if someone is experiencing an overdose, the biggest issue and the reason why people pass away is because it shuts down your respiratory system.

So it causes something called respiratory depression.

Some people stop breathing, and that's how they die.

And so this drug shuts down all of those receptors that the opioids are attaching to, and it releases them so that now you're stopping all of those side effects from the opioid.

-Okay.

So NARCAN now available over the counter?

-Yes.

There's actually two formulations that are available that you can purchase, and it comes in a box of two.

-When we were speaking on the phone about this, you said you think everybody needs to have this on, on them.

Like, you carry it in your purse?

-I do.

-Why?

I could understand you, you are within the medical profession.

But me, why would I carry that in my purse?

-Because you never know.

I mean, we've had people have overdoses in libraries, on the Strip, at a restaurant, like pretty much anywhere.

Like you can see it anywhere.

And again, I think there's two different sides to the story.

So there's people who are using, you know, illicit drugs that are street drugs that may be laced with fentanyl.

But then there's also somebody who maybe took it for a surgery and then became addicted.

And now they can't get it from their prescriber, so now they're getting it on the street.

Then they're getting a pill that they think is just, you know, an opioid, but then when they get it, it's laced with fentanyl, and then they end up having an overdose.

So it's two different sides of the story.

It's people who maybe found themselves addicted and really are really just trying to treat their pain versus someone who is using to try to, you know, stave off withdrawals.

-So that shows how widespread-- -Absolutely.

- --the issue is.

If I come across someone that I believe is maybe overdosing-- I mean, how would I even know?

And then if I give them this, could it potentially harm them if they're not overdosing?

-Yeah, so there's no harm that will come to anyone that has not taken an opioid.

So if, say, I found someone nonresponsive, tried to wake them, Are you okay?

Are you okay?

I would activate the emergency response system, have someone dial 911.

But if I felt like this person may be experiencing an overdose, I could administer it.

If they wake up, I know that they were having an overdose.

If they don't, then it could be something else.

But I've already activated the emergency response system, EMS should be on their way.

We can put them in what's called the recovery position, and we can do CPR if necessary.

So there's other reasons why people are found down and nonresponsive, but usually an adult, it's because of either an opioid or because of something that happened with their heart.

So usually, in that instance, they have the inability to pump oxygenated blood.

So that's usually why people have consequences associated with that.

But this is really that somebody stopped breathing.

Instantly stopping breathing, that doesn't usually happen if somebody hasn't used an opioid.

-How accessible is it?

-As far as the NARCAN?

-You know, price point, yes.

-Ah, yes.

So this one is a little bit more pricey.

So depending on where you go, it can range from anywhere from $30 to $45 for a box of two.

But there are lots of places in town where you can get it for free.

So you can go into the Southern Nevada Health District, walk right up to their pharmacy and say, I want an opioid reversal agent, and they will give you a kit free.

No charge.

No questions asked.

-How do you find out where that is?

-You can just go right now to the Health Department.

-Okay.

Go to the Health Department, and the Health Department also supplies NARCAN to lots of different agencies, including Impact Exchange.

So they're the harm reduction agency.

You can get it from one of their vending machines if you're signed up with them.

You can go to Impact Exchange yourself and go and get it.

There's Center for Behavioral Health, they have NARCAN available.

So there's lots of places here in town where you can get free NARCAN.

I think that shouldn't be the barrier.

But if it's just somebody who just wants to have it on their person, it is something that they can go and purchase from the pharmacy as well.

-I'd like to move to Ozempic now.

Quite the talker, meant to treat diabetes, but made so popular by celebrities and social media influencers who are using it to lose weight.

It's even available to Costco members now.

-Yes.

-As part of a weight loss program, your thoughts on that?

-I think all access points are good.

So my thing is that I just want people to understand that this is potentially a life-changing medication for somebody who's suffering from obesity.

This, the average weight loss is anywhere from 40 to 50 pounds.

And so I do want people to understand this is not just something like if you want to lose 10 or 15 pounds, and you have a Costco membership, and now you can go get it.

This is part of an overall wellness plan that has to include diet and exercise, because you can gain the weight back after you lose it if you don't implement the healthy choices that is going to help you to maintain that weight loss.

And as far as it being available at Costco, I think it's great.

Honestly, any other access point, especially for people that can get it at a slightly more discounted rate, because it is quite expensive, is another way to get access to people who may have not been able to get it because they couldn't afford it.

That's the way I'm looking at it.

It's another access point, it helps with the cost, and really, you know, what's better?

We want more people to have access because it's not just the weight loss, it's the cardiovascular benefits now that we're seeing from this drug.

So it's actually now approved to help reduce cardiovascular disease as well.

So I think the sky's the limit.

I'm sure we're going to be hearing more about it.

I'm hopeful that the company that makes it can continue to keep it in good stock and good supply.

Because the other part of this is we want to make sure we have accessibility to it for people who are actually taking it for diabetes, not necessarily weight loss.

-That has been an issue.

-And it has.

It's fluctuated.

And again, the company stated that they did not anticipate this like overwhelming demand.

And so they're trying their best to kind of ramp up production in order to make sure that it is available for the people who are, who have been on it and have been taking it consistently for their diabetes.

-The side effects of Ozempic that most concern you are?

-So possibility of something called pancreatitis, which is where it can cause inflammation of the liver-- or excuse me, the pancreas.

It can also cause some problems with your stomach and your GI tract.

So it can cause problems with the transit of your foods.

So like part of this as it changes, how fast the food is metabolized in your system.

And so it can cause it to where now you can't process food anymore at the same rate that you were before.

And then it can also cause something called short gut syndrome.

So I think there's-- obviously those are extremes.

And that's, you know, less than 1% of people that take it, but it is something to consider, especially if you already are at risk of of getting those conditions.

-When we talked on the phone the other day, you said, You got to realize you have to inject this.

-Yep.

That's another thing too.

There's a lot of people who are afraid of needles.

It's interesting, because I've seen some other providers.

We were talking about Costco, but there's also this company that's an online company called Ro that is also talking about that they have this as a weight loss program.

And they, the way that they're advertising it is it's a tiny little prick for 20% loss of your body weight.

And so I don't know if I believe that it's a tiny little prick, but it is something that you would have to self-inject or have someone else inject, and it's subcutaneous.

So you have to do it in the fat.

So if you are somebody who doesn't like needles, this is probably not going to be for you.

-You also mentioned that there's no guarantee of where the weights going to come off from.

I mean, is that typical of all diet medication?

-Yes.

But in this particular instance, there have been cases where there's something called "Ozempic face," where people lose the fat, but it's in their face.

And so it can really alter your appearance.

-Wow.

Okay, we have been talking about the availability of a lot of medications right now.

There is an argument from the world of pharmacy that a US Supreme Court case, if they do in fact decide to restrict access to the abortion medication mifepristone, that it could have this much bigger effect on drugs.

Will you explain that argument, and do you believe that argument?

-Yeah.

So just to kind of get people up to speed.

So there's a medication called mifepristone.

This medication is used in combination with something called misoprostol in order to provide medical abortion care.

And so these two pills used together, that particular combination, has been evaluated by the FDA multiple times.

And then in the last couple of years, they've actually taken some of the restrictions away and actually expanded the amount of time that it is safe to be able to use this product.

So the debate here is that when the FDA expanded that usage, that somehow they did not have the authority to do that.

And the case that is in front of the Supreme Court is stating that the FDA does not have that authorization, which is huge because this is how drugs are approved in this country.

And if we now have a judicial system that is saying that the FDA can't make that decision, now every drug that has gone through FDA approval process is up for debate and potential for challenge in the judicial courts.

And so that's why this is so scary is because it could be mifepristone today, but it could be contraception tomorrow.

It could be Plan B.

They could come back and say, Oh, well, you guys didn't have enough safety data, and you shouldn't have approved this use.

Even though the FDA, this is what they do.

They look at the science.

They research.

And the other thing that's so important is that they go based on what they know at the time.

And so if new information comes out, they adapt that, which is what happened in the case of mifepristone.

So when they saw that the data looked like it could be used longer, so not just that seven weeks but up to ten, they changed the labeling to reflect the new science.

And so I think that's really where we're at right now and the scariness of the nature that this could uproot everything we know about how drugs are approved in this country.

-And let's say that it only applies to mifepristone, there are consequences to that as well, because I didn't know, but as you explained to me, it's used, and as you just explained, it's used in conjunction with another drug.

-Yes.

And so if we don't have access to that medication, abortions are going to be-- utilizing the medication side could be more dangerous because we're using just one medication versus both.

And it can also cause more side effects and the potential for hemorrhage, bleeding, complications post using that medication.

So it's a challenging time to be working in this space and to have a daughter that may not have the same reproductive health rights that I grew up with.

-Christina Madison, Public Health Pharmacist, thank you for joining Nevada Week.

-Thank you so much for having me.

-Christina Madison also joined us for Nevada Week In Person earlier this month.

It's a show that features our Nevada Week guests in a more personal light.

And in this excerpt, she shares what life is like right now as a vaccine advocate amid the current political and social climate.

-It's very difficult when you've got people who are telling you that, you know, the vaccines have microchips in them, and they're going to, you know, cause you to be infertile, and all of these different, you know, mis- and disformation that has been coming out.

Ultimately, I think we can stand on Public Health Foundation, which is the fact that the reason why we don't have all of these illnesses and premature death, in particular for small children, is because we routinely vaccinate.

And it is one of the single most effective medical marvels in modern history.

-To see the rest of Christina Madison's In Person interview, go to our website, vegaspbs.org/nevadaweek.