Why was change required?

Abortion care involves the provision of up to seven medicines: abortifacients,1 analgesia, an antiemetic, contraception2 and occasionally an antibiotic. This is a large volume of pharmaceuticals supplied and is similar to the amount of medicines supplied after a heart attack. More medicines per intervention carries greater complexity and associated problems.3

Legislation changes during the COVID-19 pandemic allows for abortion medicines to be taken at home in Scotland for up to 12 weeks’ gestation.4 Previously mifepristone needed to be consumed at an approved clinical site. Significant time was spent by clinical staff assembling medicines boxes for postage and collection. Full packs of antiemetic medicines and analgesia were given locally, more than required for the procedure, leading to accumulation and wastage in patient homes. Provision of analgesia and antiemetics across Scotland vary leading to unnecessary variation.

To reduce staff time spent on medicines-related activities, minimise wastage and harmonise medicines usage, an over-labelling unit was commissioned to produce the early medical abortion at home (EMAH) pack. Such units possess licenses that allow for ‘packing down’ of medicines to create pre-labelled packs that do not require any further manipulation to meet relevant regulatory requirements before supply to patients, saving time at clinic level. The pack would be rolled out in Glasgow and made available to all health systems in the country for medical abortion up to 10 weeks.4

EMAH packs are prescribed by doctors as per Abortion Act 1967 and Human Fertilisation and Embryology Act 1990 requirements.5 6 The EMAH pack is pre-bagged and labelled …