GPs may soon refer patients for medical abortion with methotrexate used off label. Next month, Marie Stopes International will begin a three-month pilot service at its NSW clinics in Westmead and Homebush. Depending on the results and demand for the procedure, the organisation plans to extend the service to all its clinics. Dr Philip Goldstone, who will run the pilot, said the organisation had considered applying to the Therapeutic Goods Administration for permission to use mifepristone (RU486), which is slightly more effective than methotrexate and works more quickly.

"It's a very long, complicated [TGA application] process - methotrexate is available now," he said. "We know it's safe and effective from other studies that have been done." Marie Stopes International will only offer the service to women before they have exceeded their seventh week of pregnancy. A 75mg IM dose of methotrexate will be used and the patient will be given 800µg of Misoprostol to take buccaly at home on day five.

Twenty-one days after administration of methotrexate the patient will return for a physical examination and ultrasound. A recent Royal Australia and New Zealand College of Obstetricians and Gynaecologists publication reported about 60% of women who used the methotrexate and Misoprostol method aborted within 24 hours, but it might take 3-4 weeks "to reach cumulative abortion rates close to 90%". RANZCOG spokeswoman Professor Caroline de Costa said many medications were justifiably used off label" because drug companies cannot afford to keep licensing them for other indications". Meanwhile, a newly appointed Federal Government expert advisory committee will soon meet to discuss provider standards for the pregnancy counselling item number to be introduced in November.

Chairman Dr Andrew Pesce said the item number and counselling helpline would deal with all issues related to pregnancy, not only termination.