Louisiana lawmakers have added two drugs commonly used in pregnancy and reproductive health care to the state\u2019s list of controlled dangerous substances, a move that has alarmed doctors in the state.<\/p>\n
Mifepristone and misoprostol have many clinical uses, and one use approved by the FDA<\/a> is to take the pills to induce an abortion at up to 10 weeks of gestation.<\/p>\n The bill that moved through the Louisiana Legislature this spring lists both medications as Schedule IV<\/a> drugs under the state\u2019s Uniform Controlled Dangerous Substances Law<\/a>, creating penalties of up to 10 years in prison<\/a> for anyone caught with the drugs without a valid prescription. Gov. Jeff Landry, a Republican, signed the bill<\/a> into law in May. It takes effect Oct. 1.<\/p>\n The new law is the latest move by anti-abortion advocates trying to control access to abortion medications in states with near-total abortion bans, such as Louisiana. The law is the first of its kind, opening a new front in the state-by-state battle over reproductive medicine.<\/p>\n Republican-controlled states have passed various laws regulating medication abortion in the past, said Daniel Grossman<\/a>, an OB-GYN and a reproductive health researcher at the University of California-San Francisco.<\/p>\n But after the Dobbs v. Jackson Women\u2019s Health Organization<\/em> decision in 2022, in which the Supreme Court ruled there was no constitutional right to an abortion, scrutiny of medication abortions escalated as clinics in certain states shuttered completely or were required to stop offering in-clinic procedures.<\/p>\n \u201cIt\u2019s not surprising that states are trying everything they can to try to restrict these drugs,\u201d Grossman said. \u201cBut this is certainly a novel approach.\u201d<\/p>\n Before the Louisiana bill passed, more than 250 OB-GYNs and emergency, internal medicine, and other physicians from across the state signed a letter<\/a> to the bill\u2019s sponsor, state Sen. Thomas Pressly<\/a>, a Republican, arguing the move could threaten women\u2019s health by delaying lifesaving care.<\/p>\n \u201cIt\u2019s just really jaw-dropping,\u201d said Nicole Freehill, a New Orleans OB-GYN who signed the letter. \u201cAlmost a day doesn\u2019t go by that I don\u2019t utilize one or both of these medications.\u201d<\/p>\n Mifepristone and misoprostol are routinely used to treat miscarriages<\/a>, stop obstetric hemorrhaging<\/a>, induce labor, or prepare the cervix for a range of procedures inside the uterus, such as inserting an IUD or taking a biopsy of the uterine lining.<\/p>\n Bill<\/strong> Born From a Family\u2019s Misfortune<\/strong><\/p>\n The proposal to reschedule the drugs as controlled dangerous substances was introduced as amendments to Pressly\u2019s original bill creating the crime of \u201ccoerced criminal abortion\u201d \u2014 where someone \u201cknowingly\u201d gives abortion pills to a pregnant woman to cause or attempt to cause an abortion \u201cwithout her knowledge or consent.\u201d<\/p>\n Pressly\u2019s sister, Catherine Pressly Herring, testified at the hearing on the bill that she had been given abortion drugs without her knowledge<\/a> by her former husband. Pressly said his sister\u2019s story prompted the legislation<\/a>.<\/p>\n In a statement, Pressly said that he added the new amendments to \u201ccontrol the rampant illegal distribution of abortion-inducing drugs.\u201d He did not respond to requests for comment.<\/p>\n \u201cBy placing these drugs on the controlled substance list, we will assist law enforcement in protecting vulnerable women and unborn babies,\u201d Pressly wrote in this statement<\/a>.<\/p>\n Louisiana Right to Life, the state\u2019s most influential anti-abortion group, helped draft the bill. And the group\u2019s communications director<\/a>, Sarah Zagorski, said that claims that rescheduling the drugs as dangerous could harm women\u2019s health are \u201cfearmongering.\u201d<\/p>\n The real problem, she said, is that mifepristone and misoprostol are too accessible in Louisiana and are being used to induce abortions despite the state\u2019s ban.<\/p>\n \u201cWe\u2019ve had pregnancy centers email us with many stories of minors getting access to this medication,\u201d Zagorski said.<\/p>\n Studies have shown a surge<\/a> in the ordering of abortion pills online in states that have severe restrictions on abortion.<\/p>\n In the Louisiana Legislature committee hearing on the bill, anti-abortion advocates said that physicians would still be allowed to dispense mifepristone and misoprostol for lawful medical care, and that women who give themselves abortions using the medications would be exempted from criminal liability.<\/p>\n \u201cUnder this law, or any abortion law, in Louisiana we see the woman as often the second victim,\u201d testified Dorinda Plaisance, a lawyer who works with Louisiana Right to Life. \u201cAnd so Louisiana has chosen to criminalize abortion providers\u201d rather than women who use the medications for their own abortions.<\/p>\n Move \u2018Not Scientifically Based,\u2019 Doctors Say<\/strong><\/p>\n The U.S. Drug Enforcement Administration and individual states have the power to list drugs as controlled dangerous substances.<\/p>\n State and federal regulations aim to control access to drugs, such as opioids, based on their medical benefit and their potential for abuse, according to Joseph Fontenot, executive director of the Louisiana Board of Pharmacy<\/a>, the agency that monitors drugs listed as controlled dangerous substances.<\/p>\n Like other states, Louisiana tracks prescriptions in databases that include the name of the patient, the health provider who wrote the prescription, and the dispensing pharmacy.<\/p>\n Physicians need a special license to prescribe the drugs \u2014 in 2023, there were 18,587 physicians in Louisiana, 13,790 of whom had a license to prescribe controlled dangerous substances, according to data from the Louisiana State Board of Medical Examiners<\/a> and the Board of Pharmacy<\/a>.<\/p>\n \u201cEvery state has a prescription drug monitoring program. And they really are designed to identify prescription drug mills that are hawking fentanyl and opioid painkillers,\u201d said Robert Mikos<\/a>, a professor of law and a drug policy expert at Vanderbilt University.<\/p>\n What happened to Pressly\u2019s sister \u2014 being tricked into taking mifepristone or misoprostol \u2014 is a form of drug abuse, said Zagorski of Louisiana Right to Life, which is why the drugs should be more strictly controlled.<\/p>\n But Fontenot, of the Louisiana Board of Pharmacy, said that under Louisiana\u2019s law, abuse refers to addiction. Jennifer Avegno<\/a>, a New Orleans emergency physician and the director of the New Orleans Health Department, agrees. \u201cThere is no risk of someone getting hooked on misoprostol,\u201d Avegno said.<\/p>\n Under the new law, mifepristone and misoprostol will be added to a list comprised of opioids, depressants, and stimulants. \u201cTo classify these medications as a drug of abuse and dependence in the same vein as Xanax, Valium, Darvocet is not only scientifically incorrect, but [a] real concern for limiting access to these drugs,\u201d Avegno said.<\/p>\n Doctors worry that the bill could set a dangerous precedent for state officials who want to restrict access to any drug they consider dangerous or objectionable, regardless of its addictive potential, Avegno said.<\/p>\n Fears Over Delays in Care<\/strong><\/p>\n In their letter opposing the reclassification, doctors said the \u201cfalse perception that these are dangerous drugs\u201d could lead to \u201cfear and confusion among patients, doctors, and pharmacists, which delays care and worsens outcomes\u201d in a state with high rates of maternal injury and death.<\/p>\n The increased scrutiny could have a statewide chilling effect and make doctors, pharmacists, and even patients more reluctant to use these drugs, the doctors wrote.<\/p>\n The state database allows any doctor or pharmacist to look up the prescription history of his or her patient. The data is also accessible by the Louisiana State Board of Medical Examiners<\/a>, which licenses physicians and other providers, and by law enforcement agencies with a warrant.<\/p>\n \u201cCould I be investigated for my use of misoprostol? I don\u2019t know,\u201d said Freehill, the New Orleans OB-GYN.<\/p>\n Pharmacists could become more reluctant to dispense the medications, Freehill said, exacerbating a problem she and other OB-GYNs have been dealing with<\/a> since Louisiana banned nearly all abortions. That reluctance could lead to patients miscarrying without timely treatment.<\/p>\n \u201cThey could be sitting there bleeding, increasing their risk that they would have a dangerous amount of blood loss\u201d or risking infection, she said.<\/p>\n Before the bill passed, Freehill routinely phoned in every prescription for misoprostol when her patients were miscarrying so she could explain to the pharmacist why she was prescribing it. Once the bill goes into effect in the fall and the drug becomes a controlled dangerous substance, that will no longer be possible because those types of prescriptions must be written on a pad or sent electronically.<\/p>\n In hospitals, the drugs will also have to be locked away<\/a>. That could potentially cause delays getting the drug when a patient is hemorrhaging after childbirth.<\/p>\n Doctors worry some patients might be afraid to take the medications once they\u2019re listed as dangerous, Avegno said.<\/p>\n In a written response<\/a> to the Louisiana physicians who signed the protest letter, Pressly said the doctors whom he\u2019s spoken with feel the bill \u201cwill not harm health care for women.\u201d<\/p>\n Criminalizing Support for Abortions<\/strong><\/p>\n Louisiana\u2019s abortion ban already makes it a crime to provide an abortion, including by giving someone medications used to induce abortion. And a 2022 law<\/a> added up to 50 years in prison for mailing mifepristone or misoprostol.<\/p>\n Because the new law explicitly exempts pregnant women, opponents like Elizabeth Ling<\/a> believe it is meant to isolate those women from others who would help them. Ling, a reproductive rights attorney at If\/When\/How<\/a>, is particularly concerned about the prison penalties, which she believes are intended to frighten and disrupt underground networks of support for patients seeking the pills.<\/p>\n Pregnant patients might worry about ordering online or enlisting a friend to help obtain the pills: \u201cIs my friend who is simply just providing me emotional support going to somehow, you know, be punished for doing that?\u201d Ling said.<\/p>\n Ling added that there\u2019s concern that the law could also be used to target people who aren\u2019t pregnant but who want to order abortion pills online and stock them in case of a future pregnancy. That practice has become increasingly popular<\/a> in states with abortion bans.<\/p>\n This article is from a partnership that includes <\/em>WWNO<\/em><\/a>, <\/em>NPR<\/em><\/a>, and KFF Health News<\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n