Louisiana lawmakers have added two drugs commonly used in pregnancy and reproductive health care to the state鈥檚 list of controlled dangerous substances, a move that has alarmed doctors in the state.
Mifepristone and misoprostol have many clinical uses, and one use is to take the pills to induce an abortion at up to 10 weeks of gestation.
The bill that moved through the Louisiana Legislature this spring lists both medications as drugs under the state鈥檚 , creating penalties of up to for anyone caught with the drugs without a valid prescription. Gov. Jeff Landry, a Republican, into law in May. It takes effect Oct. 1.
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.
Republican-controlled states have passed various laws regulating medication abortion in the past, said , an OB-GYN and a reproductive health researcher at the University of California-San Francisco.
But after the Dobbs v. Jackson Women鈥檚 Health Organization 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.
鈥淚t鈥檚 not surprising that states are trying everything they can to try to restrict these drugs,鈥 Grossman said. 鈥淏ut this is certainly a novel approach.鈥
Before the Louisiana bill passed, more than 250 OB-GYNs and emergency, internal medicine, and other physicians from across the state to the bill鈥檚 sponsor, state Sen. , a Republican, arguing the move could threaten women鈥檚 health by delaying lifesaving care.
鈥淚t鈥檚 just really jaw-dropping,鈥 said Nicole Freehill, a New Orleans OB-GYN who signed the letter. 鈥淎lmost a day doesn鈥檛 go by that I don鈥檛 utilize one or both of these medications.鈥
Mifepristone and misoprostol are routinely used to , stop , 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.
Bill Born From a Family鈥檚 Misfortune
The proposal to reschedule the drugs as controlled dangerous substances was introduced as amendments to Pressly鈥檚 original bill creating the crime of 鈥渃oerced criminal abortion鈥 鈥 where someone 鈥渒nowingly鈥 gives abortion pills to a pregnant woman to cause or attempt to cause an abortion 鈥渨ithout her knowledge or consent.鈥
Pressly鈥檚 sister, Catherine Pressly Herring, testified at the hearing on the bill that she had been given abortion drugs by her former husband. Pressly said his sister鈥檚 story .
In a statement, Pressly said that he added the new amendments to 鈥渃ontrol the rampant illegal distribution of abortion-inducing drugs.鈥 He did not respond to requests for comment.
鈥淏y placing these drugs on the controlled substance list, we will assist law enforcement in protecting vulnerable women and unborn babies,鈥 Pressly .
Louisiana Right to Life, the state鈥檚 most influential anti-abortion group, helped draft the bill. And the group鈥檚 , Sarah Zagorski, said that claims that rescheduling the drugs as dangerous could harm women鈥檚 health are 鈥渇earmongering.鈥
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鈥檚 ban.
鈥淲e鈥檝e had pregnancy centers email us with many stories of minors getting access to this medication,鈥 Zagorski said.
Studies have shown in the ordering of abortion pills online in states that have severe restrictions on abortion.
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.
鈥淯nder this law, or any abortion law, in Louisiana we see the woman as often the second victim,鈥 testified Dorinda Plaisance, a lawyer who works with Louisiana Right to Life. 鈥淎nd so Louisiana has chosen to criminalize abortion providers鈥 rather than women who use the medications for their own abortions.
Move 鈥楴ot Scientifically Based,鈥 Doctors Say
The U.S. Drug Enforcement Administration and individual states have the power to list drugs as controlled dangerous substances.
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 , the agency that monitors drugs listed as controlled dangerous substances.
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.
Physicians need a special license to prescribe the drugs 鈥 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 and the .
鈥淓very state has a prescription drug monitoring program. And they really are designed to identify prescription drug mills that are hawking fentanyl and opioid painkillers,鈥 said , a professor of law and a drug policy expert at Vanderbilt University.
What happened to Pressly鈥檚 sister 鈥 being tricked into taking mifepristone or misoprostol 鈥 is a form of drug abuse, said Zagorski of Louisiana Right to Life, which is why the drugs should be more strictly controlled.
But Fontenot, of the Louisiana Board of Pharmacy, said that under Louisiana鈥檚 law, abuse refers to addiction. , a New Orleans emergency physician and the director of the New Orleans Health Department, agrees. 鈥淭here is no risk of someone getting hooked on misoprostol,鈥 Avegno said.
Under the new law, mifepristone and misoprostol will be added to a list comprised of opioids, depressants, and stimulants. 鈥淭o 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,鈥 Avegno said.
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.
Fears Over Delays in Care
In their letter opposing the reclassification, doctors said the 鈥渇alse perception that these are dangerous drugs鈥 could lead to 鈥渇ear and confusion among patients, doctors, and pharmacists, which delays care and worsens outcomes鈥 in a state with high rates of maternal injury and death.
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.
The state database allows any doctor or pharmacist to look up the prescription history of his or her patient. The data is also , which licenses physicians and other providers, and by law enforcement agencies with a warrant.
鈥淐ould I be investigated for my use of misoprostol? I don鈥檛 know,鈥 said Freehill, the New Orleans OB-GYN.
Pharmacists could become more reluctant to dispense the medications, Freehill said, exacerbating a problem she and other OB-GYNs have since Louisiana banned nearly all abortions. That reluctance could lead to patients miscarrying without timely treatment.
鈥淭hey could be sitting there bleeding, increasing their risk that they would have a dangerous amount of blood loss鈥 or risking infection, she said.
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.
In hospitals, the drugs will also . That could potentially cause delays getting the drug when a patient is hemorrhaging after childbirth.
Doctors worry some patients might be afraid to take the medications once they鈥檙e listed as dangerous, Avegno said.
In a to the Louisiana physicians who signed the protest letter, Pressly said the doctors whom he鈥檚 spoken with feel the bill 鈥渨ill not harm health care for women.鈥
Criminalizing Support for Abortions
Louisiana鈥檚 abortion ban already makes it a crime to provide an abortion, including by giving someone medications used to induce abortion. And a added up to 50 years in prison for mailing mifepristone or misoprostol.
Because the new law explicitly exempts pregnant women, opponents like believe it is meant to isolate those women from others who would help them. Ling, a reproductive rights attorney at , 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.
Pregnant patients might worry about ordering online or enlisting a friend to help obtain the pills: 鈥淚s my friend who is simply just providing me emotional support going to somehow, you know, be punished for doing that?鈥 Ling said.
Ling added that there鈥檚 concern that the law could also be used to target people who aren鈥檛 pregnant but who want to order abortion pills online and stock them in case of a future pregnancy. That in states with abortion bans.
This article is from a partnership that includes , , and 麻豆女优 Health News.