Abortion, including medication abortion, has been completely banned in Louisiana, except in very limited circumstances, since the Supreme Court’s decision Dobbs v. Jackson Women’s Health Organization. But anti-abortion lawmakers took things a step further: On Oct. 1, Louisiana became the first state in the nation to classify mifepristone and misoprostol, the two drugs used in medical abortions, as “controlled, dangerous substances.” Possession without a prescription is a felony punishable by high fines and up to ten years in prison.
However, both drugs are not only used for abortion care. Healthcare providers use mifepristone and misoprostol to treat a variety of other reproductive and non-reproductive conditions, including intrauterine device insertion and postpartum hemorrhage, an emergency where delays in treatment are dangerous and potentially life-threatening.
Dr. Anitra Beasley, medical director at Planned Parenthood Gulf Coast — which operates in Louisiana and Texas — explained that unlike mifepristone and misoprostol, most drugs classified as “controlled, dangerous” substances have the potential for abuse.
“The classification of these drugs in the same category as opioids means that hospitals, healthcare facilities and doctors’ offices will now have to come up with new protocols to ensure [them] or whether they can have or not [these] drugs in their offices,” Beasley said. “We know these drugs are safe and there’s absolutely no reason to restrict their use, and any additional conditions you put on them will just make it harder to get and use them.”
Although it’s only been in effect for a little more than two months, the new law is already causing problems for providers and patients alike.
“Even in the first few weeks what we’ve seen, particularly on the outpatient side, is delays and/or significant confusion about getting misoprostol for medically necessary legal procedures,” said Dr. Jennifer Avegno, emergency medicine physician and director. of the New Orleans Department of Health is overseeing a study into the effects of the new law.
Avegno added that this confusion has included pharmacies telling patients they no longer carry misoprostol or to check with their doctor to make sure it’s not being used for an abortion, even when they have a prescription indicating it’s for another condition.
“On the part of our patients, I know that our doctors and pharmacists have had to work very hard to develop new protocols that allow misoprostol to be somewhat close [for emergency use]but there are still delays,” Avegno said. “And this is in a highly urbanized location that has all the resources you could possibly have.”
But there are differences in readiness for the new law.
“At the end of September, there were providers in rural areas in the upstate that didn’t even know this was going to happen,” Avegno said. “There’s a lot of concern about what’s going on in those facilities that don’t have all the resources and awareness that we have.”
But the world is fighting back. The Birthmark Doula Collective, Lift Louisiana, the Lawyering Project and several individuals filed a lawsuit Oct. 31 challenging the law, saying it violates the state constitution’s equal protection clause. The lawsuit also challenges the process by which the law was passed — done at the last minute as an amendment to another bill, without a public hearing; NBC News reported.
Louisiana has one of the highest maternal mortality rates in the countryand advocates and health care providers worry that the new law will only make the situation worse.
“It’s a crisis, but it doesn’t make us unique among states that have banned abortion,” said Lift Louisiana Executive Director Michelle Erenberg. “We’ve already seen the impact of Louisiana’s near total abortion ban, and any additional laws that could limit access to treatment for pregnancy complications, such as miscarriages and postpartum hemorrhage, will further exacerbate what is already a maternal health crisis in our state.”
The law also states that anyone who helps a pregnant woman obtain the drug should be prosecuted. Chasity Wilson, executive director of the Louisiana Abortion Fund, said misinformation affects the level of conversation they can have with their clients.
“Having to add on the level of education on top of all our other work is such an unfortunate part of our job and creates such a huge burden,” Wilson said. “We just hope that the people who are voted in to protect us have our best interests at heart.”
Beasley said since medication abortion was already illegal in the state, there was no need for a law.
“Putting it in the same category as a drug of potential abuse makes it look dangerous when it’s not,” Beasley said. “People already have difficulty accessing health care. There are already disparities in health care, and the people who are going to be hurt the most are the people who are already being harmed by the health care system.”
Even before the law went into effect, “there were reports of misoprostol being pulled from bleeding carts in hospitals, which is a big concern because it’s needed quickly in an emergency situation,” Erenberg said. Health care providers and certified nurse midwives who were able to prescribe and administer misoprostol will now need a controlled substance license, which is monitored by law enforcement.
This could prove burdensome for providers working in private practices or small hospitals or community-based clinics.
“If they don’t have a giant team of lawyers, they might just decide not to use that drug at all rather than risk being tracked or investigated,” Ehrenberg said.
While there are no reports yet of anyone dying as a direct result of the law, “I hope I don’t hear of a tragic consequence of someone bleeding out because of this,” Avegno said.
Advocates are also concerned about copycat legislation in other states and are already preparing toolkits and talking points for providers and organizers to fight similar legislation. Dr. Daniel Grossman, director of the University of California, San Francisco’s Advancing New Standards in Reproductive Health research program, said he expects to see a “series of attacks” on medication abortion, even in states with near-total bans.
“This could also have the broader chilling effect of turning people away from either using telehealth services or ordering these drugs, which are by far the safest ways to end a pregnancy,” Grossman said. “Instead, they could hear about this law and think they might get arrested if they order these pills and resort to more dangerous techniques.”
