BATON ROUGE, La. (AP) — On Tuesday, Louisiana will become the first state in the U.S. to classify two widely used abortion pills as “controlled dangerous substances.”
Opponents argue that the designation could have disastrous effects in a state that already has a near-total ban on abortion and one of the highest maternal mortality rates in the country. Doctors fear the reclassification will lead to delays in access to the drugs mifepristone and misoprostol, which can be used together to treat miscarriages, while misoprostol induces labor and treats severe bleeding after delivery. They also worry that the practice of drug reclassification could spread beyond Louisiana.
Supporters say the modern law should support prevent forced abortions, pointing to a case in Texas in which a pregnant woman was given seven misoprostol pills by her husband without her knowledge; the baby survived. Over the past 15 years, news outlets have reported similar cases — none in Louisiana — but the problem does not appear to be widespread.
Here’s what you should know about the modern law:
How does Louisiana law differ from federal regulations?
Mifepristone and misoprostol are both available by prescription in Louisiana, but the state has reclassified the pills as “Schedule IV drugs,” putting them in the same category as the opioid tramadol and other substances that can be addictive.
Mifepristone is usually taken with misoprostol and was approved by the U.S. Food and Drug Administration in 2000 after federal regulators found it secure and effective for terminating pregnancies in the first few weeks of pregnancy. The drug, which blocks the hormone progesterone, also prepares the uterus to respond to the contraction-inducing effects of misoprostol.
Last year, nearly two-thirds of all abortions in the United States were medication abortions.
Gynecologists say a petite proportion of patients experience “serious” or “serious” adverse events after taking mifepristone. In June, the Supreme Court unanimously upheld access to the drug, dismissing a lawsuit from abortion opponents who argued the FDA overlooked stern safety problems when it made it easier to obtain mifepristone.
Medical experts say it is possible and secure to utilize misoprostol alone to end a pregnancy, but it is slightly less effective than two-drug therapy. Misoprostol is used not only in reproductive medicine, but also to prevent stomach ulcers in people who take certain painkillers.
Will people face prison time if they utilize, distribute or possess the pills?
It depends on.
Under current Louisiana law, doctors convicted of performing an illegal abortion, including one involving pills, face up to 15 years in prison, $200,000 in fines and the loss of their medical license.
The modern classification means that someone who knowingly possesses mifepristone or misoprostol without a valid prescription for any purpose could be fined up to $5,000 and jailed for one to five years.
The law provides protections for pregnant women who receive the drug for self-administration without a prescription.
Louisiana Attorney General Liz Murrill, a Republican who supports the current abortion ban and reclassification, said in September that the “intentional distribution of these drugs by organizations operating over the Internet or other networks” is illegal and subject to criminal prosecution .
What concerns do doctors have?
Doctors say the law could harm patients because of extra steps and stricter storage requirements – particularly in emergency cases where misoprostol is used to treat threatening postpartum bleeding.
“Once the clock strikes midnight… this will become a reality almost immediately because we call for it so frequently in an emergency situation,” Dr. Jane Martin, a gynecologist at Ochsner Health in New Orleans, whose hospital handles up to 5,000 births a year. It is administered “at least once daily during labor and delivery,” often more frequently.
In hospitals like hers, misoprostol is typically kept in a gynecology department in a “blood box” in the room, on the delivery table or in a nurse’s bag, said Martin, who is with the American College of Obstetricians and Gynecologists in Louisiana, emphasizing that she speak for yourself and not for the hospital. With the modern law, there will be more “red tape” to access the medication – perhaps down the hall in a locked container, or perhaps in an on-site pharmacy in smaller hospitals.
Health experts said two alternative anti-bleeding drugs had more side effects, could not be used in patients with certain medical problems and needed to be refrigerated.
Murrill responded that the law “does not limit a health care provider’s ability to use, prescribe or dispense these medications for legitimate health care purposes or impose restrictive requirements for access for emergency purposes.”
Dr. Kylie Cooper, a maternal-fetal specialist in Minnesota who is dynamic with the American College of Obstetricians and Gynecologists, said she was concerned that other states like Louisiana would implement restrictions.
According to the Joint Commission, a nonprofit organization that sets standards and accredits healthcare organizations, up to 5% of obstetric patients experience postpartum hemorrhage, which accounts for 11% of maternal deaths in the United States.
“Patients can lose a large amount of blood in a very, very short period of time,” Cooper said. “So in many situations, seconds and minutes count.”
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The Associated Press Health and Science Department receives support from the Science and Educational Media Group of the Howard Hughes Medical Institute and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
