Starting Tuesday in Louisiana, the two drugs used in medication abortion — mifepristone and misoprostol — will be reclassified as controlled substances in the state, making it a crime punishable by up to five years in prison to possess the drugs without a prescription.
The law, the first of its kind in the nation, will designate the pills as Schedule IV controlled substances, a classification typically given to drugs that carry a potential for dependency or abuse, such as Ambien or Xanax.
Abortion is already banned in Louisiana with few exceptions. That means that mifepristone and misoprostol couldn’t be prescribed for that purpose, according to Dr. Jennifer Avegno, the director of the New Orleans Health Department. What concerns experts is that the new law could limit the use of the drugs to treat other conditions, some of which are life-threatening, putting women’s health at risk.
The move, experts say, isn’t based on medical science but instead on ongoing efforts from anti-abortion advocates to restrict access to abortion medications in states with near-total bans, like Louisiana. As of Aug. 22, more than a dozen states have banned abortions or no longer have facilities where women can receive abortions, according to an NBC News tracker.
“These medications are being placed on this list due to a perceived moral implication,” said Dr. Greg Caudill, the immediate past president of the Louisiana Society of Addiction Medicine and a physician who prescribes controlled substances. The change, he said, can increase the time between the drug being prescribed to the patient and it actually being dispensed, a difference that “could result in death in certain situations.”
Avegno said that aside from abortion, the drugs are routinely used to treat miscarriages, induce labor, prepare the cervix for surgical procedures and stop postpartum hemorrhaging — a life-threatening condition that requires immediate medical attention and occurs in 5% of pregnancies.
During labor, misoprostol is typically kept at the patient’s bedside, she said. Under the new state law, the medication must be stored in a locked cabinet, potentially on a different floor of the hospital, and will require a nurse to order the drug, enter a code and retrieve it, she said.
“Even if that adds a few minutes — which it will — in the setting of a life-threatening hemorrhage, minutes are really important,” Avegno said. “We already have a maternal health crisis in Louisiana, as we do in the rest of America. This will not make it better.”
A ‘scare tactic’
Mifepristone blocks a hormone called progesterone, which the body needs to support a pregnancy. Misoprostol causes the uterus to contract and empty. During a medication abortion, mifepristone is given first, followed by misoprostol one to two days later. As a two-dose regimen, the drugs successfully end a pregnancy nearly 100% of the time, according to a study published in the journal Obstetrics & Gynecology.
According to the new law, it’s not a crime for a patient to possess the medications if they were prescribed to them. However, anyone who isn’t a health care provider who helps get a pregnant woman mifepristone or misoprostol, such as friends or family members, could face legal repercussions, including a fine of up to $5,000 or up to five years in prison.
Doctors and pharmacists can still prescribe the drugs in the hospital for postpartum hemorrhage and incomplete miscarriage, as long as they follow the state’s legal requirements for their use, such as keeping the medication in a locked cabinet.
But Tamika Thomas-Magee, a nurse and the director of clinical services at Planned Parenthood Gulf Coast, which operates health centers in Louisiana, said she believes the law is being used as a “scare tactic” to deter doctors and pharmacists from prescribing and dispensing the medications.
Because the drugs are now controlled substances, she said, there will be increased oversight and scrutiny of their use.
“Am I going to face legal ramifications because I’m providing health care that is valid, that is evidence-based, to a person who needs it?” Thomas-Magee said. “It makes the provider vulnerable, just as it makes the patient vulnerable, because it’s our livelihood, and I don’t want to be prosecuted just because I’m trying to save a person’s life.”
Thomas-Magee worries about the impact on patients in the state, particularly Black women, who account for nearly two-thirds of all pregnancy-associated deaths, according to a report from the Louisiana Department of Health.
“We’re afraid of increasing the maternal mortality rate that’s already three times [more] likely than a white person to die during childbirth, during pregnancy or during postpartum,” Thomas-Magee said.
Avegno said the New Orleans Health Department has already received reports that pharmacists have refused to fill patients’ prescriptions.
“They are afraid that they’re going to get in trouble because someone might misinterpret that it’s being written for an elective abortion when it’s really being written for a miscarriage,” Avegno said. “When patients don’t get a medication that’s prescribed for them for a significant condition, then they likely get worse or they need more intervention that would have been unnecessary.”
The Louisiana Department of Health did not respond to a request for comment.
In a statement, a spokesperson for Louisiana Right to Life, an anti-abortion group that helped draft the bill, said physicians will continue to have access to misoprostol in medical situations, “including but not limited to miscarriage management, induction of labor, management of postpartum hemorrhage, stomach ulcers, and more,” citing guidance from the Louisiana Department of Health. Hospitals don’t need to remove misoprostol from hemorrhage carts, the spokesperson added, or hesitate to administer misoprostol to patients experiencing health emergencies.
Liz Murrill, the state’s attorney general, said in a statement that lawmakers added the drugs to the Schedule IV list following testimony from a state senator’s sister, who testified that her ex-husband attempted to end her pregnancy at eight weeks by “lacing her drinks” with the abortion pills.
The testimony “illustrated that easy access to these drugs can be dangerous to pregnant women,” Murrill said in the statement.
It ‘literally keeps me up at night’
In 2022, shortly after the Supreme Court overturned Roe v. Wade, Kaitlyn Joshua, 31, of Baton Rouge said she woke up in a pool of blood. She was around 11 weeks into her pregnancy and was miscarrying, she said.
When she arrived at the emergency room, she said staff told her they couldn’t verify whether she was miscarrying and advised her to return if the pain got worse. The next day, at a second emergency room, staff again refused to confirm the miscarriage, provide a procedure to empty the uterus or prescribe medication for an abortion, she said.
“She hands me a paper that says, ‘take Tylenol,’” Joshua said.
Joshua — who is working with city council members in Baton Rouge to get the law repealed — said the Louisiana law taking effect Tuesday “literally keeps me up at night.”
“One of my girlfriends who called me earlier, she’s pregnant with twins, and she’s only eight weeks and she has a history of hemorrhaging,” Joshua said. “I said make sure you’re talking to your provider because these two medications that would normally be available on crash carts is now going to be under lock and key.”
Hospitals may authorize the medications to be on crash carts, per the new law, but if so, they must be in a locked area.
Staying prepared
Lisa Boothby, president-elect of the Louisiana Society of Health-System Pharmacists, a professional organization, said she doesn’t think the new law will require hospitals and pharmacies to hire more staff to manage the demands of moving the medications to scheduled drugs.
However, she said, the group has spent the last several months educating providers and pharmacists about the law to prevent delays in patients’ getting the medications.
“I think the most important thing is getting the message out to our providers and our pharmacies so that they’re not afraid because sometimes patients can be harmed if we have misinformation,” Boothby said.
Physicians will need a special license to prescribe the drugs, she said. They’ll also need to include a diagnostic code, clearly indicating that the prescription isn’t intended to cause an abortion, along with the patients’ names and the pharmacy dispensing the medication.
Meanwhile, Boothby said, pharmacists will need to treat the medications similarly to other Schedule IV drugs, including keeping a detailed inventory list.
In hospitals, that may be a bit easier: Typically there are machines that help keep track of the inventory and expiration date of the medication, she said. For community retail pharmacies, they’ll need to take an initial inventory count of their supply Tuesday, followed by monthly inventory checks going forward.
“We have to know how many tablets; capsules, if it’s a liquid, how many mills of it we have at all times because we’re accountable to the DEA for that and to our state organization for that,” Boothby said.
Avegno, of the New Orleans Health Department, said city health officials are educating providers as well, more recently holding a listening session earlier this month.
She said some providers still have a lot of apprehensions about prescribing the drugs and others are unaware.
“Some providers across the state don’t even know this is happening,” she said. “I can see that happens if you are working in a rural area, and you are just taking care of patients, working 60 hours a week. You’re not going to keep up with what’s happening in the Louisiana Legislature.”
