Louisiana lawmakers are considering adding two drugs commonly used in pregnancy and reproductive health care to the state's list of controlled dangerous substances, in a move that has alarmed doctors in the state.
Mifepristone and misoprostol have many clinical uses, but one FDA-approved use is to take the pills to induce an abortion up to ten weeks gestation.
The bill moving through the Louisiana legislature would list both medications as Schedule IV drugs under the state's Uniform Controlled Dangerous Substances Law, creating penalties of up to 10 years in prison for anyone caught with the drugs without a valid prescription.
It's the latest move by anti-abortion advocates trying to control access to abortion medications in states with near-total abortion bans, such as Louisiana. If passed, the law would be the first of its kind, opening up 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 Dr. Daniel Grossman, an OB-GYN and reproductive health researcher at the University of California San Francisco.
But after the Dobbs decision in 2022, scrutiny of medication abortions escalated even more as clinics in certain states shuttered completely or were forced to stop offering in-clinic procedures.
"It's not surprising that states are trying everything they can to try to restrict these drugs," Grossman said. "But this is certainly a novel approach."
More than 250 OB-GYNs, emergency, internal medicine and other physicians from across Louisiana have signed a letter to the bill's sponsor, Republican state senator Thomas Pressly, arguing the move could threaten women's health by delaying life-saving care.
"It's just really jaw-dropping," said Dr. Nicole Freehill, a New Orleans OB-GYN who signed the letter. "Almost a day doesn't go by that I don't utilize one or both of these medications."
Mifepristone and misoprostol are routinely used to treat miscarriages or stop obstetric hemorrhaging, 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.
Proposal added as amendments
The proposal passed out of an Apr. 30 Louisiana House Administration of Criminal Justice committee hearing as amendments to Pressly's original bill creating the crime of "coerced criminal abortion" — where someone "knowingly" gives abortion pills to a pregnant woman to cause or attempt to cause an abortion "without her knowledge or consent."
Pressly's sister, Catherine Pressly Herring, testified during the hearing that she was given abortion drugs without her knowledge by her former husband. Pressly said his sister's story prompted the legislation.
In a statement, state Sen. Pressly explained he added the new amendments to "control the rampant illegal distribution of abortion-inducing drugs." He did not respond to NPR's requests for comment.
"By placing these drugs on the controlled substance list, we will assist law enforcement in protecting vulnerable women and unborn babies," Pressly wrote.
Louisiana Right to Life, the state's most powerful anti-abortion group, helped draft the bill. Claims that rescheduling the drugs could harm women's health represent "fearmongering," said communications director Sarah Zagorski.
The real problem, she says, is mifepristone and misoprostol are too accessible in Louisiana, and are being used to induce abortions despite the state's ban.
"We've had pregnancy centers email us with many stories of minors getting access to this medication," Zagorski said. "That's just going to create an epidemic in Louisiana of minors and women and putting the public health at risk."
Studies have shown a spike in people ordering abortion pills online to give themselves abortions in states with restrictive abortion bans.
In the Louisiana committee hearing, anti-abortion advocates stressed the bill would still allow physicians 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.
"Under this law, or any abortion law, in Louisiana, we see the woman as often the second victim," testified Dorinda Plaisance, a lawyer who works with Louisiana Right to Life. "And so Louisiana has chosen to criminalize abortion providers."
Move not "not scientifically based," doctors say
The Drug Enforcement Agency as well as 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 Joe Fontenot, the executive director of the Louisiana Board of Pharmacy, the state agency that monitors drugs listed as controlled dangerous substances.
As in other states, Louisiana tracks those prescriptions in databases which 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 — in 2023, there were 18,587 physicians in Louisiana, 13,790 of whom had a controlled dangerous substance license, according to data from the Louisiana State Medical Society and the Board of Pharmacy.
"Every state has a prescription drug monitoring program. And they really are designed to identify prescription drug mills that are hocking fentanyl, and opioid painkillers," said Robert Mikos, a professor of law and drug policy expert at Vanderbilt University.
But what happened to Pressley's sister — being tricked into taking mifepristone or misoprostol — 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's law, abuse refers to addiction.
Dr. Jennifer Avegno, a New Orleans emergency physician and the director of the New Orleans Department of Health, agrees.
"There is no risk of someone getting hooked on misoprostol," Avegno said.
Under the bill, the two medications would be added to a list comprised of opioids, depressants, and stimulants.
"To 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," Avegno said.
Doctors worry the bill could also 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, doctors said the bill's "false perception that these are dangerous drugs" could lead to "fear and confusion among patients, doctors, and pharmacists, which delays care and worsens outcomes" in a state with high rates of maternal injury and death.
The increased scrutiny could have a state-wide chilling effect and make doctors, pharmacists and even patients more reluctant to use these drugs, the doctors wrote in their letter.
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, which licenses physicians and other providers, and by law enforcement agencies with a warrant.
"Could I be investigated for my use of misoprostol? I don't know," said Freehill.
Pharmacists could be even more reluctant to dispense the medications, Freehill said — exacerbating a problem she and other OB-GYNs have already been dealing with since Louisiana banned nearly all abortions. That could leave patients miscarrying without timely treatment.
"They could be sitting there bleeding, increasing their risk that they would have a dangerous amount of blood loss" or risking infection, she said.
Already, Freehill now routinely phones in every prescription for misoprostol when her patients are miscarrying so she can explain to the pharmacist why she's prescribing it — something that won't be possible if it's made a controlled substance because those prescriptions have to be written on a pad or sent electronically.
In hospitals, the drugs would also have to be locked away, according to a midwife who works in New Orleans and asked not to be identified so she could speak on a sensitive topic. 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're listed as "dangerous," Avegno said.
In a written response to the Louisiana physicians who signed the protest letter, state Sen. Pressley said the doctors that he's spoken with feel the proposal "will not harm healthcare for women."
Criminalizing support for people giving themselves abortions
Louisiana's current abortion ban already makes it a crime to provide an abortion, including by giving someone medications used to induce abortion. And a 2022 law added up to 50 years in prison for mailing mifepristone or misoprostol.
Because the new proposal explicitly exempts pregnant women, opponents like Elizabeth Ling believe it is meant to isolate those women from others who would help them. Ling, a reproductive rights attorney at If/When/How, 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: "Is my friend who is simply just providing me emotional support going to somehow, you know, be punished for doing that?" Ling said.
The proposed regulation could also target people who aren't pregnant, but want to order abortion pills online and stock them in case of a future pregnancy, a tactic has become increasingly popular in states with abortion bans.
In a written response to the Louisiana physicians who signed the protest letter, state Sen. Pressley made it clear he intends to push the bill forward. The bill awaits a full floor vote in the state House, and then would need to be reconciled with a Senate version. If it passes before the legislature adjourns on June 3, it's expected to be signed by Republican Governor Jeff Landry, an outspoken opponent of abortion rights.
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