On May 23, 2024, the Louisiana Legislature granted approval to a bill that would redesignate two abortion pills, misoprostol and mifepristone, as “controlled, hazardous substances.” There is a lengthy history of the safe and effective use of both pills in the treatment of miscarriages and other conditions, as well as in medication abortions. The state’s governor is anticipated to sign the bill into law, which prohibits the possession of either of the drugs without a prescription. Louisiana has already prohibited surgical and medication abortions, with only a few exceptions.
The Conversation U.S. contacted Jamie Rowen, a legal expert, and Tami Rowen, an obstetrician and gynecologist, to explain the new law’s implications for both patients and providers.
What is the significance of Louisiana’s legislation regarding these abortion pills?
MifMisoprostol and mifepristone have been classified as noncontrolled substances for an extended period of time. Though a prescription is necessary to acquire them, there have been no criminal repercussions for individuals who possess these medications.
The pills would be reclassified as Schedule 4 drugs in Louisiana once the new bill is enacted. This classification includes medications such as diazepam, which is more commonly known as valium, and tramadol, an opioid that is frequently used.
In Prescription medications are classified into two categories in the United States: controlled and not controlled. These are predicated on the drug’s potential to induce both physical and mental addiction. isiana has recently transitioned the two medications from non-controlled to controlled.
Access to A prescription is already required in all states of the United States to access medication abortion. individuals who are interested in obtaining abortions will still require a prescription to obtain the drugs under Louisiana’s new law, as was previously the case.
What this The primary purpose of this legislation is to criminalize the possession of abortion pills by individuals who are not pursuing them. The provision of a medical or surgical abortion in Louisiana is prohibited unless there is a risk of mortality or “substantial and irreversible bodily impairment” to the woman. Residents of Louisiana who desire medication abortions must obtain the drugs from sources outside of the state. Whoever transports or stores mifepristone or misoprostol in Louisiana without a valid prescription may be subject to a penalty of one to five years in prison and a maximum fine of US$5,000 under this new law.
Controlled subschedules are used to further categorize controlled substances. The severity of abuse, its risk to public health, and a few other factors are the determining factors for schedule designations under federal law.
Under LouisianaAccording to Louisiana state law, there are five schedules that adhere to the same classifications as federal law. assification indicates that the drug or other substance has a low potential for abuse, a currently accepted medical use, and the potential for limited physical or psychological dependence if abused.
The legislature is asserting that there are dependence and abuse risks associated with the medication by classifying mifepristone and misoprostol as controlled Schedule 4 drugs, without any evidence to support this assertion.
What, if any, scientific principles did the Legislature employ?
This is the initial instance in which a state has classified abortion medication as a controlled substance; however, it is not an unprecedented classification of abortion medication as a Schedule 4 narcotic.
Mifepristone is classified in a comparable manner in Taiwan.
The classificNevertheless, the classification is not based on any scientific evidence, as no studies have indicated that the substance is at risk of dependence or abuse. is more effective than traditional treatments with misoprostol alone, and it can be used for elective abortion, miscarriage management, and even labor induction.
In terms of In terms of safety, it is beneficial to compare the risks of mifepristone with Viagra, another frequently prescribed medication. Viagra is not classified as a controlled substance, despite the fact that it necessitates a prescription. uncommon reported cases of nonspecific fatal sepsis associated with mifepristone, which may be linked to women who undergo medical abortions in the United States.
In contrast, ViIn contrast, Viagra was associated with 1,473 significant adverse outcomes and 522 reported deaths in the United States over a 13-month period. history of Louisiana fails to provide an explanation for the science that lies behind its classification scheme.
It should be noThere is no risk of dependence associated with either misoprostol or mifepristone. Misoprostol was authorized by the Food and Drug Administration for its capacity to alleviate the symptoms of gastric ulcers. However, it is frequently employed in the field of obstetrics and gynecology to induce labor and prevent postpartum hemorrhage. less likely to cause side effects in individuals who are using it for gynecological care or ulcers, as compared to other Schedule 4 pharmaceuticals.
AP Photo/Jose Luis Magana
In what ways could the new law impact access to nonabortion procedures?
According to the new law, criminal penalties of up to five years in prison can be imposed, irrespective of whether the drugs are intended for a person who is electing an abortion or attempting to complete a miscarriage. The law does not differentiate between the possession of misoprostol for the treatment of gastric ulcers and gynecological care.
The law may erect new obstacles to access for a diverse range of individuals by penalizing individuals who transport or store medications for others, even if it does not criminalize pregnant individuals who consume the tablets.
What are the implications of the statutes for other states?
The Supreme CouThe Constitution has been interpreted by the Supreme Court as enabling the federal government and the states to regulate controlled substances. The availability of medications may differ from one state to another.
However, states typiNevertheless, states generally adhere to the federal scheduling guidelines and practices when determining their own drug classifications. a rare but uncommon exception to this prevalent practice, as numerous states have decriminalized or legalized it in violation of federal law.
The immediate impactThe immediate effects will be on clinical evaluations of the two drugs in other states that have patients in Louisiana. Clinical trials involving medications that are not classified as controlled substances may be administered in any state with minimal or no additional state regulation. The requirements for clinical trials of controlled substances can result in increased costs and development delays.
The most probable long-term consequence is that other states may implement comparable legislative initiatives to restrict medication abortion access, particularly in those that have previously failed to prevent access to medical abortion through other means.
