Two common abortion pills are, as of Tuesday, classified as “controlled substances” in Louisiana, due to a first-of-its-kind law that medical professionals warn will endanger the lives of women by restricting medication used to treat postpartum hemorrhage and other conditions.
Louisiana, which already bans abortion, passed a law reclassifying mifepristone and misoprostol as schedule IV drugs – a designation typically reserved for drugs that carry a risk of abuse or dependence. People caught with the drugs without a valid prescription could face up to five years in prison, although pregnant women who procure it for their own use are exempted from punishment under the law.
Although the drugs are typically used in US medication abortions, they are also regularly used in an array of other circumstances, such as to help with miscarriage management, treat ulcers and soften the cervix during labor and other procedures.
Normally, at the Louisiana hospital where OB-GYN Dr Nicole Freehill works, misoprostol is kept in so-called hemorrhage carts, which can be easily wheeled into the rooms where patients deliver babies and which carry medications normally used to treat hemorrhaging, including misoprostol. It takes about 15 seconds to pull the misoprostol out of the cart, Freehill said.
Now, due to the security requirements placed on schedule IV drugs, the hospital must keep misoprostol stocked outside of patients’ rooms. When the hospital ran a drill to see how long it took nurses to grab the misoprostol under the new rules, it took nurses two minutes, Freehill said.
“A lot of people might go: ‘Oh, two minutes, that’s really fast.’ And yes, in the long scheme of things, that’s fast. But when you have someone who is actively hemorrhaging – in two minutes, they can lose hundreds of cc’s of blood,” Freehill said. “So those seconds count. I’m definitely worried about what’s going to happen to patients who are hemorrhaging.”
Compared to other wealthy nations, the United States already has a far higher maternal mortality rate, particularly among Black Americans.
Before the law’s passage, more than 200 doctors wrote a letter to the state legislator behind the law, asking him to reconsider it. “Controlled substances require more complex coordination by pharmacists, patients and providers, with increased documentation and often longer waits for patients,” they wrote. “Overall, this results in fear and confusion among patients, doctors, and pharmacists, which delays care and worsens outcomes.”
In the two years since the US supreme court overturned Roe v Wade, more than a dozen states, including Louisiana, have banned almost all abortions. However, the number of abortions performed in US clinics rose, as did the number of self-induced abortions using pills. (Self-managed abortions are usually safe and effective in the first trimester of pregnancy.) In response, anti-abortion activists have tried to narrow access to abortion pills, which are used in two-thirds of all US abortions.
However, there is no medical reason to reclassify mifepristone and misoprostol as schedule IV drugs, Freehill said.
“It could be five out of seven days of the week that I’m utilizing this medication, and obviously not for abortion care,” Freehill said. “I don’t see how this is going to help my patients be safer.”
