The two drugs used in a medication abortion, mifepristone and misoprostol, are now controlled substances in Louisiana, making it a crime punishable by up to five years in prison to possess the drugs without a prescription.
The law, which passed in May and took effect Tuesday, classifies the two abortion pills as the highest grade of controlled substances, making Louisiana the first state to mandate prison or financial penalties for possessing the drug without a prescription.
Various challenges to the regulation of mifepristone have been a flashpoint in the abortion debate in the lead-up to the 2024 election, considering that nearly two-thirds of the nearly 1 million abortions in the United States last year involved pregnancy-ending medications.
Abortion during any stage in pregnancy has been illegal in Louisiana since the fall of Roe v. Wade in 2022, with the only exceptions being to save the pregnant woman’s life, prevent serious risk to physical health, or if the fetus is not expected to survive.
But the new regulation has sparked significant controversy in the medical community, as mifepristone and misoprostol are used to treat several conditions, including pregnancy-related emergencies.
Here are the answers to the most common questions about the new law.
Where did this law come from?
Louisiana state Sen. Thomas Pressly introduced the bill making abortion pills controlled substances in honor of his sister, who was the victim of her husband’s attempt to force an abortion by giving her misoprostol without her consent or knowledge.
The incident with Pressly’s sister, Catherine Herring, occurred in Texas, where abortion was already a felony crime punishable by up to 20 years in prison. However, instead of being charged under abortion statutes, Herring’s husband was charged with felony assault, and he was sentenced to 180 days in jail after accepting a plea bargain.
Herring’s daughter survived the attempted forced abortion but was born prematurely with severe developmental delays.
Pressly said in a press release when his bill passed out of the state Senate in April that he hoped the law would “assist law enforcement in protecting vulnerable women and unborn babies.”
“Federal law is clear that when a drug is frequently abused and is a risk to the health of citizens, it is appropriate to include it as a controlled substance,” Pressly said. “My sister’s story is clear proof that these drugs are being weaponized and are a risk to the public health.”
As many as 24% of abortions may be unwanted or coerced, according to peer-reviewed research conducted by the anti-abortion Charlotte Lozier Institute. Another approximately 43% of women reported consenting to their abortions but said they were “inconsistent with their values.”
How do doctors use mifepristone and misoprostol?
During a chemical abortion, also called a self-managed abortion, mifepristone works by blocking the patient’s progesterone, the hormone that supports a pregnancy in the uterus. Misoprostol, taken one to two days after mifepristone, induces contractions to expel the pregnancy tissue, including the placenta and the fetus.
But both pills are also routinely used in miscarriage treatment in a hospital setting, particularly when it is early in pregnancy and impossible for the fetus to survive.
Misoprostol is also used during labor and delivery of healthy viable pregnancies, including to induce labor, prepare the cervix for surgical procedures, and stop postpartum hemorrhaging.
Postpartum hemorrhaging is severe bleeding after birth and usually occurs within the first 24 hours after childbirth. It affects between 1% and 10% of patients, according to the Cleveland Clinic.
Pressly has said that mifepristone and misoprostol are used for more than elective or self-induced abortions and that he does not believe that the law will interfere with its use for other reasons.
“Louisiana law is clear that if abortion-inducing drugs are used for purposes other than elective abortion, they are legal for use,” Pressly said. “The medical community is well-versed with using controlled substances in the course of their medical practice.”
Are these drugs only for abortions or pregnancy emergencies?
Both misoprostol and mifepristone are used for non-pregnancy-related conditions as well, but their use is relatively rare.
Misoprostol can be used to decrease the risk of stomach ulcers for patients on chronic anti-inflammatory drugs, like aspirin, according to the Mayo Clinic. However, there is a warning on the drug label that misoprostol should not be taken if the patient is pregnant or planning to become pregnant during her next menstrual cycle.
Also, although mifepristone’s primary use is to induce an abortion, it can be prescribed as a second-line treatment for patients with Cushing syndrome, a rare disorder when there is too much of the stress hormone cortisol in a patient’s system for a prolonged period.
Can doctors still use mifepristone and misoprostol?
The Louisiana Department of Health issued guidance on the new law on Sept. 6 to prepare hospitals and healthcare providers about how to use mifepristone and misoprostol in compliance with the new law.
As of Tuesday, the medications are required to be packaged, dispensed, and securely stored “in accordance with the hospital’s current policies and procedures,” and the hospital’s pharmacy must be current in its license to dispense controlled substances.
Hospitals are still also allowed to have misoprostol in an obstetric hemorrhage cart, or a “crash cart,” for easy access and quick treatment during such medical emergencies.
Can a woman be charged for having abortion pills without a prescription?
No, the law does not allow for a woman to be charged with a crime for possessing abortion pills, even without a prescription.
“Women are often the second victims of an abortion, and we are aware of increasing incidents of men using threats of violence or duress to cause women to take abortion pills against their will,” Pressly said in April.
How do women get the pills for an abortion if the procedure is against the law?
In the wake of the Dobbs v. Jackson Women’s Health Organization decision, five states enacted shield laws that prevent doctors and other healthcare professionals from being prosecuted for prescribing abortion pills to patients online across state lines, even those with abortion bans.
Those five states are New York, Massachusetts, Washington, Vermont, and Colorado.
Telehealth prescribing of mifepristone and misoprostol is largely credited for the increase in abortions nationwide since the fall of Roe, with approximately 20% of abortions facilitated by online transactions for abortion pills.
Between July 2023 and March 2024, over 65,000 patients in states with total or six-week abortion restrictions have accessed abortion pills from providers protected by state shield laws.
How could the law affect patient care?
Planned Parenthood Gulf Coast said in a statement on Tuesday that it fears the scheduling of mifepristone and misoprostol will worsen medical care for pregnant women in Louisiana.
“This dangerous law adds another layer of unnecessary restriction to health care in [Louisiana] that could be the difference between a patient’s life & death in emergencies. This law does nothing to protect [Louisianans’] lives — it furthers a climate of fear and confusion for patients and providers,” the abortion provider wrote.
Even before Roe was overturned, Louisiana had one of the highest maternal mortality rates in the country, ranking as the 47th out of 48 states in 2019. Louisiana also had the fifth-highest infant mortality rate in the U.S. in 2019.
This is particularly true for black mothers and infants. As of 2019, four black mothers died due to pregnancy for every one white mother, and two black infants died for every one white baby, according to the state Office of Public Health.
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Since the state’s abortion ban took effect, physicians, healthcare providers, and patients have reported a decline in medical care in Louisiana out of fear that providing a medically necessary pregnancy termination, or even a risky delivery, could result in criminal penalties.
However, anti-abortion advocates and policymakers have emphasized that no abortion restriction in the country prevents medical professionals from treating any type of pregnancy emergency, even if it means that the fetus will likely die.