Louisiana classifies abortion drugs as controlled substances

This spring, Louisiana passed a law classifying mifepristone and misoprostol as controlled substances, making it the first state to do so. The two drugs are commonly used in pregnancy and reproductive healthcare, including for abortion.

Under the law, which goes into effect Oct. 1, a person who obtains the drugs "for her own consumption" would not face prosecution, but anyone helping them, with the exception of a healthcare provider writing or filling a valid prescription, would. Individuals who are charged and convicted under the law could receive a jail sentence of one to five years, as well as a fine up to $5,000.

According to Louisiana Attorney General Liz Murrill (R), the law "does not limit a healthcare provider's ability to use, prescribe, or fill these medications for legitimate health purposes nor does it impose restrictive burdens on access for emergency purposes."

Louisiana Gov. Jeff Landry (R) also called the law a "commonsense" way to protect women.

In a letter from Sept. 6, the Louisiana Department of Health said misoprostol and mifepristone can be legally used to treat postpartum hemorrhages and incomplete miscarriages, but hospitals have to keep the drugs in a "locked/secured cabinet, compartment or other system," in a "secured automated medication dispensing/delivery system," or "in a locked or secured area of an obstetric hemorrhage cart or 'crash cart.'"

How healthcare providers are preparing for the law

According to the Washington Post, some hospitals in Louisiana are preparing their staff with timed drills to ensure that they will be able to get from patients' rooms to locked medicine cabinets for mifepristone and misoprostol when needed.

"It adds a few minutes," said Jennifer Avegno, director of the New Orleans Health Department. "Most patients would likely make it. But I've seen myself what can happen when someone is bleeding out from a miscarriage. And a few minutes could mean life and death in some cases."

Avegno added that she fears that the law will reverse recent improvements in the state's poor maternal mortality outcomes. Currently, CDC data shows that Louisiana has one of the higher maternal mortality rates in the country.

"Most hospitals don't have a crash cart with locked areas and controlled tracking," Avegno said. "It's not medically correct to make these drugs controlled substances. It's like the goal is stop all abortions. But there's not much concern about collateral damage. Now who knows what will happen?"

According to Advisory Board's Ellie Wiles, "many abortion drugs are also used for the safe and effective management of miscarriage and postpartum hemorrhaging. Reclassifying these as controlled substances will pose roadblocks that can detrimentally complicate and delay the delivery of life-saving care."

"Like with many other pieces of anti-abortion legislation, the implications are much more far-reaching than the narrow goal they aim to achieve," Wiles added.

In addition, pharmacists say there will likely be multiple calls back and forth with doctors' offices to confirm why the two drugs are being prescribed. All pharmacies must report "their eligible prescription transactions" to the Louisiana Prescription Monitoring Program.

"It will definitely make more work for providers and pharmacists," said Lisa Boothby, president-elect of the Louisiana Society of Health-System Pharmacists. According to Boothby, the organization is working to "educate our physicians and pharmacists on the new law to prevent delays in care or other patient harm."

Separately, Neelima Sukhavasi, an ob/gyn based in Baton Rouge and fellow with Physicians for Reproductive Health, said she fears that patients will have problems getting prescriptions filled, "especially if there are nervous pharmacists."

"This whole thing is ridiculous," she said, adding that classifying mifepristone and misoprostol as controlled substances creates unnecessary surveillance of reproductive health issues that could put patients at greater risk.

"Every hospital is trying really hard to figure this out," Avegno said. "But we know hospitals are very afraid of scrutiny. Our only goal is to make this safe for patients."

Advisory Board's women's health resources

For more insights into women's health issues, check out Advisory Board's library of resources.

We have several resources on the top drivers of change in the maternal and reproductive health market, as well as the outlook for the women's health service line.

To learn more about ways to improve women's health in the United States, this report outlines six key factors to take into consideration, including the roles of various healthcare stakeholders and the importance of cross-industry collaboration.

In addition, this expert insight outlines the business case for investing in women's specialty care. This research also describes five steps organizations can take to improve women's health and well-being.

For resources specifically related to abortion, we offer this infographic explaining the potential health outcomes for individuals denied abortions in their state, as well as an expert insight on the groups that are disproportionately impacted by abortion restrictions. This expert insight also explains how leaders can help their clinical workforce amid changing abortion laws. (Brasted, Axios, 9/18; Wax-Thibodeaux, Washington Post, 9/17)