Anti-Abortion Groups Eye Louisiana Pill Restriction Law as Model

A first-of-its-kind Louisiana law classifying abortion-inducing drugs as dangerous controlled substances is motivating national anti-abortion groups to ramp up policy work in states to limit access to the medications.

Republican Gov. Jeff Landry on May 24 signed into law a bill adding mifepristone and misoprostol—the two drugs used in the FDA-approved regimen to induce an abortion—to the list of Schedule IV drugs under Louisiana’s Uniform Controlled Dangerous Substances Law.

The law, which officially takes effect Oct. 1, means the medications would be under the same category as drugs with the potential for addiction or abuse, and allow Louisiana to impose criminal penalties for possessing the pills without a prescription.

The law prompted concern from the White House, medical providers, and others who say it contradicts the Food and Drug Administration’s judgment on the safety and efficacy of medications, even if states have authority to more strictly regulate controlled substances. They argue it will have a chilling effect on reproductive health care, especially since the medications are used for miscarriage management and other indications.

But national advocacy groups that have helped craft and support state abortion restrictions praised the law as a win for patient safety, and are considering similar policies in other states, as well as actions against telehealth companies offering abortion medication by mail.

They argue restricting the pills at the state level is even more urgent now, as analysts predict the US Supreme Court will soon toss a legal challenge by anti-abortion physicians to the FDA’s safety decisions on the prescribing and dispensing of mifepristone.

“States have to stand up for their people because the FDA is asleep at the wheel on this issue,” said Katie Daniel, state policy director for the national anti-abortion advocacy organization Susan B. Anthony Pro-Life America.

“Our goal is to prevent these drugs from getting into the hands of abusers, so if this is a tool to do that, it’s something we’re very interested in talking to other lawmakers about,” Daniel said of the Louisiana law.

Eyes on States

Anti-abortion groups say more states should follow Louisiana’s lead to protect individuals from coerced abortion and other potential harms they argue are associated with abortion medication.

The Louisiana lawmaker behind the law said it was inspired by his sister, whose ex-husband was accused of slipping abortion-inducing medication into her drinks when she was pregnant. A Massachusetts man was also recently charged with misleading his partner into taking abortion pills while she was pregnant.

Louisiana is one of 14 states where abortion is almost completely banned, with 15 additional states only allowing physicians to dispense abortion-inducing pills. Medication abortion is the most used form of abortion in the US at 63% in 2023, according to the Guttmacher Institute, a reproductive health research organization.

The FDA has repeatedly defended the safety of mifepristone, which is approved as the first drug to end a pregnancy through 10 weeks gestation. Misoprostol, the second drug used in the medication abortion regimen, is approved by the FDA to reduce the risk of ulcers caused by prolonged anti-inflammatory use. Both drugs are also used for patients experiencing a miscarriage, and misoprostol is widely used to induce labor and control postpartum bleeding.

Supreme Court justices are considering whether anti-abortion doctors have standing to sue the FDA over its regulation of mifepristone. The doctors object to the FDA’s 2016 and 2021 decisions on the medication that, in part, allowed any advanced practice clinicians to prescribe the medication and permitted the pill to be sent to patients by mail.

Louisiana Right to Life, which helped state Sen. Thomas Pressly (R) craft the legislation there, didn’t consider the pending high court case while developing the bill, said Sarah Zagorski, the group’s communications director.

But Daniel said listing mifepristone and misoprostol on controlled substance schedules is a policy option for other states to consider.

“States organize their schedules differently, so it probably would be state to state how the bill would look,” Daniel said.

While the federal government has its own scheduling under the Controlled Substances Act, states may impose stricter requirements to limit public health risks. A dozen states, for example, classified tramadol combination pain treatment products as Schedule IV substances before the federal government did so in 2014.

Americans United for Life, a national law firm and advocacy group that’s helped craft dozens of state abortion restrictions, has not specifically looked into legislation on the scheduling of abortion pills, but “generally encourages and supports bills that protect pregnant women from coerced abortion,” said Carolyn McDonnell, the group’s litigation counsel.

One of these is AUL’s model legislation, known as the Coercive Abuse Against Mothers Prevention Act. It aims to “prohibit actions intended to coerce or otherwise force a woman to abort her unborn child.”

Indiana and North Dakota passed laws in 2022 and 2023, respectively, with language drawn from AUL’s model bill. Massachusetts also considered a bill on coerced abortion in 2019, and Maryland had similar legislation introduced in the state House and Senate this year.

Mail Order Limits

Another key prioritiy of anti-abortion groups in the wake of the Louisiana law is examining how to limit telehealth companies from prescribing and sending abortion medication to patients in states with abortion bans or other restrictions.

Requests for abortion pills from online providers like Aid Access and Carafem have jumped amid abortion bans implemented after the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. While Carafem says it only offers medication abortion care to patients in states without restrictions on the pills, Aid Access offers shipping to all 50 states.

The FDA in 2021 permanently removed its previous in-person dispensing requirement for mifepristone after an extensive review of evidence determined the restriction was no longer necessary to uphold the drug’s safety.

But AUL believes “it’s good public policy that if you’re going to allow abortion-inducing drugs, there should be in-person distribution,” McDonnell said.

Arkansas Attorney General Tim Griffin (R) announced May 21 that he had sent cease and desist letters to Aid Access and New York-based Choices Women’s Medical Center. Abortion is completely banned in Arkansas except under limited circumstances, and “abortion pills may not be legally shipped to Arkansans or brought into the State for use by Arkansans,” Griffin said in a press release.

Daniel said SBA encourages “other AGs to take similar action where they let these companies know that you are breaking our state law, and we will enforce the law against you.”

The FDA and medical providers, however, argue that the agency’s decisions on how mifepristone should be prescribed and dispensed preempt contradictory state restrictions. The US Court of Appeals for the Fourth Circuit is expected to weigh this issue in two cases in which abortion access supporters and officials defending state-level restrictions disagree on how much of medical practice FDA regulations should cover.

FDA’s Role

Democrats and reproductive health researchers say the Louisiana law and other attempts to restrict these medications will have far-reaching effects beyond abortion, and that the FDA can do more to defend their safety.

“When a state law contradicts federal law, they should be more vocal about explaining the safety profile, being more of a public voice so that voters understand what’s happening and also what’s at stake,” said Ushma Upadhyay, a professor at the Advancing New Standards in Reproductive Health research program at the University of California, San Francisco.

The FDA didn’t respond to a request for comment.

Listing these medications as controlled substances means “there’s more hoops to jump through,” said state Rep. Mandie Landry (D), who vocally opposed the law as it moved through the state legislature.

“A lot of pharmacies in general won’t fill this anymore because it’s associated with abortion,” Landry said.

Upadhyay said the Lousiana law “is really shocking, given that both medications that make medication abortion are extremely safe and effective.”

“To me it’s very clear that this law is not based in any medical evidence or any reason or any concerns about patient safety,” Upadhyay said.