Louisiana Doctors Are Fighting GOP Bill That Would Criminalize Possession of Abortion Pills

Louisiana doctors are asking a state legislator to reconsider last-minute amendments he made to a bill last week that would add medication abortion to the state’s controlled dangerous substances list. If passed, abortion pills would be criminalized and scheduled alongside drugs that are addictive, adding even more unnecessary stigma to the medication and further eroding the already precarious doctor-patient relationship in a state with a near-total abortion ban.

“If it is incorrectly labeled as a controlled substance” doctors who use this medication “would be subject to unjustified mistrust by patients and fear of the medication,” reads an open letter obtained by Jezebel, which was circulated to physicians across the state and sent to State Sen. Thomas Pressly (R) on Tuesday morning. “This could also delay treatment that could be life-saving.” ER doctor Jennifer L. Avegno, the head of the New Orleans Health Department, co-wrote the letter along with other OB-GYNs and physicians in the field.

Pressly’s original bill, SB 276, focused on making “coerced criminal abortion by means of fraud” a crime. Pressly filed it after his pregnant sister’s husband slipped abortion pills in her drink without her consent. (He has since been sentenced to 180 days in jail and 10 years probation in Texas.) While the bill itself has not caused much controversy, Pressly added a set of amendments on Tuesday, April 30 that would classify mifepristone and misoprostol as Schedule IV controlled substances under Louisiana law. People with a prescription would still be able to use the drug, and pregnant women planning to consume the medication themselves would be exempt from criminal penalties. But anybody else found in possession of the medication would be subject to a felony punishable by up to five years in prison. If they are found to possess with the intent to distribute, they could get up to ten years in prison.

“The majority of people with a uterus have had a reason to need misoprostol at some point,” Louisiana maternal fetal medicine specialist Dr. Jane Martin, who was one of the doctors to sign the open letter, told Jezebel, adding that “misoprostol is not addictive.” But “when you put that medication on that list it sends [a message] to the general public, that has no medical education, no medical training, that misoprostol is an addictive medicine. Patients might wonder ‘What is my doctor not telling me?’ There are so many layers of this type of taboo and stigma it adds.”

And Martin says that while she’s “empathetic to the terrible crime” Pressly’s sister experienced, he’s using the word abuse to mean something different than when it’s used in medical terminology for classifying a drug. “I don’t disagree with him that his sister was abused, she was the victim of a criminal act,” Martin said. “It doesn’t matter whether it was misoprostol or lethal doses of Tylenol, she was given something that could have had a very negative impact on her health and her unborn fetuses’ health. You can slip somebody lethal doses of anything to hurt them but that doesn’t mean that a state should mark this as a controlled substance.”

Controlled substances can require complex coordination, increased documentation, and longer wait times. The physicians expressed their concern to Pressly that this will result “in fear and confusion,” particularly since misoprostol is not only safe but regularly utilized for cervical ripening, the prevention of catastrophic obstetric hemorrhage following delivery, etc. In a statement to Jezebel, Avegno adds, “Labeling medications routinely used to safely treat miscarriage as well as to promote safe labor and healthy childbirth as ‘dangerous’ and at high risk for abuse is not only scientifically incorrect, but creates confusion and fear for patients and providers.”

The majority of people with a uterus have had a reason to need misoprostol at some point.

Martin also emphasized that, in the obstetrics field, they are already fighting against internet taboos and TikTok videos spreading misinformation and rumors about medication. “We already have to spend a lot of our time convincing patients that the recommendations we are making are valid and evidence-based. Adding any kind of control or restrictions to how a medication is distributed or seen by the general public will add to that layer of difficulty.”

Dr. Nicole Freehill, a New Orleans-based OB-GYN, said that since Dobbs—which ultimately triggered Louisiana’s near-total abortion ban—she’s already had problems getting misoprostol filled at pharmacies. “I’ve had to personally get on the phone with many pharmacists” she says, adding that she needs to constantly reassure pharmacists she is using misoprostol for the diagnosis code she submitted to them. “There are so many things that we have to do that require us to go through the cervix and into the uterus; IUD insertions, to induce labor or for endometrial biopsies to evaluate the uterus for bleeding problems.”

Freehill and Martin both said they’re concerned this will make pharmacies even more reluctant to fill prescriptions. They also, independently of one another, talked about the dangerous precedent the amendments are setting, because they are potentially massive changes to Louisiana’s medical practice and were conducted seemingly quickly and without large consensus from OB-GYNs across the state.

“The biggest fear I have is that it’s going to set a dangerous precedent for other drugs that really do not have abuse or addiction potential,” Freehill said. “If they’re taking these medicines that clearly nobody is going to abuse or become addicted to and making them Schedule IV, then it’s basically throwing the rules out and saying, ‘No, we just want to put it on here.’ What else is coming next? Are IUDs going to be [classified as] Schedule IV, are birth control pills?”

In a statement following the addition of his amendments last week, Pressly said, “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. My sister’s story is clear proof that these drugs are being weaponized and are a risk to the public health.” While introducing the amendments, Pressly (who is a lawyer, not a doctor) forgot the name of one of the drugs.