Earlier this month, Louisiana became the first state in the country to classify the two most common drugs used in medication abortions, mifepristone and misoprostol, as Schedule IV controlled substances, creating stiff penalties for their unauthorized use. Medical providers sounded alarms when the GOP-controlled legislature passed the law: Abortion is already banned in the state in nearly all cases, and the new classification would delay lifesaving care for people experiencing miscarriages and health conditions unrelated to pregnancy.
Now, in a just-filed lawsuit, doulas, medical providers, and women denied care under the state’s abortion law argue that the new classification of mifepristone and misoprostol runs afoul of Louisiana’s constitution. By separating the drugs from others with similar risk profiles, the suit contends, the new law discriminates against people on the basis of their physical conditions, ones that are treated with mifepristone and misoprostol.
In Louisiana, controlled substances fall into five categories depending on their medical indications and risk for abuse—Schedule I being the highest risk, and Schedule V the lowest risk. The current list of Schedule IV drugs includes opioids, barbiturates, and benzodiazepines, all drugs with high potential for addiction. The classification of mifepristone and misoprostol as dangerous drugs subjects them to tight regulations. But they’re not dangerous drugs, nor do they have abuse potential like their Schedule IV counterparts; more than 100 studies have shown them to be safe and effective in ending pregnancy. Contrary to their current classification in Louisiana as having addictive potential, the Food and Drug Administration—which approved the drugs decades ago—has never found the medications to lead to physical or psychological dependence.
Misoprostol and mifepristone have proven to be effective in a variety of contexts. Both are used in miscarriage care, mifepristone is used to treat ovarian cancer, and misoprostol is crucial to managing postpartum hemorrhages. Under Louisiana’s law, anyone in possession of either drug—except for pregnant women—is subject to five years in prison and a $5,000 fine.
The classification, the lawsuit argues, subjects the drugs to a “highly regulated legal scheme” that delays care. Previously, misoprostol was commonly stored in obstetric hemorrhage carts or in staff’s pockets. But under its new status, only a provider licensed to administer controlled substances can retrieve the drug from locked cabinets where other scheduled substances, like narcotics, are stored. As a New Orleans OB-GYN told my colleague Julianne McShane, in a medical emergency, time is of the essence, and even a delay of several minutes can have disastrous consequences.
Pregnant women were already being denied care before the medications were reclassified. One of the plaintiffs, Kaitlyn Joshua, was denied miscarriage care by two hospitals because of the state’s abortion ban. “Now lawmakers have passed yet another law making it harder to get care during a miscarriage, and they did it without following the requirements of the State’s constitution,” Joshua said in a news release.
