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Louisiana's first-in-the-nation Law Listing the abortion drugs mifepristone and misoprostol as “controlled dangerous substances” took effect Tuesday, sparking fears among health care providers and pharmacists that routine care for women in the state could worsen.
In addition to abortion, doctors say the drugs are used to treat miscarriages and, in the case of misoprostol, to stop dangerous bleeding after childbirth. Now, in Louisiana, It is misoprostol required Like other controlled substances, they are stored in a sealed box, which doctors fear could delay treatment in emergency situations.
“You want to have it right now,” he said Dr. Jennifer AvenoEmergency physician and director of the New Orleans Health Department.
He said health care providers in the region have been conducting exercises to determine how long it takes to retrieve misoprostol from a locked cabinet in case of birth emergencies.
“It adds a lot of minutes to that process,” she said. “Like I've seen, the minute you see someone bleeding postpartum, you know it's going to make a difference.”
Abortion was already there. Illegal In Louisiana, with narrow exceptions. Governor Jeff LandryWhen you sign the bill, he said. He protects women throughout the state. Possession of the drugs without a valid prescription can result in up to five years in prison and a fine of up to $5,000, although the law exempts pregnant women who possess the drugs for “self-consumption”
law, passed In May, he puts mifepristone and misoprostol together category in Louisiana such as benzodiazepines including Valium, Xanax, and Ativan. It is presented by Republicans State Senator Thomas Pres After claiming that his sister had been given misoprostol without her consent, he pleaded guilty to “fraudulently induced criminal abortion”.
Mifepristone and misoprostol are drugs used for medical abortion, now the Very common How people can get abortions in the United States. Mifepristone blocks the hormone progesterone, which is needed to maintain pregnancy, and misoprostol causes uterine contractions, leading to cramping and bleeding.
For abortion, they are They are used in emergency situations when patients have complex problems and for patient care.
“One of the most common reasons people choose medical treatment for miscarriage is because they want timely treatment and to get the process behind them as quickly as possible,” says family physician Dr. Honor MacNaughton. Knowledge in Reproductive Health at the Cambridge Health Alliance in Massachusetts. “Many people don't want to make an appointment for the procedure or wait for the miscarriage to happen because this process can take days or sometimes weeks.”
Dr. Anitra Beasley, Medical Director Planned Parenthood GulfWith two clinics in Louisiana, the law's new restrictions mean patients can't get the drugs in a timely manner because doctors are afraid to prescribe them or pharmacists are afraid to fill the prescriptions. Patients who have legally prescribed medications for miscarriage care may be confused about whether it is legal to take the medication, she said.
“Knowing that the pregnancy is over and trying to manage that process medically and being told you can't or going through the parish and trying to find someone who can give you the proper medication. “I can't imagine the heartache that man must be going through at this point,” Beasley said.
Supporters of the law argued It does not affect legal prescriptions for the drugs and the Louisiana Department of Health has issued a statement. Instruction In September, they want to clarify to health care providers that the drugs can be used in hospitals to treat postpartum hemorrhage and incomplete miscarriage. He said the drugs should be kept in a locked cabinet.
He said that large health institutions and pharmaceutical companies have been preparing for the implementation of the law for months. Ochsner HealthThe main health system in the region last week responded to the frequently asked questions of their employees, explaining which providers can order misoprostol, how to order the drug and what steps are needed to get it from a locked drawer.
“Beginning October 1, 2024, providers in all specialties must adopt a controlled patient record process,” the guidelines state. It says pharmacists must specify why the drug was prescribed, or the electronic health record system won't allow the prescription to go through. He also noted that there would be an override mechanism that would allow the misoprostol to be released from the locked cabinet in an emergency.
Doctors in addiction treatment identify these drugs as controlled substances, which is an overdose of what the programming system is designed to do. Wanting misoprostol and mifepristone to be placed in the same category as sedatives like benzodiazepines is, “frankly, silly,” said Dr. Lucille Howard, MD, an addiction medicine fellow at Tulane University in New Orleans. “They don't have the capacity to become that dependent or addictive.”
“It's an abuse of the scheduling system,” he added. Dr. Smita Prasadpresident of the Louisiana Association for Addiction Medicine and assistant professor at Tulane. “It also takes away from a real problem we have in the United States: fentanyl and other substances that are killing people like synthetic fentanyl.”
Scheduling the drugs and their use in a Prescription drug monitoring program“a statewide program where I can search for a patient under my care and if they were prescribed prescription drugs in the past 15 years, I can see who the doctor is, where they filled the drug,” and information about dates and doses used, Prasad said.
Anna LeGrade, senior director of government relations, said the DOP was a system designed to curb opioid abuse American Association of Health-System PharmacistsBut members of her organization expressed concern that it could exclude patients legally prescribed mifepristone and misoprostol, a sentiment shared by doctors.
“Every time one of our doctors writes a prescription for misoprostol, it's recorded,” said Avegno, director of the New Orleans Department of Health. “There's a concern that someone might say, 'Oh, that OBB wrote 20 warrants last month. I wonder if they are secretly having abortions. I'm going to check it out, right?”
The DOP organization, which represents pharmacists working in hospitals and other health care facilities, revised its policy after the Louisiana law was passed. Resist Rescheduling medications used for reproductive health and reporting those medications to prescribed medication monitoring programs.
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“Almost immediately, our members raised concerns that if this was done in one state, it could easily become a template for other states to use,” Dopp said.
Louisiana, which has one of the highest Maternal mortality rates In the country, he made a hard-winner development Over the past decade, postpartum hemorrhage has reduced mortality, Avegno said.
“Now we're adding a reason for postpartum hemorrhage to come back up,” she said. “Our OBs really break the standard of care you're used to experiencing.”
The New Orleans City Council directed the Department of Health to study the impact of the law, Aveno, and established a group. Online form For patients, pharmacists and medical providers to share their experiences confidentially.
“Just to document what's actually happening, we can bring that back to our decision makers and say, 'Look, these are the results,'” Avegno said. “We don't want anyone to suffer in silence and not being able to get care is something no one cares about. Because we really do.