Staff in some Louisiana hospitals are doing timed drills, sprinting from patient rooms and through halls to the locked medicine closets where the drugs used for abortions, incomplete miscarriages and postpartum hemorrhaging will have to be kept — as newly categorized controlled substances — starting Oct. 1.
Pharmacists are still trying to decipher guidance from state officials about the two drugs and the diagnosis codes that will be required before prescriptions for them can be filled. And they and doctors are speaking out about the extra layers of difficulty expected because of the law, which they worry will put patients experiencing serious pregnancy-related complications at even greater risk.
“It adds a few minutes,” Jennifer Avegno, director of the New Orleans Health Department, said of the looming restrictions. “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.”
No other state has labeled mifepristone and misoprostol as “controlled dangerous substances,” putting them in the same category as opioids, depressants and other drugs that can be highly addictive. Louisiana’s law, passed this spring despite significant opposition from doctors, threatens incarceration and fines if an individual possesses the pills without a valid prescription or outside of professional practice.
In a Sept. 6 letter, the Louisiana Department of Health told health-care providers and professionals that the drugs should be stored “in locked/secured cabinet, compartment, or other system.”
For a hospital, that can include a “secured automated medication dispensing/delivery system,” the letter says. Or, with the approval of a facility’s chief medical officer and pharmacy director, the drugs can be kept “in a locked or secured area of an obstetric hemorrhage cart or ‘crash cart.’”
Avegno, an emergency medicine physician, said her concerns “have only grown” because of the state’s instruction. She fears that recent improvements in the state’s dismal maternal mortality outcomes will falter.
“Most hospitals don’t have a crash cart with locked areas and controlled tracking,” she 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?”
Louisiana’s new law, signed by Republican Gov. Jeff Landry, comes amid intense national attention 0n reproductive rights and conservative states’ efforts to limit them. Abortion is a key focus in the presidential race, as well as with ballot measures in 10 states from Nevada to New York — most of those proposed constitutional amendments to enshrine abortion rights.
Abortion opponents hope Louisiana’s approach will be a template for others. They believe that narrowing access to mifepristone and misoprostol could be another path to restricting a woman’s ability to terminate a pregnancy. Medication abortions now constitute half of all U.S. abortions.
The statute says a person obtaining the two drugs “for her own consumption” would not face prosecution. But anyone helping her get the pills would be, with the exception of a health-care practitioner who has written or is filling a valid prescription. An individual who is charged and convicted could face a jail sentence of one to five years and a fine up to $5,000.
Louisiana already bans both medication and surgical abortions except to save a patient’s life or because a pregnancy is “medically futile.” In May, legislators rejected adding exceptions for teenagers under 17 who become pregnant through rape or incest.
Their move to categorize the two drugs as controlled substances was a surprise, added at the last minute to a Senate bill criminalizing an abortion when someone gives a pregnant person the pills without her consent. That scenario of “coerced criminal abortion” nearly occurred with one senator’s sister. Her ex-husband was sentenced to 180 days in jail.
The amendment, like the bill, was written with guidance from Louisiana Right to Life. The Louisiana Society of Addiction Medicine called it “legislative overreach” that went against “the spirit of the drug scheduling system, which is designed to classify substances based upon their danger, potential for misuse and medical benefit.”
Pharmacists are predicting there will be multiple calls back and forth with busy doctors’ offices while staff confirm why mifepristone or misoprostol is being prescribed. All pharmacies will have to 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. She said her organization is trying to “educate our physicians and pharmacists on the new law to prevent delays in care or other patient harm.”
Misoprostol in particular has important uses beyond medication abortions. It also is taken to soften the cervix during labor, ahead of biopsies for cancer and to prevent gastrointestinal ulcers.
Neelima Sukhavasi, an OB/GYN based in Baton Rouge and a Physicians for Reproductive Health fellow, fears there will be problems in getting prescriptions filled — “especially if there are nervous pharmacists.”
Placing the drugs in this new category is unnecessary surveillance of reproductive health issues that could put patients at greater risk, she said. “This whole thing is ridiculous.”
The hospitals practicing with drills are in Baton Rouge, New Orleans and its suburbs, according to Avegno, whose department in New Orleans interacts with two major hospital systems and a network of more than a dozen community clinics there.
“Every hospital is trying really hard to figure this out,” she said. “But we know hospitals are very afraid of scrutiny. Our only goal is to make this safe for patients.”
Sarah Zagorski, communications director for Louisiana Right to Life, said mifepristone and misoprostol will remain available for “legitimate health-care needs just like all other controlled substances are still available for legitimate uses.” She referred other questions to the state health department’s letter.
