Louisiana\u2019s first-in-the-nation law listing the abortion medications mifepristone and misoprostol as \u201ccontrolled dangerous substances\u201d took effect Tuesday, triggering fears among health-care providers and pharmacists that routine care may be worsened for women in the state. <\/p>\n
Beyond abortion, the medicines are used for miscarriage management and, in misoprostol\u2019s case, to stop dangerous bleeding after childbirth, physicians say. Now, in Louisiana, <\/strong>misoprostol is <\/strong>required to be stored in a locked box like other controlled substances, which doctors fear could delay treatment in emergency situations. <\/p>\n \u201cYou want to be able to have it right there in the moment,\u201d said Dr. Jennifer Avegno, an emergency physician and director of the New Orleans Health Department. <\/p>\n She said health-care providers in the state have been doing drills to see how long it will take to get misoprostol from locked cabinets in emergencies during childbirth. <\/p>\n \u201cIt adds several minutes to that process,\u201d she said. \u201cIf you\u2019ve ever watched someone bleed out after childbirth, as I have, you know that minutes can make a difference.\u201d <\/p>\n Abortion was already illegal in Louisiana, with narrow exceptions. Gov. Jeff Landry, on signing the bill, said it would protect women across the state. Possessing the medicines without a valid prescription could now come with penalties of up to five years in prison and a fine of up to $5,000, although the law specifically exempts pregnant women who possess the drugs \u201cfor her own consumption.\u201d <\/p>\n The law, passed in May, puts mifepristone and misoprostol in the same category in Louisiana <\/strong>as benzodiazepines including Valium, Xanax and Ativan. It was proposed by Republican state Sen. Thomas Pressly after he said his sister had been given misoprostol against her will, and it established the crime of \u201ccoerced criminal abortion by means of fraud.\u201d <\/p>\n Mifepristone and misoprostol are the regimen used for medication abortion, now the most common way people access abortion in the United States. Mifepristone blocks progesterone, a hormone needed for continuing a pregnancy, and misoprostol causes the uterus to contract, leading to cramping and bleeding. <\/p>\n For miscarriages, they are <\/strong>used in emergency settings when patients are having complications and for outpatient care. <\/p>\n \u201cOne of the most common reasons that people choose medication management of a miscarriage is because they want timely treatment and to put the process behind them as soon as possible,\u201d said Dr. Honor MacNaughton, a family physician with expertise in reproductive health at Cambridge Health Alliance in Massachusetts. \u201cA lot of people don\u2019t want to wait to be scheduled for the procedure or wait for the miscarriage to happen on its own, since that process can take days or sometimes even weeks.\u201d <\/p>\n Dr. Anitra Beasley, medical director of Planned Parenthood Gulf Coast, which has two clinics in Louisiana, said she worries that the law\u2019s new restrictions could mean patients can\u2019t get timely access to the medicines, because doctors could be afraid to prescribe them or pharmacists could be afraid to fill the prescriptions. Patients legally prescribed the medicines for miscarriage care could also be confused about whether it\u2019s legal to take them, she said. <\/p>\n \u201cKnowing that you have a pregnancy that has ended and wanting to medically manage that process and being told you that you can\u2019t, or having to travel through parish to parish to parish trying to find someone who\u2019s going to give you the appropriate medications,\u201d Beasley said, \u201cI just can\u2019t imagine how much heartache that person must have at that particular point.\u201d <\/p>\n Proponents of the law argue that it doesn\u2019t affect legal prescriptions of the medications, and the Louisiana Department of Health issued guidance for health-care providers in September seeking to clarify that the medicines can be used in hospitals to treat postpartum hemorrhage and incomplete miscarriages. It said the medicines should be stored in a locked cabinet. <\/p>\n Large health systems and pharmacy organizations said they have been preparing for the law to go into effect for months. Ochsner Health, a major health system in the state, issued a set of answers to frequently asked questions for its staff last week, addressing which providers can prescribe misoprostol, how to order the drug and what steps will be required to access it from a locked drawer. <\/strong> <\/p>\n \u201cBeginning Oct. 1, 2024, providers in all specialties will need to follow the controlled substance patient record documentation process,\u201d the guidance says. Prescribers will need to specify why the medicine is being prescribed, or the electronic health record system won\u2019t allow the prescription to go through, it says. It also notes that there will be an override system to allow misoprostol to be released from the locked cabinet in emergencies. <\/p>\n Doctors in addiction medicine said that characterizing these drugs as controlled substances is an overreach of what the scheduling system aims to do. Requiring misoprostol and mifepristone to be stored the same way as sedatives such as benzodiazepines, \u201cfrankly, is absurd,\u201d said Dr. Lucille Howard, an ob\/gyn who is an addiction medicine fellow at Tulane University in New Orleans. \u201cThey just don\u2019t have that same potential for dependence or addiction at all.\u201d <\/p>\n It\u2019s \u201cmisusing the schedule system,\u201d added Dr. Smita Prasad, president of the Louisiana Society of Addiction Medicine and an assistant professor at Tulane. \u201cIt also really deflects from a real problem that we have in the United States: other substances like fentanyl and synthetic fentanyl, that are killing people.\u201d <\/strong> <\/p>\n Scheduling the drugs also requires that their use be tracked by a Prescription Drug Monitoring Program, \u201ca statewide program where I can look for a patient under my care and I can see for the past 15 years if they\u2019ve been prescribed any scheduled medications, who the prescriber was, where they filled that medication,\u201d and information about dates and amounts used, Prasad said. <\/p>\n It was a system designed to curb opioid abuse, said Anna Legreid Dopp, senior director of government relations for the American Society of Health-System Pharmacists, but her organization\u2019s members expressed concern that it could stigmatize patients who were legally prescribed mifepristone and misoprostol, a concern shared by physicians. <\/p>\n \u201cEvery time one of our physicians writes a misoprostol prescription, that\u2019s going to be documented,\u201d said Avegno, the director of New Orleans\u2019 health department. \u201cThere is a real fear that someone is going to say, \u2018Oh, that OB wrote 20 prescriptions last month. I wonder if they\u2019re secretly doing abortions. I\u2019m going to investigate,\u2019 right?\u201d <\/p>\n Dopp\u2019s organization, which represents pharmacists working at hospitals and other health-care facilities, revised its policy after Louisiana\u2019s law was passed to oppose rescheduling medications used for reproductive health and reporting of those medications into prescription drug monitoring programs. <\/p>\n \u201cAlmost immediately, our members raised concern that if this is being done in one state, it can easily be a template for other states to use it,\u201d Dopp said. <\/p>\n Louisiana, which has one of the highest maternal mortality rates in the country, has made hard-won progress over the past decade in reducing deaths from postpartum hemorrhage, Avegno said. <\/p>\n \u201cNow we\u2019re adding a reason for postpartum hemorrhage to go back up,\u201d she said. \u201cIt really violates the standard of care that our OBs are used to practicing.\u201d <\/p>\n The New Orleans City Council directed the health department to study the effects of the law, Avegno said, and her team has set up an online form for patients, pharmacists and medical providers to share their experiences confidentially. <\/p>\n \u201cReally just to document what is occurring so we can bring that to our decision-makers and say, \u2018Look, these are the consequences,\u2019\u201d Avegno said. \u201cWe don\u2019t want anybody to suffer in silence and feel like not being able to access care is something that no one cares about. Because we certainly do.\u201d <\/p>\n<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" Louisiana\u2019s first-in-the-nation law listing the abortion medications mifepristone and misoprostol as \u201ccontrolled dangerous substances\u201d took…<\/p>\n","protected":false},"author":1,"featured_media":2442,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-2441","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-news"],"_links":{"self":[{"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/posts\/2441","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/comments?post=2441"}],"version-history":[{"count":0,"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/posts\/2441\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/media\/2442"}],"wp:attachment":[{"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/media?parent=2441"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/categories?post=2441"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthyretirementnews.com\/index.php\/wp-json\/wp\/v2\/tags?post=2441"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} Fears over timely treatment<\/h2>\n
\u2018Misusing the schedule system\u2019<\/h2>\n
\n
<\/ul>\n<\/ul>\n<\/div>\n