With growing restrictions on abortion across the US, women are increasingly turning to medication abortion to end pregnancy as an alternative to a clinic-based procedure.

According to data from Guttmacher Institute, 54% of all abortions in the US now involve abortion medications.

Jones RK, Nash E, Cross L, et al. Medication abortion now accounts for more than half of all us abortions. Guttmacher Institute. Updated March 2, 2022.

But this method has also come under legal fire in the wake of the Supreme Court decision to overturn Roe v Wade, with growing restrictions on access to these medications.

 

As patients turn to the internet and other resources to self-manage abortion care, physicians must be prepared to give factual, evidence-based, timely information to help prevent unintentional harm.

 

'Abortion pill' defined

Abortion medications such as mifepristone and misoprostol can only be prescribed by licensed healthcare professionals (HCPs) with specific qualifications.

Mifeprex (mifepristone) information. FDA. Updated December 16, 2021.

To induce early abortion, HCPs must prescribe both mifepristone and misoprostol together.

Medaris A. What 'abortion pills' are also used for, from suicide prevention to stomach ulcers. Insider. June 27, 2022.

The first drug stops the production of progesterone, which is essential to maintaining a pregnancy; misoprostol then works on uterine tissues to expel the products of conception.

 

Mifepristone, for example, was approved by the FDA in 2012 for the treatment of Cushing’s disease. Researchers are also examining mifepristone to treat Gulf War Syndrome, certain cancers, alcohol use disorder, and even depression.

Misoprostol has already been useful in treating various stomach ulcers. Investigated applications for the medication include treating postpartum hemorrhage, C-section complications, and uterine fibroids. There is some indication it may also help increase IUD insertion success rates.

Thus, restricting access to these two medications also limits treatment options available for patients not seeking abortion.

And it's not just the "abortion pill" being restricted.

The Supreme Court ruling also carries unexpected ramifications for patients, providers, and pharmacists with regards to other prescription medications such as methotrexate—a drug commonly used to treat arthritis. Methotrexate may also be prescribed in some cases to induce abortion or treat patients after an ectopic pregnancy or miscarriage, and now some patients are reporting difficulty getting their methotrexate prescriptions filled as individual states restrict access.

Mahase E. US anti-abortion laws may restrict access to vital drug for autoimmune diseases, patient groups warn. BMJ. 2022;378.

 

“This is a terrible situation since so many patients depend on methotrexate,” said Donald Miller, PharmD, professor and chair of the Department of Pharmacy Practice at North Dakota State University, in an article published by the Arthritis Foundation.

It’s very sad that pharmacists must protect themselves from going to jail for filling a prescription.

 

Patients want solutions

Studies show that patients are increasingly turning to online and other resources to try to manage abortion care on their own. A study published in Reproductive Health in 2022 suggested that about one-third of patients would definitely or probably consider taking matters into their own hands if they were unable to receive abortion care at a medical facility.

Ralph L, Ehrenreich K, Kaller S, et al. A cross-sectional study examining consideration of self-managed abortion among people seeking facility-based care in the United States. Reprod Health. 2022;19(1):176.

 

Privacy concerns, cost, travel distance to healthcare facilities, and fear of violence or negative response all play a role.

In some cases, patients travel across state lines to receive abortion medications.

Vestal C. Abortion medications set to become next legal battlefield. Pew Trusts. July 13, 2022.

They may also consult with physicians using telehealth technologies to obtain the drugs by mail using prescriptions in other states and countries.

 

This raises questions about ethical and legal ramifications, including enforcement and punishment (under individual states’ laws) for those attempting to obtain abortion care remotely.

 

Providing care in uncertain times

It’s too early to know exactly how the overturning of Roe will ultimately impact a person’s ability to receive an abortion—but leading medical associations and others in healthcare industry are speaking out for patients’ rights.

“The American Medical Association is deeply disturbed by the U.S. Supreme Court’s decision to overturn nearly a half century of precedent protecting patients’ right to critical reproductive healthcare,” wrote AMA President Jack Resneck, Jr., MD, in a June 2022 press release. “We will fight to protect the patient-physician relationship, and we will oppose any law or regulation that compromises or criminalizes patient access to safe, evidence-based medical care, including abortion.”

As the health of millions of patients hangs in the balance, this is a fight we will not give up.