The U.S. Supreme Court will hear a case involving mifepristone, one of two drugs that are used to end pregnancy.

The demand for the abortion pills misoprostol and mifepristone has increased as more states have implemented restrictions, bans or attempted to limit abortions following the June 2022 reversal Roe v. Wade.

Conservative groups have filed lawsuits against mifepristone – the only drug specifically approved for abortion – to reverse approvals or rollback policies which made it more accessible. In the spring, the Supreme Court will consider a case that could restrict mifepristone’s use and block access through mail order.

Restrictions include limiting the time during pregnancy that the drug can safely be taken and requiring a physical office visit to obtain a prescription.

This article will explain how misoprostol and mifepristone work, and what legal issues they face.

How do abortion drugs work?

Take the prescription medication at least a week apart.

Mifepristone must be taken by mouth first. The drug dilates cervixes and blocks progesterone’s effects, which are needed to maintain a pregnancy.

Misoprostol is also used for stomach ulcers. It’s taken between 24 and 48 hours after the first dose. The pill dissolves when it is placed between gums and teeth, or in the vagina. The pill causes the uterus cramping and contraction, which leads to bleeding and expulsion of pregnancy tissue.

Misoprostol can be used by itself, even though the combination of two drugs is more effective. This practice is more prevalent in countries that have banned mifepristone.

HOW ARE ABORTION DRUG ADMINISTERED?

Abortion medications are currently approved up to 10 weeks of pregnancy.

Patients can take the pills in a clinic or doctor’s office, but they may need to undergo a lab test or ultrasound first. Some providers offer the pills via telehealth and mail the medication.

More than half of U.S. abortions are caused by pills.

What are the side effects?

When taken together, studies and real-life evidence have shown that the pills can be up to 99% efficient and safe.

Nausea, vomiting, and diarrhea are all possible side effects. Normal bleeding is common; however, very heavy bleeding requires medical attention.

Serious complications are rare. Since its approval more than 20 year ago, the U.S. Food and Drug Administration reported that 5.9 million women had used mifepristone. The FDA has received 32 reports about deaths among women who use the drug, including two cases of ectopic pregnancy, where the baby grows outside the womb. These deaths cannot be directly attributed to the mifepristone, as many women were suffering from other conditions or taking other medications.

Certain patients are not advised to take the medication, such as those who have a suspected ectopic pregnancy or IUDs implanted.

Dr. Stephanie Rand is a New York OB/GYN, abortion specialist, and member of the Physicians for Reproductive Health advocacy group. She says that pregnancy tests are not the best way to tell if a medication-induced abortion has been successful, because pregnancy hormone can remain in the body for weeks. She said that bleeding with blood clots containing lighter tissue is a sign of success.

How much does medication abortion cost?

The cost varies depending on where you are, but can be as high as $500. Some health insurance plans cover the pills for free or at a low cost, while others do not.

Mifepristone and misoprostol are sold under the brands Mifeprex, and Cytotec under Cytotec. Both pills are generics.

What is the legal status of MIFEPRISTONE

Mifepristone is still fully approved despite legal challenges. The FDA and Biden administration reiterated the fact that multiple studies have confirmed the safety and effectiveness of the drug since its approval in 2000.

The availability of abortions is largely dependent on the location where the patient lives. Currently, 14 state laws prohibit abortions (including medication abortions) throughout pregnancy. Other 15 states have laws that limit how mifepristone is prescribed and distributed. For example, they require a doctor’s visit in person.

Some women who live in states that have banned the pill are still able to get it through the mail. This is not tightly regulated.

In 2022, Christian conservatives filed a lawsuit to challenge the FDA’s initial approval of mifepristone. In an initial victory, a Texas judge agreed with the group and ordered the drug be taken off the market. An appeals court, however, left the drug’s approval in tact. Instead of issuing a decision that would reverse the changes made by the FDA between 2016 and 2021 to ease access to the medication.

All those changes were put on hold by the Supreme Court while it considered the case.

WHAT IMPACT COULD THE SUPREME CREEK’S RULE HAVE ON ACCESS?

If the justices rule in favor of abortion opponents, the drug will likely no longer be able to be sent via mail. This has been allowed since 2021. The window of use would be reduced from 10 weeks to 7 weeks, which was previously approved in 2016.

Women would also have to undergo three office visits in person with a physician before they could receive a prescription. Women may also have been required to take higher doses of the drug that the FDA deems necessary. A negative ruling could also reverse a FDA determination that a lower dose was safe.

The U.S. Supreme Court will likely decide the case in late June.