Dispensing Mifepristone for Abortion Via Mail-Order Pharmacies

Topic: Pharmaceutical Information
Author: University of California - San Francisco
Published: 2024/05/13 - Updated: 2024/06/14
Publication Type: Findings - Peer-Reviewed: Yes
Contents: Summary - Definition - Introduction - Main - Related

Synopsis: Mail order pharmacy dispensing of Mifepristone after in-person screening by sending abortion pills through the mail is timely and effective. After the U.S. Supreme Court ended the constitutional right to abortion in 2022, allowing state abortion bans to take effect, anti-abortion groups turned their sights on medication abortion. The case in front of the Supreme Court asks the justices to ratify a conservative federal appeals court ruling that would roll back the FDA regulations to require that mifepristone, which is only approved for use in medication abortion, be dispensed in person at a doctor's office, clinic, or hospital.

Defining Mifepristone

Mifepristone

Mifepristone is a synthetic steroid. It is a medication most commonly used for medically induced abortions. Mifepristone has two main FDA-approved indications. These are pregnancy termination combined with misoprostol through ten weeks gestation (70 days or less since the first day of the last menstrual period) and the management and treatment of hyperglycemia in patients exhibiting signs of Cushing syndrome. The FDA first approved Mifeprex (mifepristone) in September 2000 for medical termination of pregnancy through seven weeks gestation and this was extended to ten weeks gestation in 2016. In addition to the above indications, mifepristone has shown efficacy with off-label uses when it comes to postcoital emergency contraception, cervical maturation, and adjunct therapy for uterine leiomyomas.

The FDA approved mifepristone dosing regimen is:

Day one: 200 mg of mifepristone taken by mouth.
24 - 48 hours after taking mifepristone: 800 mcg of misoprostol taken buccally (in the cheek pouch).
About seven to fourteen days after taking mifepristone: follow-up with the health care provider.

Introduction

The findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.

Main Digest

Dispensing abortion pills through the mail works as well as requiring patients to get them in person from a clinic or doctor's office, according to new research from UC San Francisco, which comes as the Supreme Court is considering whether to disallow the practice.

Researchers found that using a mail-order pharmacy to deliver the drugs after an in-person assessment was both safe and effective, and patients appreciated the privacy and convenience of receiving their abortion medication that way.

"The study provides additional evidence that the abortion medication mifepristone should be treated like every other medication and can be easily dispensed by pharmacists, including through a mail-order pharmacy," said Daniel Grossman, MD, a UCSF professor of Obstetrics, Gynecology, and Reproductive Sciences and director of the Advancing New Standards in Reproductive Health (ANSIRH) program. "Any attempt to restrict it is not based on science."

The findings were published May 13, 2024, in the journal JAMA Internal Medicine.

The percentage of abortions that are done with medication, often via telemedicine, has grown rapidly in recent years, as the Food and Drug Administration (FDA) updated regulations on how the medication can be dispensed, and as many states have banned abortion. In 2023, nearly two-thirds of all abortions in the United States were done with medication.

Sending abortion pills through the mail has only been allowed since the COVID-19 pandemic when the FDA removed the in-person dispensing requirement, first temporarily and then, based on the evidence of its safety, permanently. Before then, patients had to see a certified provider at a doctor's office, hospital, or clinic to get mifepristone, which is the first of the two drugs used in medication abortion.

Since most physicians do not store many medications in their offices, however, requiring them to keep mifepristone on hand impedes access.

"There is a lot of interest among gynecologists, as well as family medicine and internal medicine clinicians and pediatricians to be able to provide this care for their patients who need it," Grossman said. "This model of care using a mail-order pharmacy can help them do that."

No adverse events from mail-order dispensing Researchers analyzed the experiences of 510 people who received mifepristone, which blocks progesterone, a hormone needed to continue pregnancy, and a second drug, misoprostol, which is used one to two days later to bring on contractions.

Patients received the drugs through the mail after being seen at abortion and primary care clinics in seven states - California, Colorado, Delaware, Georgia, New York, Pennsylvania, and Rhode Island - between January of 2020 and May of 2022.

Researchers found that nearly 98% of patients had complete abortions, and there were no adverse events related to mail-order pharmacy dispensing. More than 85% of the participants received the medication within one to three days, a timeframe that 94% of the participants described as reasonable. And 96.6% said they were satisfied with mail-order dispensing. Almost all said their confidentiality was maintained through the shipping and delivery process.

U.S. Supreme Court

After the U.S. Supreme Court ended the constitutional right to abortion in 2022, allowing state abortion bans to take effect, anti-abortion groups turned their sights on medication abortion. They sued the FDA to restrict mifepristone, despite extensive research supporting its safety and efficacy.

The case in front of the Supreme Court asks the justices to ratify a conservative federal appeals court ruling that would roll back the FDA regulations to require that mifepristone, which is only approved for use in medication abortion, be dispensed in person at a doctor's office, clinic, or hospital. The case does not involve misoprostol, which is approved for other indications.

The high court heard oral arguments in March, but isn't expected to issue a decision until June. In addition to making it harder for patients receiving in-person abortion care, a ruling that rolled back access to mifepristone would also affect virtual abortion providers since they would no longer be able to send it through the mail.

In February, UCSF researchers published a study that found medication abortion can be delivered safely and effectively through telemedicine.

Authors

UCSF co-authors include Sara Raifman, MSc, Natalie Morris, MPH, Lela Bachrach, MD, Jessica Beaman, MD, Antonia Biggs, PhD, and Eleanor B. Schwarz, MD.

Funding

This study was funded by the Society of Family Planning Research Fund (SFPRF12-MA8).

Related Information

U.S. Supreme Court Unanimously Upholds Access to Abortion Pill Mifepristone: American Psychological Association (APA) applauds U.S. Supreme Court’s opinion allowing Mifepristone, a drug commonly used for medical abortions to remain on the market.
Possible Denial of Drugs for Women with MS, Migraine, Epilepsy Due to Abortion Ban: The University of California, San Francisco perspective article says abortion ban ruling may result in an increased risk of deaths, disability.
Care for Women Who Miscarriage May Be Compromised in States Restricting Abortion: A female who miscarriages in U.S. states with restrictive abortion policies may be less likely to receive optimal care than in states with supportive abortion policies.
Psychiatric Harm from Restricting Access to Abortion: Severe stress from an inability to access abortion harms the fetus and can trigger psychiatric illness, suicide, or postpartum psychosis in the mother.
25 Million Unsafe Abortions Annually Worldwide: A study by WHO and the Guttmacher Institute reveals majority of unsafe abortions occurred in developing countries in Africa, Asia, and Latin America.
FDA Approves Ella Abortion Drug as Emergency Contraceptive: Ella is a drug that can cause abortions but is misleadingly labeled as an effective Emergency Contraceptive.
Trust in U.S. Supreme Court Plummets Due to Rising Political Polarization: Survey exposes declining public confidence in Supreme Court approval and legitimacy process.
Care for Women Who Miscarriage May Be Compromised in States Restricting Abortion: A female who miscarriages in U.S. states with restrictive abortion policies may be less likely to receive optimal care than in states with supportive abortion policies.

Attribution/Source(s):

This peer reviewed publication was selected for publishing by the editors of Disabled World due to its significant relevance to the disability community. Originally authored by University of California - San Francisco, and published on 2024/05/13 (Edit Update: 2024/06/14), the content may have been edited for style, clarity, or brevity. For further details or clarifications, University of California - San Francisco can be contacted at ucsf.edu. NOTE: Disabled World does not provide any warranties or endorsements related to this article.

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