Abortion pills prescribed by pharmacists are the latest effort in the fight against abortion

Pharmacists have begun prescribing abortion pills rather than just dispensing them – a move aimed at expanding access to abortion by taking advantage of policies that give them the ability to prescribe the drugs in most states.

The modern effort is tiny so far – a pilot program in Washington state – but the idea is expected to be tried in other states where abortion remains legal.

“I think it will grow and it is growing,” said Michael Hogue, chief executive of the American Pharmacists Association, a national professional organization that is not involved in the modern program and does not take a position on abortion.

Nearly 40 states now allow pharmacists to prescribe at least some drugs and are trained to do so, he said. He added that his organization thought it made sense that “someone so accessible in the local community would be able to provide protected access to treatments that can sometimes be complex to obtain.”

Abortion rights supporters see pharmacists’ prescribing as part of an effort to open up as many options as possible at a time when abortion pills face growing attacks from abortion opponents.

Pharmacists are regulated by states, so the federal government cannot block them from prescribing certain medications. But if the modern Trump administration wanted to prevent pharmacists from prescribing abortion pills, it could try to restore Food and Drug Administration rules that required mifepristone, the first pill in a two-drug abortion regimen, to be prescribed only by doctors.

Anti-abortion activists have expressed opposition to pharmacists prescribing abortion pills, calling the practice reckless and unsafe.

“Pharmacists who have not received clinical training should not distribute these unsafe drugs,” Dr. Ingrid Skop, vice president and chief medical officer at the Charlotte Lozier Institute, an anti-abortion organization, said in a statement. “By formulating abortions without medical supervision, the FDA and abortion advocates continue to slide down a slippery slope in lowering medical standards for women seeking abortions.”

The pill is now the method used in nearly two-thirds of abortions in the United States, and many studies have shown that medication abortion is protected and that stern complications are scarce.

Rules governing pharmacists’ prescribing vary from state to state. Some allow prescribing only a specific class or classes of drugs. Some require doctors to sign every prescription. Washington state is considered the most easygoing and only requires physician approval of a general prescribing and training protocol.

Dr Hogue, from the Pharmacists’ Association, said that during the coronavirus pandemic, when access to doctors for non-emergency care was often circumscribed or delayed, patients had become accustomed to pharmacists writing prescriptions. In many states, pharmacists can, he said prescribe contraception and morning-after pills.

However, a lawsuit seeking to force the FDA to sharply restrict the apply of mifepristone was recently revived after the Supreme Court dismissed the case, finding that the original plaintiffs did not have standing to bring the lawsuit.

The Texas attorney general recently sued an abortion provider in Fresh York for sending abortion pills to a patient in Texas. Abortion rights advocates fear that a future Trump administration could invoke a 151-year-old federal anti-violence law known as the Comstock Act to prevent abortion drugs from being mailed.

“Attacks on access to abortion care have created an urgent medical, public health and human rights crisis,” said Dr. Beth Rivin, who leads the Seattle-based global health nonprofit Uplift International and is managing director of the modern program: under called the Abortion Access Project for Pharmacists. “Even in Washington state, where abortion is legal, people still face barriers to accessing abortion care, especially those who struggle to make ends meet, live in rural areas, and do not have straightforward access to reproductive health care.”

On Tuesday, the Pharmacist Abortion Access Project reported that 10 pharmacists across Washington state prescribed abortion pills to 43 patients in a pilot program conducted between October 31 and November 26.

Prescribing was done via telehealth screening, with patients filling out forms asking about their pregnancy and medical history. Patients had to be Washington residents and could be pregnant up to 10 weeks. They paid $40, much less than many services. The prescriptions were forwarded to Honeybee Health, a California mail-order pharmacy that works with many telemedicine abortion services, which sent the pills to patients.

Don Downing, project co-leader and professor emeritus of pharmacy at the University of Washington, said that in addition to providing a hotline for questions and concerns, pharmacists reached out to patients to see how they were doing, asking questions such as: “Have you had hefty bleeding or not? were you bleeding? Do you have a fever, pain, anything?”

During follow-up, patients asked typical questions, such as whether they were experiencing appropriate levels of bleeding as they passed through the pregnancy tissue, he said. “We didn’t see any seriously negative impacts, but we had a full network of other resources available in case something like this happened so we could address them,” he said.

Dr. Rivin said the goal of the project is to enable prescribing by full-time pharmacists later this year and eventually enable in-person prescribing at Washington pharmacies, meaning patients will be able to go to a pharmacy and get their prescription and pills while one visit.

This would work in tandem with the FDA’s recent policy of allowing pharmacies to obtain certification to dispense mifepristone, which is subject to a special regulatory regime that previously required it to be dispensed primarily by clinics or other abortion services. The second drug in the abortion program, misoprostol, is less restrictive and has long been widely available.

Last year, Walgreens and CVS began dispensing mifepristone in some states, as did dozens of smaller pharmacies in at least a dozen states.

Brian Noble, director of the Family Policy Institute in Washington and an evangelical pastor, said he is not opposed to pharmacists prescribing drugs or counseling women who choose to continue their pregnancies. But he said: “I am against anything that ends life,” which he believes begins at conception.

“I believe in the rights of aborted children,” Mr. Noble said, adding: “I see that women have the great privilege of being trusted to carry life in their bodies.”

Jessica Nouhavandi, a pharmacist and president of Honeybee Health who is co-director of the modern project, said she came up with the idea of ​​having pharmacists prescribe abortion pills several years ago because “we need more providers and we need them to be more accessible and cheaper.” “

Dr Nouhavandi said the project’s patient consultation form contained slightly more information than abortion services, for which doctors or nurses write prescriptions. “We dug a little deeper into the medical history,” she said. “We wanted our pharmacists to feel more comfortable.”

The protocol was submitted to the state Department of Health and approved by an OB-GYN, Dr. Downing said. He said that pharmacists participating in the pilot project worked for a variety of employers on a daily basis, including chain and community pharmacies, hospitals and insurance companies. They transcribed the pilot in their spare time and did not want to be identified.

Dr. Downing, who has pioneered other prescribing programs that have spread across the country, said other states may need to make changes to their laws or regulations to allow pharmacists to prescribe abortion pills. Still, he said, “if in fact abortion is legal in a given state, I don’t think there are too many insurmountable barriers.”