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Mifepristone is part of a two-drug protocol used in 98% of medication abortions in 2020, according to a recent study.
Allen G. Breed/AP
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Allen G. Breed/AP

Mifepristone is part of a two-drug protocol used in 98% of medication abortions in 2020, according to a recent study.
Allen G. Breed/AP
A federal judge will make a seemingly contradictory decision Friday night that could dramatically affect access to drugs used in nearly all medical abortions in the United States.
In Texas, US District Court Judge Matthew Kacsmaryk ruled that the US Food and Drug Administration improperly approved the drug mifepristone more than 20 years ago. He ordered his FDA to maintain its approval and gave the government seven days to seek relief from the Court of Appeals.
Kacsmaryk’s decision doesn’t just affect people living in states where abortion is illegal or highly restricted. Because the case is in federal court, judges have the power to make nationwide decisions.
The White House is reviewing the verdict, according to a White House official who was not authorized to speak publicly.
At the same time, a federal judge’s ruling in another lawsuit filed in Washington state on Friday prevented the FDA from removing mifepristone from the market.
It’s not clear how each judge’s decision will affect the other, and both cases could undoubtedly be appealed and eventually made their way to the U.S. Supreme Court.

Mifepristone was approved by the FDA in 2000 for use with a second drug, misoprostol. According to the Guttmacher Institute, more than half of all abortions in the United States are done using medication as opposed to surgical procedures, and in 2020, 98% of them used a combination of the two drugs. it was done.
The Coalition Against Abortion Rights filed a lawsuit in Texas last year, alleging the protocol was improperly approved by the FDA. was asking Kacsmaryk, who has
The decision came three weeks after Kaksmalik held hearings in Amarillo. The court only had room for a few dozen members of the public and the press. No recordings or public live streams are allowed.

The appeal will be filed in the US Court of Appeals for the Fifth Circuit, which has a reputation for conservative jurisdiction. This case may eventually go to the U.S. Supreme Court.
national impact
Abortion providers nationwide say they are preparing to turn to another medical abortion regimen that uses only misoprostol. It is widely used off-label for gynecological purposes.
Studies have shown that monotherapy is somewhat less effective and often causes additional side effects. It is said to be safe and effective in

The decision is likely to represent uncertainty and confusion for doctors and patients, said Farah Diaz-Tello, senior attorney at reproductive rights legal advocacy group If/When/How.
“People seeking abortions on the pill will have a much harder time getting them, especially while providers know what they can do,” she said. increase. “So I think the access crisis that started already in June 2022 will be quickly exacerbated.” Dobbs v. Jackson Women’s Health Organizationoverturned decades of abortion rights precedent.
Diaz-Tello predicts that more people will try to induce abortions on their own without a doctor’s supervision, using drugs obtained online or in other countries. We are also concerned about the risk of increased scrutiny of patients seeking treatment for emergency complications from miscarriage.
To her knowledge, there is no state law mandating that patients suspected of having induced abortions be referred to health care providers, but she fears the ruling will foster confusion and misinformation.
“I worry that it will lead to misunderstandings and criminalization of those who terminate pregnancies,” says Diaz-Tello.

duel decision
The implications of the Texas ruling are complicated by the outcome of a Washington lawsuit filed by a coalition of 12 Democratic attorneys general. The group sought to block the FDA from removing the drug from the market and asked the court to remove the FDA’s additional layer of restriction on mifepristone.
A judge in that case ruled on Friday that the defendants were barred from “altering the status quo and rights relating to the availability of mifepristone.”
Washington Attorney General Bob Ferguson said his lawsuit would prevent patients in those 12 states from having abortions, even if a federal judge in Texas issued a ruling meant to block access to mifepristone. He told NPR he believes it may allow him to continue using mifepristone for
Amanda Allen, senior counsel and director of The Lawyering Project, which advocates for abortion rights, said the two courts “could issue two very contradictory orders that would be very unacceptable and very unacceptable to the FDA.” It may impose different obligations on the FDA.” try to reconcile. ”
Allen said the FDA may decide to issue guidance for prescribers on how to interpret the ruling. However, she said any such confrontation between federal courts would likely end before the U.S. Supreme Court.
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