Abortion drug mifepristone remains legal and available in AZ, official says

Arizona Attorney General Kris Mayes emphasized Monday that the abortion drug is still legal here, clarifying confusion that followed contradicting court decisions about mifepristone last week.

"I want to assure Arizonans that legal access to the drug remains available for providers and patients," Mayes said in a written statement.

U.S. Judge Matthew Kacsmaryk's Friday ruling that seeks to revoke the U.S. Food and Drug Administration's approval of mifepristone "flouts two decades of science and consensus in the medical community and it will cause needless pain and suffering for patients," Mayes said.

The ruling from Kacsmaryk, a Trump appointee assigned to the U.S. District Court for the Northern District of Texas Amarillo Division, does not take effect immediately and has already been appealed by the Biden administration.

More than half of abortions in the U.S. are medication abortions, a two-drug combination recommended for use up to 10 weeks of pregnancy, though many clinics prescribe it at up to 11 weeks of pregnancy, and the World Health Organization has authorized its use up to 12 weeks of pregnancy.

The two drugs used in a medication abortion, often referred to as abortion with pills, are mifepristone and misoprostol.

Washington court orders the FDA to maintain status quo

Arizona is one of the plaintiffs in a separate federal lawsuit over mifepristone in a case that was filed Feb. 23 by Democratic attorneys general in the U.S. District Court in the Eastern District of Washington. In that case, Obama appointee Judge Thomas Rice, also on Friday, ordered the FDA to maintain the availability of mifepristone in plaintiff states in the case.

"It is unclear at this time how and when these various legal proceedings will play out, but this case will likely end up at the U.S. Supreme Court before long," says an April 10 policy analysis from the Guttmacher Institute, which is a research and policy organization committed to advancing sexual and reproductive health and rights in the U.S.

The Washington state ruling applies specifically to Arizona, 16 other states and the District of Columbia in a multi-state coalition of plaintiffs, according to Mayes' statement. The plaintiffs want the FDA to end restrictions on mifepristone.

"I joined this challenge to protect Arizonans' access to mifepristone, which has a long record of safe and effective use by millions of Americans over the last 23 years," Mayes said in her statement.

Rice's ruling heightened an already intense fight over access to mifepristone that has escalated since the U.S. Supreme Court last summer overturned the landmark Roe v. Wade decision, leaving states to set their own laws without any federal standard protecting abortion access.

The reversal of Roe has "created a new focus on medication abortion as an option for expanding access to people facing barriers to abortion care," the Kaiser Family Foundation wrote in a Feb. 24 health policy brief.

Both surgical and medication abortion is already banned or unavailable in 14 U.S. states and "we expect more states to follow," The Guttmacher Institute policy analysis says.

"The elimination of medication abortion with mifepristone could severely impact marginalized groups' access to abortion care, as medication abortion offers specific benefits that might make it a preferable option for people with few financial resources," the analysis says.

What's happening with abortion in AZ? New rules debated; courts consider bans

Doctors groups say medication abortions are 'safe and effective'

A coalition led by the conservative legal advocacy organization Alliance Defending Freedom filed the Texas lawsuit Nov. 18 in federal court in Amarillo, Texas, arguing the drug comes with medical risks and should be pulled from the market.

Anti-abortion advocates have argued that abortion pills leave women to face the physical and emotional risks of a medication abortion alone.

However, doctors groups, including the American College of Obstetricians and Gynecologists and the American Medical Association, say medication abortions are a "safe and effective method" of providing an abortion.

The Texas-based court’s "disregard for well-established scientific facts in favor of speculative allegations and ideological assertions will cause harm to our patients and undermines the health of the nation," American Medical Association president Dr. Jack Resneck Jr. said in a statement after Friday's decision. "Substituting the opinions of individual judges and courts in place of extensive, evidence-based, scientific review of efficacy and safety through well-established FDA processes is reckless and dangerous."

Mayes said that decision in Texas "runs contrary to established legal principles" and, if upheld on appeal, would mark the first time a court ordered the FDA to reverse its approval of a drug, "endangering not only reproductive rights but also Americans' ability to obtain crucial FDA-approved medications."

Mayes later Monday was one of a multistate coalition of 24 attorneys general to file an amicus brief in the Texas case to oppose Kacsmaryk's ruling. The amicus brief urges the court to stay the ruling pending an appeal. The coalition warned that revoking federal approval for mifepristone drastically would reduce access to abortion care and miscarriage management for millions of people across the country.“Judge Kacsmaryk’s outrageous and appalling ruling, if allowed to stand, would upend decades of scientific research and established legal principles,” Mayes said in a statement. “I am proud to join my fellow attorneys general in fighting for the rights of individuals to make their own personal medical decisions without interference from extremist judges and anti-abortion activists."

Other state attorneys general that are part of the coalition that filed the amicus brief are from California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, Wisconsin, and the District of Columbia.

Kacsmaryk stayed his decision for seven days to give the FDA time to appeal. An April 8 policy Q&A from the Kaiser Family Foundation, like The Guttmacher Institute, says the U.S. Supreme Court could be called upon to resolve the conflict and "decide the merits of both cases."

The Kaiser Family Foundation analysis says it's not known how the FDA will respond to the two conflicting rulings and that it's therefore too soon to predict how they will impact the availability of medication abortions moving forward.

"The FDA approves drugs for the whole country and does not vary its approval by state," the analysis says. "If the FDA is forced to suspend its approval of mifepristone, some clinics may respond to this ruling by switching from the mifepristone/misoprostol regimen to using a higher dose of misoprostol alone."

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.

This article originally appeared on Arizona Republic: Mifepristone remains legal in Arizona, attorney general says