COLUMBIA - A new report from researchers at the Brown University School of Public Health finds that restrictions on mifepristone, misoprostol, and methotrexate as proposed in H. 4760 are delaying emergency care, disrupting treatment across medical specialties and putting patients at risk — even when the medications are used for non-abortion care.
As South Carolina lawmakers consider H. 4760 — legislation that would reclassify mifepristone, misoprostol, and methotrexate as Schedule IV controlled substances — the report examines Louisiana’s experience as a potential preview of how similar restrictions could affect patient care in South Carolina.
The report, Classifying Mifepristone, Misoprostol, and Methotrexate as Controlled Substances: Patient Care Consequences and Clinical Implications, describes these medications as “staples of modern medicine” used across emergency medicine, obstetrics, rheumatology, and oncology, and documents reported delays in hemorrhage treatment, reduced pharmacy availability, and instances of denied or delayed care for miscarriage and other legal medical uses.
“This bill is a political strategy masquerading as healthcare policy,” said Ashley Lidow, Chief Strategy Officer of the Women’s Rights and Empowerment Network (WREN). “By targeting safe, essential medications used for miscarriage care, childbirth, and routine treatment, lawmakers are creating barriers across the entire healthcare system and putting women at risk when care is delayed.”
“Mifepristone, misoprostol, and methotrexate are medications physicians use every day to treat miscarriage, hemorrhage, ectopic pregnancy, cancer, and autoimmune disease,” said Dr. Dara Kass, a lead author of the report and director of the AIM Lab at the Brown University School of Public Health. “These are staples of modern medical care, not drugs associated with misuse or dependency. Reclassifying them as controlled substances is not supported by pharmacologic evidence and risks creating delays in time‑sensitive medical care.”
Key Findings
- These medications treat a wide range of conditions beyond abortion. - The report notes that mifepristone, misoprostol, and methotrexate are used for miscarriage management, postpartum hemorrhage, ectopic pregnancy, cancer, and autoimmune diseases, including rheumatoid arthritis.
- Restrictions delay emergency care and create life-threatening risks. - Following Louisiana’s Act 246, providers reported retrieval delays of up to 10 minutes during hemorrhage response. In postpartum hemorrhage, blood loss can exceed half a liter per minute, and rapid intervention is critical to prevent shock, organ failure, or death.
- Pharmacy availability declined following reclassification. - A New Orleans Health Department survey found that 61% of Orleans Parish and 42% of Jefferson Parish pharmacies reported stocking misoprostol after the law took effect, with some pharmacies discontinuing inventory or declining to fill prescriptions.
- Legal uncertainty causes clinicians to withhold care — even when permitted. - The report documents cases in Florida and Texas where patients were denied methotrexate for ectopic pregnancy despite legal exemptions. In one case, a patient’s pregnancy ruptured before treatment, requiring emergency surgery and resulting in the loss of a fallopian tube.
- Restrictions are expanding across multiple states. - Similar legislation is advancing in South Carolina, Mississippi, Texas, Kentucky, and Iowa, including proposals to reclassify medications as controlled substances, impose criminal penalties, and restrict telehealth and mail delivery.
The report finds that efforts to classify these medications as Schedule IV controlled substances are not supported by medical evidence. Unlike drugs typically placed in that category, mifepristone, misoprostol, and methotrexate do not produce dependence, tolerance, or abuse potential. The American College of Medical Toxicology has stated that reclassification is clinically unjustified.
The report concludes that Louisiana’s experience provides a cautionary example, documenting delays in emergency care, reduced pharmacy availability, and barriers to treatment for miscarriage, hemorrhage, ectopic pregnancy, and other time-sensitive conditions unrelated to abortion.
Based on these findings, the report recommends that states avoid reclassifying these medications as controlled substances, repeal burdensome reporting requirements, conduct independent public health impact assessments, and protect clinicians’ ability to provide standard medical care. As lawmakers consider similar legislation, the report urges policymakers to review Louisiana’s experience and ensure that restrictions do not delay emergency care or undermine treatment across multiple medical specialties.
Click HERE to view the full report.