Washington Attorney General Nick Brown wants the Food and Drug Administration to drop certain restrictions on one of the drugs used for medication abortions and treating miscarriages.
In a court filing Wednesday, Brown and a coalition of 15 other state attorneys general argued mifepristone is proven to be safe.
"Mifepristone has been safely used by millions of women in this country over the last 25 years," Brown said in a statement Wednesday. "In a post-Dobbs world, we should be removing unnecessary barriers to reproductive health care in states that protect abortion so people have the freedom to plan when and whether to have a family."
The FDA currently requires specific registration for providers to prescribe mifepristone and and certification for pharmacies that distribute the medication.
The attorneys general argue these restrictions make accessing the drug significantly harder in rural and medically underserved areas.
It's already hard to find in mid-sized cities.
"I put a lot of effort into calling around to local pharmacies, and nobody stocks it," said Holly, a nurse midwife in Spokane.
SPR News has agreed not to use Holly's full name because she fears for her safety as a reproductive health care provider in the Inland Northwest.
"So even if I could get my waiver to prescribe it, I can't send a patient or a client to a pharmacy and know that they'll be able to pick it up," she said.
Right now, Holly says the only places she knows of in the Spokane area with mifepristone access are Planned Parenthood and certain specialty infertility clinics.
"We are constantly exploring ways to access it, but it's just an incredible additional burden on the clinicians who are motivated to explore it when it's a very safe, low-risk medication," she said.
Without access to mifepristone, misoprostol can be used on its own for care, but a combination of mifepristone and misoprostol is considered the gold standard for medication abortion and miscarriage care by the World Health Organization and other groups like the American Medical Association.
If the FDA were to grant Brown’s request, it would allow Holly to prescribe the best care possible to her patients.
"We could be more effective in our treatment. We could potentially have folks with lower side effects because they could take a lower dosage of the misoprostol, which is a really uncomfortable medication to take," Holly told SPR News. "It causes cramping, gastrointestinal upset, diarrhea, vomiting.
It can cause transient fever. It's a really uncomfortable medication to take in high doses, and that's what you have to take if you can't access the mifepristone."
In May, Health and Human Services Secretary Robert F. Kennedy, Jr., asked the FDA to review its rules for mifepristone. In his request, he cited a highly criticized paper from the Ethics and Public Policy Center, a conservative think tank that calls for increased regulation of the medication.
The disputed and nonpeer-reviewed paper claims there are higher complication rates from taking mifepristone than previously known. The authors say data mean the FDA should reinstate earlier restrictions on mifepristone, including a ban on telemedicine and limiting use to the first seven weeks of pregnancy.
In a U.S. Senate hearing, Kennedy called the paper's findings "alarming."
"Clearly, it indicates that, at very least, the label should be changed," he said to Sen. Josh Hawley (R-MO).
More than 100 studies have shown mifepristone to be safe and effective.
