Dobbs v. Jackson muddied the waters for pharmacists in strict abortion states, who must make decisions despite misaligned state and federal laws.
Sarah Lynch, PharmD, BCACP, Clinical Associate Professor of Pharmacy Practice and Director of Skills Education at Binghamton University School of Pharmacy, discusses the medication and ethical impact of the Supreme Court’s 2022 Dobbs v. Jackson (a decision allowing each state to individually regulate abortion laws) on pharmacists with Pharmacy Times at the American Pharmacists Association (APhA) Annual Meeting & Exposition in Phoenix from March 24 to 27.
PT Staff: How will the administration of certain medications for abortion be affected by Dobbs v. Jackson?
Sarah Lynch, PharmD, BCACP: So, Dobbs w. Jackson brought the decision to the states. And so with that certain states in choosing to ban abortion or some of the trigger laws that are going through that were passed after Roe v. Wade. It's made it that certain medications can't be dispensed for certain conditions. So, mifepristone and misoprostol are two main medications that are used for abortions they can either be used in combination or can be used as misoprostol alone. So, banning abortions, and in many of the laws, it's worded as aiding or abetting in abortion access would mean that those medications can't be dispensed for the purpose of abortion. Where it gets tricky is that those medications can also be used for other conditions as well. So, for example, misoprostol we see being used for gastric ulcers, as well as for certain gynecologic procedures like intrauterine device (IUD) insertion. And it gets tricky for pharmacists to determine, you know, is this an appropriate use based on how our state law is written right now, and if there are concerns about what level pharmacists need to be policing the use of these medications.
PT Staff: How can a pharmacist in a state with severe abortion restrictions abide by federal law, which enforces nondiscriminatory care?
Sarah Lynch, PharmD, BCACP: It's making it very, very tricky right now. And it's interesting— the Department of Health and Human Services has published a guidance document to the nation's pharmacies that specifically brings up these concerns about providing nondiscriminatory care, and making sure that we are not discriminating on the basis of sex and we are not discriminating on the basis of disability, which unfortunately, some of these situations are forcing pharmacists to choose between one or the other. I think that, unfortunately, when you have a state criminal code that says that abortion is illegal, then pharmacists are in a place where they do have to follow that state criminal code, unfortunately, but it's made for a very gray area. And it, I think, challenges the oath that we say as pharmacists.
PT Staff: In the wake of this Supreme Court decision, what other consequences are pharmacists and patients continuing to struggle with?
Sarah Lynch, PharmD, BCACP: I think the biggest thing right now is the gray area. Obviously, there's individuals’ feelings about it on both sides of the spectrum. But right now, what we're really hearing from pharmacists is that it's confusing, it's a confusing time to practice.
Obviously, we want to do as much as we can for our patients. But when we're in a state where the rules are gray, or where they're changing rapidly, pharmacists are unsure what they're supposed to be doing, when there's pharmacists who are practicing in states where they're close to a border, or they're in a border state where individuals may even be traveling quite far to get to them to access maybe a more loose Practice Act that allows for medication abortion. There's concerns about whether there's going to be any liability for dispensing to a patient from another state; some states have tried to clarify that keeping it so that an individual within the state who is following the state rules, [but] it doesn't matter if an individual came from out of the state. So they've tried to clarify that but we're not seeing that everywhere and there are certainly still concerns. We're also seeing issues with medications that aren't even within this realm. So for example, methotrexate it's used for a variety of conditions; rheumatoid arthritis and other autoimmune conditions as well. But it can also be used off-label and abortifacient too, and so we have heard stories of pharmacists and doctors questioning its use in individuals and even withholding medication at times, which is certainly a concern, especially outside of the scope of this when we're limiting patients.