How Pharmacy Curricula Should Adjust to Abortion Legislature

Background

The Dobbs v Jackson Women’s Health Organization decision on June 24, 2022, overturned the precedent set by Roe v Wade, which provided a constitutional basis for the right to abortion.^1,2 Following the Dobbs v Jackson decision, it has been established that the Constitution does not grant a right to abortion. The decision has returned the authority to regulate or protect abortion to individual states, resulting in a full ban on abortions in 14 states. The following states have similar abortion laws: Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, North Dakota, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin.³ Other states have differing laws depending on the duration of the pregnancy and specific circumstances, such as rape or incest. Abortion laws vary across different states in the United States.

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In Georgia, abortion is prohibited after approximately 6 weeks, which can be before many women even realize they are pregnant. Nebraska has banned most abortions after 12 weeks, whereas states like Arizona, Florida, Nebraska, North Carolina, and Utah prohibit it after 15 to 20 weeks.³ In other states, abortion is still legal, and many implemented additional protections following the Dobbs decision.

The process for an abortion with medication involves taking 2 medications: mifepristone (Mifeprex; Danco Laboratories, LLC) and misoprostol (Cytotec; Pfizer Inc).^4,5 This common regimen, also known as abortion pills, is used to terminate a pregnancy up to 10 weeks into gestation.⁶ Misoprostol can be prescribed for various medical conditions and is not heavily regulated. However, the use of mifepristone is strictly controlled through the Mifepristone Risk Evaluation and Mitigation Strategy Program. This program requires that mifepristone be dispensed by a certified prescriber or certified pharmacy that is issued by certified prescribers. Patients can only receive mifepristone directly in a clinic, medical office, hospital, or through specific mail-order pharmacies under supervision.5 Starting in January 2023, the FDA implemented a new regulation that permits retail pharmacies to provide abortion pills.⁷

Pharmacy and Abortion Pills: What Students Should Know

To qualify for dispensing mifepristone, pharmacies must submit a Pharmacy Agreement Form for certification. With this new rule in place, pharmacies that are certified can now receive prescriptions for medication abortion and distribute the pills both in-store and by mail order.^6,7 Unfortunately, in states with restrictive abortion laws, these pills cannot be offered by pharmacies, as it would be deemed illegal.

In states where abortion is still legal, pharmacists have an increased responsibility to ensure the safe and appropriate use of abortion pills after the FDA expanded access to them. To do so, pharmacists and pharmacy students need more education on the medication abortion regimen, particularly regarding warnings, contraindications, and adverse effects (AEs). Unfortunately, the current pharmacy curriculum does not adequately prepare students for this responsibility. In terms of abortion counseling, pharmacy students should be required to conduct an objective structured clinical examination on abortion counseling. To maintain knowledge of this medication, pharmacists dispensing mifepristone should be required by regulation to obtain continuing education credits. Both changes would improve the ability of pharmacists to effectively counsel patients who may have questions or concerns about medication abortion.

As some states are banning abortions and laws on abortion are changing, it is crucial for pharmacists across all states to educate patients on contraceptive use to avoid unwanted pregnancies. Currently, 15 states in the United States permit pharmacists to prescribe oral contraceptives, with different policies on the level of access provided. In these states, pharmacists can offer contraceptive care to patients at pharmacies, making it easier for patients to obtain contraceptives quickly and without the expense and inconvenience of scheduling a visit with a health care provider.

It is important for pharmacists to have thorough training to properly screen patients for oral contraceptives. This will prevent any harmful AEs and allow them to educate patients on the advantages and disadvantages of oral contraceptives. To ensure they are equipped to fulfill this responsibility, pharmacy curricula should require comprehensive training for pharmacists who provide contraceptive care. This will help them to perform their duties confidently and competently.

As laws governing abortion continue to change, it’s essential for pharmacy students to receive education on these laws in their curricula. Since January 2023, authorized pharmacies in qualifying states will be allowed to dispense abortion pills as approved by the FDA.⁶ As of June 2023, 14 states have banned abortion completely, and only 5 states have no restrictions.¹ In other states, the legality of abortion is determined by the number of weeks of pregnancy. As a pharmacist, it’s crucial to stay up-to-date with state laws to understand how to proceed when filling prescriptions for mifepristone and misoprostol. Pharmacists must be trained to adhere to their oath to patients and interpret ambiguous laws regarding the dispensing of abortion medication.

Conclusion

As abortion laws continue to vary by state, it is essential for pharmacists to take on a more significant role. It is crucial that pharmacists be knowledgeable about contraception and abortion medications while following state regulations. Changes must be implemented in pharmacy school curricula to ensure future pharmacists are equipped to navigate this complex political environment.

About The Authors

Kruti Rao is a fourth-year student at Ernest Mario School of Pharmacy at Rutgers University in Piscataway, New Jersey, and she is in the process of obtaining her PharmD. She is currently completing advanced pharmacy practice experiences rotations for her last year of pharmacy school.

Sarah Dean is a fourth-year student at Ernest Mario School of Pharmacy at Rutgers University in Piscataway, New Jersey, and she is in the process of obtaining her PharmD. She is currently completing advanced pharmacy practice experiences rotations for her last year of pharmacy school.

Ruo Jie Wu is a fourth-year student at Ernest Mario School of Pharmacy at Rutgers University in Piscataway, New Jersey, and she is in the process of obtaining her PharmD. She is currently completing advanced pharmacy practice experiences rotations for her last year of pharmacy school.

Deepali Dixit, PharmD, BCPS, BCCCP, FCCM, is a clinical associate professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway.

References

1. Harvey SM, Larson AE, Warren JT. The Dobbs decision - exacerbating US health inequity. N Engl J Med. 2023;388(16):1444-1447. doi:10.1056/NEJMp2216698
2. Kaufman R, Brown R, Martínez Coral C, Jacob J, Onyango M, Thomasen K. Global impacts of Dobbs v. Jackson Women’s Health Organization and abortion regression in the United States. Sex Reprod Health Matters. 2022;30(1):2135574. doi:10.1080/26410397.2022.2135574
3. McCann A, Walker AS, Sasani A, et al. Tracking abortion bans across the country. New York Times. June 16, 2023. Accessed September 15, 2023. https://www.nytimes.com/interactive/2022/us/abortion-laws-roe-v-wade.html
4. Mifeprex. Prescribing information. Danco Laboratories LLC; 2016. Accessed September 15, 2023. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/020687s020lbl.pdf
5. Cytotec. Package insert. Pfizer Inc; 2009.Accessed September 15, 2023. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019268s041lbl.pdf
6. Information about mifepristone for medical termination of pregnancy through ten weeks gestation. FDA. Updated March 23, 2023. Accessed September 15, 2023. https://www.fda.gov/drugs/postmarket-drug-safetyinformation-patients-and-providers/information-about-mifepristonemedical-termination-pregnancy-throughten-weeks-gestation
7. Belluck P. Abortion pills can now beoffered at retail pharmacies, F.D.A. says. New York Times. January 3, 2023. Accessed September 15, 2023. https://www.nytimes.com/2023/01/03/health/abortion-pill-cvs-walgreens-pharmacies.html#:~:text=What%20to%20Know-Abortion%20Pills%20Can%20Now%20Be%20Offered%20at%20Retail%20Pharmacies%2C%20F.D.A.,a%20few%20mail%2Dorder%20pharmacies