Louisiana Could Make Abortion Pills a Controlled Substance

A bill passed by Louisiana lawmakers Thursday could see the state become the first in the country to classify two abortion-inducing drugs as controlled and dangerous substances—a move doctors and reproductive rights advocates say could have far-reaching implications for health care access in the state.

The bill, SB 276, passed the state Senate with a vote of 29 to 7, after having passed in the House with a vote of 66 to 30 on Tuesday. It will next go to Republican Gov. Jeff Landry, who is expected to sign it into law. Supporters of the bill say it will protect pregnant people from coerced abortions, while opponents argue that the two drugs, mifepristone and misoprostol, have many other uses aside from abortion, and that reclassifying them as controlled substances would make it more difficult for patients to access the drug when needed.

Here’s what the bill would do, and the controversy surrounding it.

What is SB 276?

The bill, sponsored by Republican Sen. Thomas Pressly, initially only focused on criminalizing intentionally using medications to cause or attempt to cause an abortion without the pregnant person’s knowledge or consent. Pressly said he sponsored the bill after his sister learned that her husband had given her abortion-inducing drugs without her knowledge or consent.

Several Louisiana doctors and reproductive rights advocates say they were concerned not by the initial bill, but by its amendment, which was added late in the legislative process. The amendment labels mifepristone and misoprostol as Schedule IV drugs under Louisiana’s Uniform Controlled Dangerous Substances Law. Schedule IV drugs are considered to have potential for abuse or dependence, and include Valium and Xanax.

Under the bill, if a person knowingly possesses these drugs without a valid prescription, they could face fines or jail time.

Is abortion banned in Louisiana?

Yes. Louisiana has a near-total abortion ban in place with limited exceptions, such as if the fetus has a fatal abnormality or if continuing the pregnancy could risk death.

But both mifepristone and misoprostol are allowed in Louisiana for non-abortion related purposes, such as stopping uterine hemorrhaging caused by complications from childbirth, inducing labor, and preparing the uterus for procedures like IUD insertions and biopsies. Because of this, opponents of SB 276 argue that the bill could reduce access to health care.

Read More: What Abortion Laws Look Like in the U.S. One Year After the Fall of Roe v. Wade

Are mifepristone and misoprostol addictive drugs?

The Food and Drug Administration does not view mifepristone and misoprostol as having a significant risk of abuse or dependence. Years of research has found that both medications are safe.

Dr. Jennifer Avegno, an emergency medicine physician and director of the New Orleans Health Department, tells TIME that the amendment to the bill could create a “false narrative” that the drugs are dangerous. Avegno, who co-wrote a letter to lawmakers signed by more than 200 Louisiana doctors objecting to the bill’s amendment, says numerous doctors agree that the drugs don’t belong on the Schedule IV list because they lack the potential for addiction.

“You have to have a clear demonstration that you have a high risk for abuse, dependence, addiction, or you’re a public health hazard,” Avegno says about Schedule IV drugs. “None of the hundreds of physicians that we’ve worked with on this have ever experienced the drugs being used in an addictive manner or abuse.”

Why are many doctors against the amendment to the bill?

Doctors say that the bill could block access to the drugs for non-abortion purposes. Classifying the drugs as controlled substances would require doctors to have a special license to prescribe them, which some may not have.

“There are just so many different regulations that you’d have to go through,” says Dr. Bhavik Kumar, a family doctor and medical director at Planned Parenthood Gulf Coast, which serves Louisiana and southeast Texas.

This could cause delays in patients receiving access to these medications, sometimes in serious or life-threatening situations

“Any delay in getting that medication is the difference, quite frankly, between life or death,” Avegno says. “So it’s not the abstract that we’re talking about and it’s not sort of these unusual, rare cases. These drugs are used all day, every day.”

Read More: Doctors Are Still Confused by Abortion Exceptions in Louisiana. It’s Limiting Essential Care

Patients also may become reluctant to take the drugs even when necessary because they may not understand that they’re safe to use, and pharmacists may be reluctant to fill these prescriptions, Avegno adds.

“What we’re already seeing is that women who are being prescribed misoprostol for miscarriage are even now being told by their pharmacy, ‘I can’t fill that, that’s the abortion drug’ because there persists so much fear out there,” Avegno says. “So if it’s happening now, when it’s not labeled as a controlled, dangerous substance, how often is that going to happen when it is?”

Louisiana has one of the highest maternal mortality rates in the country, and doctors worry that this amendment could exacerbate the situation.

What do people who support the bill say?

Proponents of the bill argue that SB 276 would not prohibit doctors from prescribing these medications, but would instead prevent people from misusing them.

“What we’re trying to do here is add an additional opportunity to keep bad actors from getting these medications,” Pressly said during the Senate meeting Thursday. The senator called the amendment “a proactive step” to prevent what happened to his sister from happening to others.

Louisiana Right to Life, an anti-abortion group that worked with Pressly on the bill, has argued that state law does not say that drugs need to be addictive in order to be classified as controlled substances. The group’s communications director, Sarah Zagorski, says that she does not think the bill would impede access to the drugs for non-abortion needs.

“The legislation itself says that for legitimate health reasons that this medication is completely legal,” she says. “Physicians prescribe controlled substances every single day, they know the protocols for that; this is no different than that.”

Read More: What to Know About the Arizona Supreme Court Abortion Ban Ruling

What happens next?

The bill is now waiting to be signed into law by Gov. Landry. If he does, the law would take effect Oct. 1.

Doctors and reproductive rights advocates say that they’re concerned that SB 276 could inspire similar bills in other states. And many worried that there could be more unforeseen consequences.

“There’s so many unknowns with this because this is just unprecedented,” says Dr. Nicole Freehill, an ob-gyn in Louisiana.

Contact us at letters@time.com.