Kansas AG’s proposed restriction on mifepristone would impact more than abortion patients

Kansas Attorney General Kris Kobach wants to restrict mifepristone, a medication commonly prescribed for abortions. But the drug also is used to treat other conditions, such as Cushing's syndrome and unresolved miscarriages. (Photo by Anna Spoerre/Missouri Independent)

TOPEKA — Janice Powers treats her hormonal disorder with the abortion pill that Kansas Attorney General Kris Kobach and attorneys general from other states want to regulate as a water contaminant.

Mifepristone, a medication researchers have found to be safe and effective, is commonly prescribed as part of a two-pill regimen to terminate a first-trimester pregnancy. It also can treat other conditions.

Powers, a 61-year-old from Andover who is a project manager at the CDC Foundation, takes it for Cushing’s syndrome, a disorder caused by high levels of the cortisol hormone. The pill blocks cortisol receptors to minimize the hormone’s effects.

“I’m exercising more now. It makes a real difference in my outlook on life,” she said. “I don’t feel as depressed. I don’t feel as angry, which, it’s kind of crazy, has improved my marriage.”

Mifepristone is used to treat Cushing’s syndrome and unresolved miscarriages. And, despite claims by Kobach and others, experts say at-home medication abortions are safe for the patient and the water supply.

An endocrinologist, a type of physician specializing in hormonal disorders, prescribed Powers mifepristone in October. Since then, she said, she has successfully managed her diabetes, lost weight and has had more energy to garden her flowers.

“This medication is literally saving my life,” she said.

On June 17, Kobach and Republican attorneys general from 13 other states sent a letter to the U.S. Environmental Protection Agency calling for the classification and regulation of mifepristone as a water contaminant.

“If mifepristone reaches sufficient concentration,” the letter said, “pregnant women who unintentionally ingest the drug through the public water supply could be at greater risk of health complications than the general population.”

Shannon Bartelt-Hunt, an expert on the presence of contaminants and pharmaceutical compounds in the environment and a University of Nebraska professor, said in an interview that the amount of pharmaceutical compounds in surface water, such as a lake or river, is trace.

The amount that can be present in drinking water is even smaller, she said.

She said in order for someone to consume 600 milligrams of mifepristone, a potential dose, one would have to drink 150,000 gallons of surface water containing one microgram of mifepristone per liter, which would be an unusually high concentration.

“Drinking water, you might drink 10 times that to get the therapeutic dose,” she said. “Instead of 150,000 gallons, maybe you have to drink 1.5 million gallons of water, which just isn’t even anywhere in the realm of possibility.”

Bartelt-Hunt said tiny amounts of compounds like the ones in mifepristone flush into water systems through human and animal waste, which potentially have negative effects to public health and the environment that scientists are still studying.

But she said those compounds come from numerous pharmaceuticals.

“They are not saying take away antibiotics,” she said, “or take away heart medication, or take away your cholesterol medication or take away any other medications that people need.”

In the June letter, the attorneys general argued endocrine disruptors, natural or synthetic compounds that mimic or interact with hormones, cause reproductive harm to humans and wildlife, citing a 2022 published study.

Bartelt-Hunt said while there is potential for harmful effects, the standard procedure would involve filtering out such compounds, not eliminating all or one of the pharmaceuticals altogether.

“Typically, if something is regulated, then the solution is to install treatment to remove that material to below that regulatory limit,” she said.

This kind of water treatment technology exists, she said, but is expensive and not mandated.

Powers wants mifepristone to remain accessible. She said she asked her physician if there are alternative treatments for her specific condition. As far as her doctor was aware, there aren’t.

“If I go off of it,” Powers said, “then those receptors will stop being blocked, and I’ll go right back to where I was before.”

People with untreated Cushing’s syndrome can experience symptoms that include weight gain, high blood pressure, diabetes, muscle weakness and mood swings.

Mifepristone and misoprostol, the medications that make up the two-pill abortion procedure, also can treat unresolved miscarriages, which occur when pregnancy tissues are not properly expelled after a sudden, early loss of pregnancy.

Lauren Ralph, a reproductive sciences associate professor at the University of California San Francisco and an expert in public health and abortion, said incomplete miscarriages can lead to infection.

“Twenty percent of pregnancies end in miscarriage,” she said. “We don’t know the exact amount, but some of those miscarriages won’t resolve on their own and need support from medications.”

“We will always continue to need access to mifepristone and misoprostol, even in a place where abortion is regulated more heavily,” she added.

While the letter state officials sent to the EPA said medication abortions are dangerous, Ralph’s research shows otherwise.

In April 2021, the U.S. Food and Drug Administration allowed certified pharmacists to distribute the abortion regimen by mail and removed in-person visit requirements because of COVID-19. The U.S. Supreme Court upheld the FDA’s decisions in 2024 and again in May.

Mifepristone has not been available in major pharmaceutical stores in Kansas since Kobach and other state officials urged companies not to sell it in 2023. Powers receives hers by mail.

State officials’ June letter said the FDA’s decisions to remove in-person dispensing and check-up requirements has “eliminated many of the protections that minimized the health risks posed by mifepristone.”

A 2024 published study Ralph authored found medication abortions by mail distribution and telehealth appointments to be as safe as in-person medication abortion procedures.

“It’s important to have mifepristone and misoprostol available,” she said, “recognizing that it’s got a safety and effectiveness profile that’s been really well established over decades of research.”