SOMERVILLE — A federal appeals court temporarily banned the mailing of mifepristone during the first weekend in May 2025. In response, the Massachusetts Medication Abortion Access Project (MMAAP) began offering patients misoprostol-only shipments to states with abortion bans.

Dr. Angel Foster, who leads the MMAAP, offered patients three options following the restriction: a refund, waiting for legal changes, or receiving only misoprostol. "Their response was: 'Whatever can get to me the fastest,'" Foster said. The organization ships abortion pills to approximately 3,500 patients nationwide each month.

Mifepristone and misoprostol together are considered the clinical gold standard for medication abortion. Misoprostol can be taken alone to induce an abortion, though studies suggest it may be less effective than the combination and can lead to a longer process with more side effects like nausea and vomiting. Misoprostol is approved by the FDA to treat ulcers and is widely used off-label to manage miscarriages, induce labor, and end pregnancies. The FDA typically does not regulate how a drug is used off-label. Drexel University law professor David Cohen stated, "There would have to be some finding that it is not safe or effective for ulcer treatment, something that there's no argument anyone could possibly show."

The temporary halt on mailing mifepristone was part of a lawsuit brought by Louisiana, which alleges that the FDA acted illegally when it allowed mifepristone to be prescribed without an in-person doctor's visit. The lawsuit has the support of 21 other states, and the Alliance Defending Freedom partnered with Louisiana in the litigation. Gabriella McIntyre, a lawyer for Alliance Defending Freedom, stated, "Stopping the FDA's unlawful mail-order mifepristone scheme will surely decrease the number of chemical abortions across the country."

The U.S. Supreme Court later restored telehealth access to mifepristone while a lower court continues to hear the case. Other organizations, such as Aid Access and online pharmacies in India, direct patients to mifepristone from outside the U.S. In 2021, the Supreme Court temporarily reinstated a requirement for mifepristone to be dispensed in person. During that period, Carafem, a company providing telehealth abortion services, switched to using only misoprostol. The FDA is currently conducting a safety evaluation of mifepristone.