Exploring the feasibility of obtaining mifepristone and misoprostol from the internet

Abstract

Given our findings, we expect that some people for whom clinic-based abortion is not easily available or acceptable may consider self-sourcing pills from the internet to be a rational option.

Motivations and Experiences of People Seeking Medication Abortion Online in the United States

“…A major unmet need among participants seeking abortion medications online was for a trustworthy source offering both medications and information. The skepticism toward online pharmacy sites is particularly interesting in light of findings from a 2017 study in which investigators ordered abortion medications from 20 online sites: Eighteen combined mifepristone‐misoprostol products were received, and 13 contained active ingredients in amounts consistent with World Health Organization recommendations for early abortion . These results suggest that the skepticism of our participants was warranted, since they had no prior information about the reliability of any site, and not all sites provided a product in its advertised dose.…”

“…The skepticism toward online pharmacy sites is particularly interesting in light of findings from a 2017 study in which investigators ordered abortion medications from 20 online sites: Eighteen combined mifepristone-misoprostol products were received, and 13 contained active ingredients in amounts consistent with World Health Organization recommendations for early abortion. 10 These results suggest that the skepticism of our participants was warranted, since they had no prior information about the reliability of any site, and not all sites provided a product in its advertised dose. However, the possibility of ordering genuine medications in correct doses from online pharmacy sites raises two important questions: First, would the participants in our study have used one of these sites if they had known which were reliable?…”

“…Online telemedicine abortion services are not available in the United States. However, despite a Food and Drug Administration risk evaluation and mitigation strategy specifying that mifepristone may not be sold by retail or mail‐order pharmacies, mifepristone and misoprostol are available for purchase in the United States through several commercial online pharmacies …”

“…However, despite a Food and Drug Administration risk evaluation and mitigation strategy specifying that mifepristone may not be sold by retail or mail-order pharmacies, 9 mifepristone and misoprostol are available for purchase in the United States through several commercial online pharmacies. 10 In 2017, Jerman et al conducted a novel survey of individuals who sought information about self-managed abortion online, finding that 41% were under the age of 17, and that 11% had previously attempted to end an unwanted pregnancy on their own, largely through the use of herbs, vitamins, alcohol or drugs. 11 Given the increasingly relevant role of the Internet in the rapid exchange of goods and information for self-care, 12 it is vital to understand the clinical and public health implications of this pathway.…”

Support for and interest in alternative models of medication abortion provision among a national probability sample of U.S. women

“…Increasingly, women in the United States are obtaining MA through nontraditional routes including online or through telemedicine services, particularly where access is difficult [2,15,16]. Those who self-manage their abortions outside of the formal health care setting presumably do so because they prefer its privacy and convenience and/or face barriers accessing care [17][18][19][20].…”