‘Chaos’ followed ruling on abortion drug access, and providers say more uncertainty lies ahead

(CNN) — Like on many other days, the last thing Leah Coplon did before she left work Friday was to check a litigation tracker. Coplon, the director of clinical operations for Abortion on Demand, was watching for any updates about legal action on abortion pills. Around 5 p.m., it was quiet.

Coplon made a short commute to downtown Portland, Maine, to attend a May Day rally. She had just arrived when she got the news.

The 5th US Circuit Court of Appeals had blocked access by telemedicine or mail to mifepristone, one of the pills used in a standard regimen for medication abortion that has been approved by the US Food and Drug Administration for decades.

Abortion providers have long been preparing for potential restrictions on telehealth abortion, but whiplash from the court ruling that landed late Friday and another that followed Monday morning challenged even some of the best-laid plans.

Providers whom CNN talked to describe the time between the court actions as some of the “craziest” and most “chaotic” days they’ve had.

In an appeal Saturday, Danco Laboratories, a maker of the mifepristone pill, said the Friday decision “injects immediate confusion and upheaval into highly time-sensitive medical decisions.”

The lower court decision was put on temporary hold by the Supreme Court on Monday morning, once again making it legal for patients to receive mifepristone in the mail. That reprieve lasts until May 11 as the high court reviews emergency appeals.

“Because of past threats to mifepristone access, we have been prepared. We had many things lined up already so that we were able to switch rapidly,” Coplon said of Friday’s decision to limit access. “I would say that we were surprised but prepared.”

Logistical plans were quickly put into action for Abortion on Demand and other providers. But some say there’s only so much preparation that can be done.

“On the one hand, we can war-game things out. We’ve definitely been thinking about different scenarios,” said Dr. Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, known as The MAP. “Even with all of that planning, it was still a very chaotic weekend, and a lot of that has to do with the uncertainty that our patients felt.”

Ready for the logistics, not the tears

The phone lines for Her Safe Harbor, a reproductive health clinic in Delaware that also offers telehealth abortion, are open 24/7. But by 7:30 Saturday morning, the clinic had tripled the amount of staff manning the phones — and the need for the extra support hasn’t let up since.

“We had the logistics covered with the extra staff, the extra meds, the printouts,” said Debra Lynch, a nurse practitioner with Her Safe Harbor. “What we were not prepared for was the massive emotional response it was going to have with the patients.”

Many women were sobbing when they called, and it would take staffers a few minutes to even figure out the source of their distress, Lynch said.

“Everybody was taking phone calls from absolutely distraught women who thought that their options had ended, that their lives as they knew it were over,” she said. “It was a lot of counseling and emotional support. It was overwhelming.”

On Saturday night, just before “everybody in all of Massachusetts” was preparing to watch the Boston Celtics play in the NBA playoffs, Foster from The MAP was on the phone with the state attorney general’s office to work through the implications of the circuit court ruling.

“It’s a little bit of a scramble. There are a lot of things that are unknown, and we’re trying to figure out next steps,” Foster said. “For us, the priority has really just been patient care.

“We wanted to be able to move forward with something that we knew was legal and that wouldn’t put us in legal jeopardy so we could keep serving our patients.”

For The MAP, that meant preparing to pivot to a telehealth abortion regimen that used only misoprostol. The mifepristone-misoprostol combination is the most common abortion method in the US, but studies show that using misoprostol alone is also a safe and effective way to have an abortion. And no matter the status of mifepristone, misoprostol would still be available and could be used for a medication abortion on its own.

The timing of the court rulings — late Friday and Monday morning — meant most patients have been able to get telehealth abortion kits that included the mifepristone-misoprostol combination. That called for significant efforts by clinic staff to coordinate and communicate with patients, as well as a little bit of luck.

The MAP serves an average of about 100 patients a day, Foster said. When the ruling landed Friday, hundreds were still waiting to receive medication abortion kits that had been mailed earlier in the week — including kits that Foster said she had dropped off just a couple hours earlier. Many of those patients reached out to seek reassurance that they could still move forward with that regimen.

It’s also common for patients who request abortion pills at the end of one month wait to pay until the first of the next month, Foster said, probably because it aligns with the timing of their paycheck. Friday was May 1, so there was a large group of patients who had been approved for the pills but had not paid. The MAP contacted hundreds of them over the weekend to talk through their options.

“We were working with those patients throughout the weekend,” Foster said. “It was a lot of back and forth.”

Another flood of questions from patients came Monday, after the Supreme Court issued the temporary stay.

“We explain that we will do everything we can to continue to provide mifepristone-misoprostol, but as this legal case evolves, we may need to pivot,” Foster said.

With more legal uncertainty ahead as the Supreme Court decision looms, The MAP is asking patients to sign two consent forms: one for the mifepristone-misoprostol combination and one for the misoprostol-only regimen.

Monday’s ruling came early enough, though, that the kits going out in the mail that day could be changed from misoprostol-only to once again include both mifepristone and misoprostol.

Dangling in legal limbo

Abortion providers CNN spoke with say they plan to use the next week to try to understand the potential implications of the circuit court ruling in case it is reinstated and to share information with patients.

“[The legal limbo] creates chaos, and I think intentionally so. That decision certainly didn’t take into account the idea that there might be patients who are in the middle of their process and what that would look like,” Foster said.

In the first few hours after the temporary stay was issued Monday, abortion providers said, they got a surge of requests from patients seeking advanced provision of mifepristone to have in case they need it — a spike similar to the one providers saw after President Donald Trump was re-elected in 2024.

“For me and for the patients that I spoke to, it just highlights so profoundly how little these court decisions belong in the medical setting,” Coplon said. “This isn’t how we should be providing care when we have just mountains of data supporting this as a standard of care, and safe.

“So to have patients feel like some people are making decisions about their own personal health care, I think it really highlighted for them, as well as for us, just how much these decisions need to be out of the clinician’s office.”

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