From the beginning, doctors have known that the commonly used “abortion pill” is Misoprostol, which was initially used as a medication for stomach ulcers. It was accidentally discovered to have the effect of increasing uterine contractions, leading to premature births, and eventually being used for abortions. Currently, the Food and Drug Administration (FDA) has declared Misoprostol a special controlled drug that companies can only sell to hospitals. Clinics cannot obtain it for use.
Although Misoprostol is an effective drug for terminating pregnancies to a certain extent, there is still more than a 10% chance of unsuccessful termination. Researchers have sought other drugs to enhance the effectiveness of Misoprostol, leading to the discovery of RU-486 or Mifepristone, which effectively inhibits the hormone necessary for embryo implantation. The World Health Organization has included the Mifepristone + Misoprostol Combination Pack in the List of Essential Medicines since 2019.
In Thailand, research on the Mifepristone + Misoprostol Combination Pack has begun in various hospitals nationwide, in collaboration with the Concept Foundation and the Department of Reproductive Health. The drug was officially registered on December 30, 2014, with the registration number 2C33/57(NC), indicating its use for terminating pregnancies in uteri up to 63 days old. It was included in the National List of Essential Medicines on June 13, 2016.
Since the drug is still on List J(1), which requires special monitoring by government agencies, the Department of Health and the National Health Security Office must establish a project for safe medical abortion using drugs within the health service system. This involves creating a system for clinical outcome monitoring and securing a budget for drug procurement. Consequently, healthcare facilities, both hospitals and clinics, must report the use of the Mifepristone + Misoprostol Combination Pack to the Department of Health to support the periodic reporting of project outcomes to the Subcommittee on the Development of the National List of Essential Medicines.
The next steps to eliminate barriers to accessing abortion drugs in Thailand are: 1. Advocating for the Mifepristone + Misoprostol Combination Pack to be reclassified as a drug on List A-K, allowing all doctors to use it for legal abortion under Criminal Code sections 28, and 2. Promoting the inclusion of Misoprostol, which has broad benefits in obstetrics and gynecology, in the National List of Essential Medicines. This would require unlocking the ability for medical clinics or pharmacies to dispense the drug based on a doctor’s prescription.
And the hope of seeing abortion become a regular health service will be one step closer.
Dr. Nithiwat Saengruang
May 26, 2023, at 1:03 AM
List J(1) A list of drugs for special projects of ministries, departments, or government agencies, with specified usage methods and monitoring and evaluation of drug use according to the project. The responsible agency reports the project outcomes to the Subcommittee on the Development of the National List of Essential Medicines periodically as appropriate, to consider categorizing it into other subcategories in the National List of Essential Medicines when sufficient information is available.
References
1. Ministry of Public Health Announcement on Special Controlled Drugs, No. 23. Royal Gazette, Volume 118, Special Part 89Ng, 2001.
2. Adverse Drug Reaction Monitoring Center, Food and Drug Administration, Ministry of Public Health. Dangers of Misuse of Misoprostol. APR Newsletter; 2001.
3. World Health Organization Model List of Essential Medicines, 21st List, 2019. Geneva; 2019.
4. Food and Drug Administration. Product Verification. https://porta.fda.moph.go.th/fda_search_all/main/search_center_main.aspx. Accessed May 26, 2023