On April 7, 2023, two conflicting rulings on the provision of mifepristone—the drug used for medication abortion—were issued by two separate federal court judges, one in Texas and one in Washington State.

U.S. District Court for the Northern District of Texas Judge Kacsmaryk issued a preliminary injunction in his case, Alliance for Hippocratic Medicine v. FDA, which blocked the FDA’s approval of mifepristone. The ruling effectively impacts the entire nation and would revoke the long-standing FDA approval granted to mifepristone.

Nearly simultaneously, U.S. District Court for the Eastern District of Washington Judge Thomas Rice ordered the FDA to maintain the current availability of mifepristone in 17 states and the District of Columbia.

As a result, the FDA received conflicting orders: to both suspend its approval of mifepristone on one hand and to not alter its existing approval, on the other. Because these two federal court rulings conflict, the Supreme Court could be called upon to resolve this conflict and decide the merits of both cases.

The US Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization—which overturned Roe v. Wade and nearly 50 years of a federal constitutional right to abortion—has had a tectonic impact. Less than a year later … one of the most consequential aftershocks of the Dobbs decision emerged…. The two April 7, 2023 decisions … have set the stage for a legal clash with the highest stakes for an essential drug in reproductive care and the stability and integrity of the FDA’s regulatory oversight.


The United States Court of Appeals for the Fifth Circuit has asked lawyers from Alliance Defending Freedom, the team representing the Texas-based plaintiffs, to respond to the appellants’ “stay pending appeal” motion and its “stay order.” As both of these cases involve the FDA’s approval and provision of mifepristone, it is likely that if/when they reach the Supreme Court, it will review the cases together in a “vided” case.

Stay tuned to the Cockle Bur for continuing coverage.