Two manufacturers of the abortion pill mifepristone asked the Supreme Court on Saturday to immediately restore full access to the medication, putting the contentious issue of abortion back before the justices in a midterm election year.

The requests came after a lower court on Friday temporarily restricted abortion providers nationwide from prescribing the pills by telemedicine and sending them to patients by mail. That process is one of the main ways women seeking abortions have obtained the medication in recent years.

If the order on Friday by a federal appeals court is upheld, it could sow confusion and upend a major avenue for abortion access across the country — not just in states with abortion bans. About one-fourth of abortions in the United States are now provided through telemedicine.

Louisiana officials had sued the Food and Drug Administration to restrict access to mifepristone, saying the availability of the medication by mail had allowed abortions to continue in the state despite its near-total ban on abortion.

A three-judge panel of the U.S. Court of Appeals for the Fifth Circuit on Friday sided with Louisiana and essentially reimposed an F.D.A. requirement that health care providers prescribe mifepristone only after seeing patients in person. That rule was first lifted in 2021. The Fifth Circuit ordered that in-person dispensing of mifepristone be reinstated until the Louisiana lawsuit made its way through the courts.

The manufacturers, Danco Laboratories and GenBioPro, are also defendants in the Louisiana lawsuit. On Saturday afternoon, Danco filed an emergency request asking the Supreme Court to lift the lower court’s order, which applied to patients across the country. GenBioPro filed a similar request Saturday evening.

“The Supreme Court must reject this unfounded and baseless attack on an essential medication,” GenBioPro’s chief executive, Evan Masingill, said on Saturday, adding: “We remain concerned that anti-abortion special interests are attempting to undermine the U.S. Food and Drug Administration’s regulatory authority. This is why we are bringing our fight to the Supreme Court.”

In its filing, GenBioPro said that “patients and clinicians have, for years, relied on dispensing mifepristone without an in-clinic visit, particularly for women from rural areas and those for whom transportation, child care or occupational constraints make it difficult to see providers in person.”

It said that the Fifth Circuit’s order “is deeply unsettling to drug sponsors, health care providers, patients and the public — all of whom rely on F.D.A.’s exercise of scientific judgment and orderly administration of the Nation’s complex system of drug regulation.”

In its filing, Danco said the Fifth Circuit’s ruling “injects immediate confusion and upheaval into highly time-sensitive medical decisions,” and requires Danco, providers, patients and pharmacies “all to guess at what is allowed and what is not.”

In a motion filed on Friday night asking the Fifth Circuit to pause its order, Danco said that the ruling would cause “chaos.” The court had not responded to the request by Saturday evening.

The Trump administration has defended the F.D.A. in court, but has not said in this case, or in public statements, whether it supports keeping in place the regulations that allow for pills to be mailed. Rather, it has said that the F.D.A. is conducting a review of mifepristone. It has also asked the court to delay the lawsuit proceedings until that review is complete.

Administration officials recently told The New York Times that the review would not be finished until the end of this year, a time frame that would fall after the midterm elections.

The mifepristone case puts the Trump administration in a politically tricky position, given that many of President Trump’s supporters oppose abortion. The Justice Department has not responded to requests for comment about whether it would appeal to the Supreme Court.

On Saturday, a spokesman for the Department of Health and Human Services, which oversees the F.D.A., declined to comment, citing “ongoing litigation.”

Following the Supreme Court’s decision in 2022 to eliminate the nationwide right to abortion, Republican-led states like Louisiana imposed strict bans on abortion. In response, many Democratic-led states passed shield laws that protect abortion providers who prescribe pills by telemedicine and send them to patients in states with abortion bans.

Nearly two-thirds of abortions in the United States are now carried out with abortion pills, typically used through the first 12 weeks of pregnancy. The medication abortion regimen usually involves taking mifepristone, which blocks a hormone necessary for pregnancy to continue, followed 24 to 48 hours later by a second medication, misoprostol, which causes contractions similar to a miscarriage. The Louisiana case targets mifepristone, which the F.D.A. approved for abortion in 2000. Misoprostol, which is also used for other medical conditions, is not affected by the Fifth Circuit ruling.

During the coronavirus pandemic, the F.D.A. lifted its requirement that patients visit a medical provider in person to obtain mifepristone. That decision was made permanent in 2023 and led to the creation of numerous telemedicine abortion services.

Louisiana has claimed in its lawsuit that the F.D.A.’s decision to remove the in-person dispensing requirement was based on inadequate or flawed data — an assertion medical organizations dispute, pointing to more than 100 studies that have found that mifepristone is safe, and that serious complications from taking it are rare.

In addition, Louisiana said that the regulations had resulted in numerous illegal abortions in the state, and that it had paid thousands of dollars in Medicaid bills for women harmed by mifepristone.

In its Supreme Court filing, GenBioPro said Louisiana’s “narrative is demonstrably false,” adding that the F.D.A.’s regulation change allowing telemedicine prescribing and pills by mail “does not require anyone to prescribe mifepristone, require anyone to dispense mifepristone or prevent Louisiana from creating or enforcing its abortion prohibitions. It simply removes a federal in-person dispensing requirement.”

In April, a district court judge in Louisiana said the state was likely to win its challenge to the regulation, but declined to pause the availability of pills by mail. Instead, the judge gave the F.D.A. time to complete the safety review of mifepristone.

In its ruling Friday, the Fifth Circuit sided with Louisiana, echoing the state’s arguments that the F.D.A.’s regulations were “undermining its laws protecting unborn human life” and also “causing it to spend Medicaid funds on emergency care for women harmed by mifepristone,” according to the order written by Judge Stuart Kyle Duncan, a Trump appointee. He was joined by Judge Kurt D. Engelhardt, another Trump appointee, and Judge Leslie Southwick, an appointee of President George W. Bush.

Other litigation over access to abortion medication has been making its way through the federal courts.

In 2024, the Supreme Court declined to limit access to mifepristone in a case brought by anti-abortion doctors and groups that sought to have its approval revoked. The court unanimously sided with the Biden administration and the manufacturer of mifepristone, and said the plaintiffs did not have legal grounds to bring the challenge.

The case was revived later that year, and is pending before a federal court in Missouri. Another similar case was filed against the F.D.A. last year by Texas and Florida.

Since last fall, new and deadly synthetic opioids called orphines have begun appearing in street drugs in the United States. They are far more potent than fentanyl but cannot be detected by standard toxicology tests.

Orphines are still much less common than fentanyl, but they are proliferating quickly. As of last month, they have been found in 14 states, mostly in the South and the Midwest. Law enforcement officials and public health officials are trying to assess the gravity and endurance of the threat they pose.

Here are answers to some basic questions.

What are orphines?

They are a class of opioids that was created in the 1960s by Paul Janssen, a Belgian doctor and pharmacologist, whose teams investigated rapid, safe pain relievers for surgery. As part of that effort, they also developed fentanyl.

Dr. Janssen and others discovered that orphines had life-threatening side effects such as acute respiratory depression and were highly addictive. Within a few years, the research on them was halted.

Researchers characterize orphines as 10 times more powerful than fentanyl, even in quantities no greater than a few sand-size grains. They can be lethal with stunning speed, with victims slumping over abruptly, respiration shutting down, chest walls rigid. Sometimes the classic signature of overdose, “the foam cone” — froth from the nostrils and mouth — does not even have time to bubble up.

Still, it is possible for people overdosing on orphines to be revived with naloxone, the opioid reversal medication. But numerous doses may be required, many more than the one or two doses typically needed for fentanyl.

Why did orphines start showing up in United States?

Orphines are among the synthetic opioids that started to appear in the street drug supply in the wake of global crackdowns on fentanyl.

In 2018, the Drug Enforcement Administration issued a temporary ban on all fentanyl-related substances, called analogs. That same year, an article in The Journal of Medicinal Chemistry addressed the challenge of developing opioids without toxic side effects and offered orphines as cautionary examples. It described them as dangerous, because they are so powerfully addictive and may affect breathing.

Researchers speculate that rogue chemists, seeking illicit drugs that can evade international drug laws, may have been inspired by the article to develop orphines. By 2019, brorphine, an early orphine, was detected in Europe.

Around that time, another class of cheap, synthetic opioids called nitazenes had been circulating in Europe and the United States, alarming law enforcement and public health officials. But in July 2025, China, a key manufacturing source of chemicals for nitazenes, banned them.

Nitazenes began to fade but, within months, orphines popped up in the American illicit drug supply.

In what form are orphines sold?

The most common orphine is an analog called cychlorphine (also known as N-propionitrile chlorphine). It seems to be circulating in counterfeit pills or as a powder, bulking and boosting fentanyl. Overdoses and fatalities may occur because the user did not know that the intended drug — such as the stimulant methamphetamine — had been adulterated with the orphine.

Cychlorphine is so new, so difficult to seize that researchers believe it is often being delivered by international mail. In addition to the United States, it has been detected in Estonia, Latvia and Lithuania, France and Germany, where, cheap and available, it has been nicknamed “poor man’s fentanyl.”

There are indications in Europe that cychlorphine is being used on its own, not just to adulterate other drugs. Medical examiners in the United States are starting to surmise this as well because a few overdose fatalities do not test positive for conventional illicit drugs, like fentanyl and benzodiazepines. When further toxicology tests have been done, cychlorphine shows up as the only deadly drug on board.