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The court is dealing with its latest controversy four years after its conservative majority and allowed more than a dozen states to effectively ban abortion outright.

The case before the court stems from a lawsuit Louisiana filed to roll back the Food and Drug Administration’s rules on how mifepristone can be prescribed. The state claims the policy undermines the ban there, and it questions the safety of the drug, which was first approved in 2000 and has repeatedly been deemed safe and effective by FDA scientists.

Lower courts concluded that Louisiana is likely to prevail, and a three-judge panel of the 5th U.S. Circuit Court of Appeals ruled that mail access and telehealth visits should be suspended while the case plays out.

The drug is most often used for abortion in combination with another drug, misoprostol. accounted for nearly two-thirds of all abortions in the U.S. in 2023, the last year for which statistics are available.

The current dispute is similar to one that reached the court three years ago.

Lower courts then also sought to restrict access to mifepristone, in a case brought by physicians who oppose abortion. They filed suit in the months after the court overturned Roe.

The Supreme Court blocked the 5th Circuit ruling from taking effect over the dissenting votes of Alito and Justice Clarence Thomas. Then, in 2024, the high court unanimously dismissed the doctors’ suit, reasoning they did not have the legal right, or standing, to sue.

In the current dispute, mainstream medical groups, the pharmaceutical industry and Democratic members of Congress have weighed in cautioning the court against limiting access to the drug. Pharmaceutical companies said a ruling for abortion opponents would upend the drug approval process.

The FDA has eased a number of restrictions initially placed on the drug, including who can prescribe it, how it is dispensed and what kinds of safety complications must be reported.

Despite those determinations, abortion opponents have been challenging the safety of mifepristone for more than 25 years. They have filed a series of petitions and lawsuits against the agency, generally alleging that it violated federal law by overlooking safety issues with the pill.

administration has been unusually quiet at the Supreme Court. It declined to file a written brief recommending what the court should do, even though federal regulations are at issue.

The case puts Trump’s Republican administration in a difficult place. Trump has relied on the political support of anti-abortion groups but has also seen and poll results that show .

Both sides took the silence as an implicit endorsement of the appellate ruling. Alito is both the justice in charge of handling emergency appeals from Louisiana and the author of the 2022 decision that declared abortion is not a constitutional right and returned the issue to the states.

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Mulvihill reported from Haddonfield, N.J.

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