WASHINGTON — Medication abortions, which have become increasingly popular in the state, will continue in Minnesota, even if a legal challenge to mifepristone, a drug used in the procedures, prevails.

Planned Parenthood clinics and other facilities that provide abortion services in Minnesota have been preparing for an adverse ruling by Judge Matthew Kacsmaryk by assuring patients that medication abortions will continue to be offered – even if they no longer involve the drug mifepristone.

The future of mifepristone was cast into doubt when Kacsmaryk, a judge in Amarillo, Texas, on Friday invalidated the Food and Drug Administration’s 23-year-old approval of mifepristone with his ruling. Kacsmaryk said in his decision on a case brought by anti-abortion groups that the FDA underreported adverse reactions to mifepristone and the drug is unsafe.

About an hour after the ruling, a judge in Washington state issued a ruling in another case that contradicts the Texas decision, ordering the FDA to make no changes to the availability of mifepristone in the 18 states, including Minnesota, that filed the lawsuit.

The Biden administration said it will appeal Kasmaryk’s decision.

“If it stands, it would prevent women in every state from accessing the medication, regardless of whether abortion is legal in a state,” President Biden said in a statement.

Ultimately, whether mifepristone remains on the market in the United States may be determined by the Supreme Court because of the dueling court rulings.

Medication abortion, available only for patients in the first 10 weeks of pregnancy, became legal in the United States in 2000, when the drug mifepristone was approved by the Food and Drug Administration. Medication abortions most commonly involve the taking of mifepristone and another drug called misoprostol 24 to 48 hours apart. The first drug stops the development of a pregnancy and the second causes contractions and bleeding like those caused by a miscarriage.

If mifepristone is taken off the market, medication abortions in Minnesota would involve misoprostol and only misoprostol.

“It would be somewhat less effective … and it makes the process more drawn out and painful,” said Paulina Briggs, executive director of the WE Health clinic in Duluth. “We’ll just educate our patients to be prepared for this.”

The popularity of medical abortions spiked during the pandemic, when in-person appointments with doctors were difficult to get and telemedicine provided a way for patients to seek prescriptions of mifepristone and misoprostol at home.

According to data from the Minnesota Department of Public Health, there were 6,179 surgical abortions and 3,711 medication abortions in the state. Two years later, in 2021 and in the midst of the pandemic, there were 3,976 surgical abortions and 6,154 medication abortion in the state.

Briggs said the popularity of medication abortion has continued. Patients can take the medication in the comfort of their own homes. And they can get help from a doctor or clinic remotely, which cost less than treatment in a clinic. A remote procedure cost $412 at the WE Health clinic. Meanwhile, a surgical abortion for a patient in the first 11 weeks of pregnancy and in in-house medication abortion at the clinic, both procedures that include an ultrasound, each cost $700.

The drugs needed for a medication abortion can be obtained by mail or in person at a clinic or at a drug store, although Walgreens stopped dispensing mifepristone in 21 states where Republican attorneys general threatened legal action against pharmacies that distribute the medication. That did not affect Walgreens stores in Minnesota, where the attorney general is a Democrat who has vowed to protect abortion rights.

Like others who decried the effort to ban mifepristone, Emily Bisek, vice president of communications for Planned Parenthood-North Central States, said the drug has been in use in the United States for more than 20 years and proven to be safe.

“Medication abortions were safe, effective and convenient,” Bisek said.  She called efforts to ban mifepristone “irresponsible and wrong.”

“Taking mifepristone off the market is a political attack,” Bisek said.

The new, one-pill medication abortion protocol involves taking one tablet of misoprostol every three hours for a total of three doses.

“Each patient’s experience will be different after that,” Bisek said.

Paul Stark, a spokesman for Minnesota Citizens Concerned for Life, said the anti-abortion group backed removing mifepristone from the market because of concerns about its safety and the approval process used by the FDA. He said abortions would continue without access to mifepristone and that opposition was based on concerns about “the health of the mother.”

“We want to protect everyone,” Stark said.

Meanwhile, Kacsmaryk’s ruling was blasted by abortion rights advocates, including Sen. Tina Smith, D-Minnesota, a former Planned Parenthood executive.

“I’m furious,” Smith said. “A single ultra-conservative activist judge just attempted to strip away access to safe and effective medication abortions for millions of women nationwide. This ruling is nothing but an extremist, anti-democratic national abortion ban.”

The American Medical Association also slammed the ruling as “reckless and dangerous” judicial interference in the provision of health care that “flies in the face of science and evidence.”

“The court’s disregard for well-established scientific facts in favor of speculative allegations and ideological assertions will cause harm to our patients and undermines the health of the nation,” AMA President Jack Resneck said.