A MARTÍNEZ, HOST:
The Supreme Court could decide before midnight tonight whether to allow an abortion pill to remain widely available.
MICHEL MARTIN, HOST:
So far, the justices have temporarily paused lower court rulings that would block or partially restrict access to mifepristone. That's a drug now being used in more than half of abortions in the U.S.
MARTÍNEZ: Kate Wells at Michigan Radio is here to tell us about what's at stake in one state where abortion is still legal. Kate, you're in Michigan. What are clinics saying there?
KATE WELLS, BYLINE: It's chaos. I mean, doctors here have not experienced this much confusion or uncertainty really since last summer, since Roe was overturned, especially since, you know, residents here in Michigan in November voted to put abortion rights in the state constitution. And yet, you know, even here, this method is still under threat. One of the doctors that I talked with is Dr. Audrey Lance. She's an OB-GYN with Northland Family Planning outside Detroit. And she told me that every time in the last few weeks that one of these legal deadlines approaches, it is disruptive.
AUDREY LANCE: It's hard, you know, when I know that I'm going to walk in to work tomorrow to provide care to patients with these medications. Am I allowed to do that? I don't know yet. I don't know what's going to happen.
WELLS: And, of course, what she wants to do is keep using mifepristone, because when you combine it with misoprostol, that two-drug combination is the gold standard of medication abortions. It is the most effective method. But if the court bans mifepristone entirely - it might also just restrict its use by not allowing it to be sent through the mail. And that especially is a big fear for doctors here.
MARTÍNEZ: But what's the biggest fear about losing the ability to send these pills directly to patients?
WELLS: Well, I mean, Michigan is a large state. You know, if - most brick-and-mortar clinics right now that provide abortion are concentrated in the southern part of the state, which means if you live farther north, if you're in the Upper Peninsula, you've got to drive for hours just to get to a clinic. But, of course, right now, these patients can get the pills remotely. Dr. Sarah Wallett is with Planned Parenthood of Michigan, and she can do a virtual appointment with these patients and then send the pills directly to them through the mail.
SARAH WALLETT: We see patients who are in their car on break from their job. We see patients at home with their small children who don't have the ability to take time off work to get childcare, to get gas money.
MARTÍNEZ: OK. So, Kate, the option to mail mifepristone could disappear depending on the Supreme Court's decision. But could misoprostol still be mailed?
WELLS: Yes, they could definitely still use that medication rather than the two-drug combination. And misoprostol alone is effective at ending pregnancies. But the doctors I spoke with say, you know, they're slightly worried about this because it is slightly less effective than when you use both pills, and they worry that this would mean more patients would need to come back in for surgical procedures afterwards. Bigger picture, they also just worry that if mifepristone isn't available, some patients just won't want to take the risk. They won't want to have a medication abortion. They will just opt for surgical procedures instead.
MARTÍNEZ: And can they handle the capacity for more of those?
WELLS: Not at first. You know, it would be a big change. A lot of people right now use medication abortions. If a lot of them instead want to do an actual procedure, that could mean longer wait times and delays in care.
MARTÍNEZ: Michigan Radio's Kate Wells. Kate, thanks a lot.
WELLS: You're welcome.
(SOUNDBITE OF MUSIC)
MARTÍNEZ: The leader of the Sudanese military today claimed he is committed to transition to civilian rule.
MARTIN: But in his first speech since fighting began, General Abdel Fattah al-Burhan made no mention of accepting a three-day-long cease-fire offered by the paramilitary forces. Gunfire was heard on the streets of Khartoum and other cities on Friday morning, and the U.S. is moving a large number of additional troops to its base in nearby Djibouti to prepare for a possible evacuation of U.S. citizens in Sudan.
MARTÍNEZ: NPR's Emmanuel Akinwotu has been monitoring the situation. He joins us now from Lagos. Emmanuel, before we hear more detail about the humanitarian situation, what more do we know about the U.S.'s plans to evacuate citizens?
EMMANUEL AKINWOTU, BYLINE: Not very much. You know, the airspace is closed. The airport in Khartoum has been actually at the center of the fighting. If there was a cease-fire, it would offer a window, but there isn't one. The fighting hasn't stopped even this morning. There's an estimated 16,000 Americans registered in Sudan. It would be a major operation to evacuate them at any time, especially now. And the State Department spokesperson said yesterday that due to the fluid situation, it's not safe to undertake an evacuation. So essentially these are preparations, but the conditions for an evacuation just isn't there. Egypt managed to evacuate about 177 troops from northern Sudan this week, but 27 remain in Khartoum. And obviously now the situation is very precarious.
MARTÍNEZ: Yeah, and I know that thousands of Sudanese have become displaced by the fighting. How bad is the humanitarian situation there?
AKINWOTU: The speed of the collapse in Khartoum and other areas surrounding it has been tragic and surreal. In places, there are dead bodies on the streets. We're hearing at least 33 - 330 people have died, thousands of people injured. The majority of hospitals have shut down, and the few that are open are absolutely overwhelmed. And people are sheltering at home, but people are also dying at home. I spoke to someone yesterday whose mother died in her living room in Khartoum, killed by shrapnel. And we've been hearing stories like this all week. The fighting has been most intense in the center of the city and areas around it. So many people in their homes are exposed to this. And then tragically, we've also seen reports of RSF fighters - Rapid Support Force fighters, the paramilitary group - taking over hospitals and bedding in people's homes, kicking residents out and committing abuses and sexual abuses. Everyone who can are trying to flee Khartoum right now.
MARTÍNEZ: Meanwhile, this instability and all this fighting is making neighbors of Sudan very, very nervous. Remind us what's at stake for those countries that are right nearby.
AKINWOTU: You know, Sudan borders seven countries, many of them with ethnic groups that cross these borders. And the borders are porous, some of them, and, you know, countries like Chad, the Central African Republic, South Sudan. And there's a potential that this conflict brings in other militia and ethnic militia. For now, that hasn't been the case. And the other militia groups in Sudan and international actors with a stake in Sudan have largely advocated peace talks. But as we can see, those calls have completely been unheard.
MARTÍNEZ: That's NPR's Emmanuel Akinwotu in Lagos. Thank you very much.
AKINWOTU: Thank you.
(SOUNDBITE OF MUSIC)
MARTÍNEZ: U.S. officials say they've identified and, quote, "infiltrated" the Mexican cartel smuggling most of the deadly fentanyl now reaching American cities.
MARTIN: They say they've launched a new effort to arrest leaders and top operatives of the Sinaloa Cartel.
MARTÍNEZ: NPR addiction correspondent Brian Mann is here. Brian, what role do officials say this cartel plays in the fentanyl crisis?
BRIAN MANN, BYLINE: Well, Justice Department and Drug Enforcement Administration officials say they now believe this one faction of the Sinaloa Cartel, known as the Chapitos network, built and now operates the major pipeline of illegal fentanyl, pumping the drug into the U.S. They say these are the guys responsible for a lot of the 80,000 Americans dying from opioid overdoses every year.
MARTÍNEZ: And how do they know that?
MANN: What they say is that over the last 18 months, they managed to infiltrate the Chapitos network and, quote, "obtained unprecedented access to the organization's highest levels." They were able to map out its operations from China to Mexico to the U.S. And in these indictments made public last week, they described secret fentanyl deals they were able to observe in locations around the world. And what they learned is pretty brutal. In addition to smuggling all that fentanyl, the Chapitos allegedly waged a campaign of violence and terror. Here's Attorney General Merrick Garland.
(SOUNDBITE OF ARCHIVED RECORDING)
MERRICK GARLAND: They often torture and kill their victims. They have fed some of their victims, dead and alive, to tigers belonging to the Chapitos.
MANN: So pretty horrible stuff. And now the U.S. is offering tens of millions of dollars in rewards, A, as they try to arrest the cartel's leaders.
MARTÍNEZ: Tell us more about the Chapitos.
MANN: Yeah. This faction of Sinaloa is led by the sons of Joaquin Guzman, known as El Chapo, who's already serving a life sentence in federal prison in the U.S. These guys took over after their dad's arrest. Sam Quinones is a veteran journalist who covers the Mexican cartels. He says capturing them would be a major victory.
SAM QUINONES: These guys are absolute creeps, these Chapito dudes. I think bringing these previously untouchable princes of drugs to some kind of justice is a very good thing all the way around.
MANN: And these indictments go beyond the top leaders. They target about two dozen Sinaloa operatives around the world.
MARTÍNEZ: Meanwhile, the Mexican government has pulled back from cooperating with the U.S in the drug war. What's their response to these indictments?
MANN: Well, this is interesting. They're angry. Everyone agrees the Chapitos network is a corrupting, violent influence inside Mexico. But President Lopez Obrador told reporters Monday, this DEA operation infiltrating the Sinaloa Cartel happened without his government's authorization. He describes this as a threat to his country's sovereignty, says it's part of a wider campaign by the U.S. government spying inside Mexico.
(SOUNDBITE OF ARCHIVED RECORDING)
PRESIDENT ANDRES MANUEL LOPEZ OBRADOR: (Speaking Spanish).
MANN: What he says there is that it's abusive, arrogant meddling that should not be accepted under any circumstance. So while the U.S. says it's making progress here, the diplomatic rift over how to tackle fentanyl - it's clearly widening.
MARTÍNEZ: And at the end of things, Brian, I mean, is there evidence that this pressure on this cartel will slow fentanyl smuggling and even maybe save lives?
MANN: Well, U.S officials say they think this will help, but most experts I talked to are really skeptical. They just don't believe it. Fentanyl is really easy to make from industrial chemicals. The demand in the U.S., the level of opioid addiction is huge, so fentanyl trafficking is incredibly profitable. If the Chapitos are put in prison, there are other factions of the Sinaloa Cartel and also other major cartels that are ready to take their place. Jon Caulkins studies drug trafficking at Carnegie Mellon University.
JON CAULKINS: I, though, am quite pessimistic. In the best of all possible worlds, we would literally shrink the supply. That's very difficult to do. That was very difficult to do even when it was cocaine and heroin. And for a bunch of reasons it's much harder with a synthetic.
MANN: So Caulkins supports this effort to take down the Chapitos. He thinks they're brutal criminals and should be brought to justice. But he also thinks, you know, the cold, hard reality is that fentanyl is here to stay.
MARTÍNEZ: NPR's Brian Mann covers addiction and drug policy for NPR. Brian, thanks.
MANN: Thank you. Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
