Application of the Comstock Act to the Mailing of Prescription Drugs That Can Be Used for Abortions ( 2022 )


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  • (Slip Opinion)
    Application of the Comstock Act to the Mailing of
    Prescription Drugs That Can Be Used for Abortions
    Section 1461 of title 18 of the U.S. Code does not prohibit the mailing of certain drugs
    that can be used to perform abortions where the sender lacks the intent that the recipi-
    ent of the drugs will use them unlawfully. Because there are manifold ways in which
    recipients in every state may lawfully use such drugs, including to produce an abor-
    tion, the mere mailing of such drugs to a particular jurisdiction is an insufficient basis
    for concluding that the sender intends them to be used unlawfully.
    December 23, 2022
    MEMORANDUM OPINION FOR THE GENERAL COUNSEL
    UNITED STATES POSTAL SERVICE
    In the wake of the United States Supreme Court’s recent decision over-
    ruling Roe v. Wade, 
    410 U.S. 113
     (1973), 1 you have asked for this Of-
    fice’s view on whether section 1461 of title 18 of the United States Code
    prohibits the mailing of mifepristone and misoprostol, two prescription
    drugs that are commonly used to produce abortions, 2 among other purpos-
    es. Memorandum for Christopher Schroeder, Assistant Attorney General,
    Office of Legal Counsel, from Thomas J. Marshall, General Counsel,
    United States Postal Service, Re: Request for an Interpretation of 
    18 U.S.C. § 1461
    , at 1 (July 1, 2022) (“USPS Request”). Originally enacted
    as part of the Comstock Act of 1873, section 1461 currently declares
    “[e]very article or thing designed, adapted, or intended for producing
    abortion,” as well as “[e]very article, instrument, substance, drug, medi-
    cine, or thing which is advertised or described in a manner calculated to
    lead another to use or apply it for producing abortion,” to be “nonmailable
    matter” that the United States Postal Service (“USPS”) may not lawfully
    deliver. 
    18 U.S.C. § 1461
    .
    We conclude that section 1461 does not prohibit the mailing, or the de-
    livery or receipt by mail, of mifepristone or misoprostol where the sender
    1 See Dobbs v. Jackson Women’s Health Org., 
    142 S. Ct. 2228
     (2022).
    2 See Ctrs. for Disease Control & Prevention, U.S. Dep’t of Health & Hum. Servs.,
    Abortion Surveillance—United States, 2019, 70 MMWR Surveillance Summaries, Nov.
    26, 2019, at 8, https://www.cdc.gov/mmwr/volumes/70/ss/ss7009a1.htm.
    1
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    lacks the intent that the recipient of the drugs will use them unlawfully. 3
    This conclusion is based upon a longstanding judicial construction of the
    Comstock Act, which Congress ratified and USPS itself accepted. Federal
    law does not prohibit the use of mifepristone and misoprostol. Indeed, the
    U.S. Food and Drug Administration (“FDA”) has determined the use of
    mifepristone in a regimen with misoprostol to be safe and effective for the
    medical termination of early pregnancy. 4 Moreover, there are manifold
    ways in which recipients in every state may use these drugs, including to
    produce an abortion, without violating state law. Therefore, the mere
    mailing of such drugs to a particular jurisdiction is an insufficient basis
    for concluding that the sender intends them to be used unlawfully. 5
    3 A cognate provision, 
    18 U.S.C. § 1462
    , imposes similar abortion-related prohibitions
    on using an express company or other common carrier for “carriage” of such items. Our
    analysis in this memorandum is applicable to that provision as well.
    Sections 1461 and 1462 refer not only to persons who transmit such items by mail or
    by common carrier—the senders—but also to individuals who “knowingly cause[]” such
    items to be mailed, 
    id.
     § 1461; “knowingly take[]” any such items from the mail for the
    purpose of circulating or disposing of them, id.; or “knowingly take[] or receive[]” such
    items from an express company or common carrier, id. § 1462. In the different contexts of
    obscenity and child pornography, courts of appeals have held that section 1461 applies to
    the act of the recipient who orders the nonmailable material and thereby “causes” it to be
    mailed. See, e.g., United States v. Carmack, 
    910 F.2d 748
    , 748 (11th Cir. 1990); United
    States v. Johnson, 
    855 F.2d 299
    , 305–06 (6th Cir. 1988). But see Johnson, 
    855 F.2d at
    307–11 (Merritt, J., dissenting); United States v. Sidelko, 
    248 F. Supp. 813
    , 815 (M.D. Pa.
    1965). As far as we know, however, these provisions have never been applied to prose-
    cute the recipients of abortion- and contraception-related materials. Moreover, the court
    of appeals decisions we discuss below construed the relevant provisions of the Comstock
    Act to turn on the nature of the sender’s intent, not that of the recipient. Consistent with
    this practice, we focus on the sender throughout this memorandum. To the extent a
    recipient might be covered, however, our analysis herein would apply and therefore
    section 1461 would not prohibit that person from ordering or receiving the drugs if she
    does not intend that they be used unlawfully.
    4 See Mifeprex (Mifepristone) Tablets, U.S. Food & Drug Admin. 2 (Mar. 2016),
    https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020687s022lbl.pdf (mifepris-
    tone label); see also Mifeprex (Mifepristone) Information, U.S. Food & Drug Admin.,
    https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers
    /mifeprex-mifepristone-information (last updated Dec. 16, 2021).
    5 For purposes of this opinion, we assume but do not decide that section 1461 could be
    constitutionally applied to the mailing of drugs intended to produce abortions. We also
    assume without deciding that state law, as well as federal, is relevant to the application of
    section 1461. In addition, we do not address here whether and under what circumstances
    the mailing of mifepristone or misoprostol might violate other federal laws. Finally, as
    2
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    I.
    The Comstock Act has a long and complex history. The original 1873
    law was the handiwork of Anthony Comstock—“a prominent anti-vice
    crusader who believed that anything remotely touching upon sex was . . .
    obscene”—who successfully lobbied Congress and state legislatures in the
    nineteenth century to enact expansive laws “to prevent the mails from
    being used to corrupt the public morals.” Bolger v. Youngs Drug Prods.
    Corp., 
    463 U.S. 60
    , 70 n.19 (1983) (omission in original) (quotation
    marks and citations omitted); see also Priscilla J. Smith, Contraceptive
    Comstockery: Reasoning from Immorality to Illness in the Twenty-First
    Century, 
    47 Conn. L. Rev. 971
    , 982–84 (2015). Originally entitled “An
    Act for the Suppression of Trade in, and Circulation of, obscene Litera-
    ture and Articles of immoral Use,” Act of Mar. 3, 1873, ch. 258, 
    17 Stat. 598
     (“1873 Act”), the Act is perhaps best known for having prohibited the
    distribution of a wide range of writings until courts and the Executive
    Branch determined that the Free Speech Clause of the First Amendment
    significantly limited the permissible reach of the law, see, e.g., Bolger,
    
    463 U.S. at
    69–75. In addition, the Act also included several restrictions
    on the conveyance of things designed to prevent conception or to produce
    abortion. 6 Congress largely repealed the references to contraceptives in
    you note, USPS Request at 3, some states have independently enacted laws to restrict the
    mailing of these drugs for abortion purposes within their jurisdiction. See, e.g., Tex.
    Health & Safety Code § 171.063(b-1). We do not here assess the possible effect of federal
    law on such state restrictions, other than to note our agreement with your view that the
    doctrine of intergovernmental immunity would preclude application of such state laws
    against USPS employees who are complying with their duties under federal law. See
    Intergovernmental Immunity for the Department of Veterans Affairs and Its Employees
    When Providing Certain Abortion Services, 
    46 Op. O.L.C. __
    , at *1–5, *10 (Sept. 21,
    2022).
    6 The original 1873 Act consisted of five sections, three of which are relevant to this
    opinion. Section 1 of the Act prohibited, inter alia, the sale, distribution, or possession, in
    the District of Columbia and federal territories, of “any drug or medicine, or any article
    whatever, for the prevention of conception, or for causing unlawful abortion,” along with
    advertisements for contraceptives and abortion services and information about how to
    obtain them. 1873 Act § 1, 17 Stat. at 598–99 (emphasis added). Congress chose not to
    include that prohibition when it comprehensively enacted title 18 into positive law in
    1948. See 
    Pub. L. No. 80-772, § 21
    , 
    62 Stat. 683
    , 864 (1948) (repealing, inter alia, 
    18 U.S.C. § 512
     (1946)).
    Section 2 of the Act, which eventually became codified as section 1461, criminalized
    the mailing of, inter alia, “obscene, lewd, or lascivious” writings; “any article or thing
    3
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    1971. See 
    Pub. L. No. 91-662, 84
     Stat. 1973 (1971) (discussed infra Part
    I.C).
    In its current form, section 1461, which is derived from section 2 of the
    1873 Act, begins by declaring “[e]very obscene, lewd, lascivious, inde-
    cent, filthy or vile article, matter, thing, device, or substance” to be “non-
    mailable matter” that “shall not be conveyed in the mails or delivered
    from any post office or by any letter carrier.” 
    18 U.S.C. § 1461
    . The next
    clauses declare nonmailable “[e]very article or thing designed, adapted, or
    intended for producing abortion, or for any indecent or immoral use; and
    [e]very article, instrument, substance, drug, medicine, or thing which is
    advertised or described in a manner calculated to lead another to use or
    apply it for producing abortion, or for any indecent or immoral purpose.”
    Id.; see also 
    39 U.S.C. § 3001
    (a) (likewise declaring such matter to be
    “nonmailable”). Section 1461 further makes it a felony to “knowingly
    use[] the mails for the mailing, carriage in the mails, or delivery” of any
    such things, or to “knowingly cause[]” them “to be delivered by mail
    according to the direction thereon.” 
    18 U.S.C. § 1461
    . In addition, 
    18 U.S.C. § 1462
     imposes two other, related prohibitions: it makes it unlaw-
    ful to bring those same things “into the United States, or any place subject
    to the jurisdiction thereof,” and it prohibits the knowing use of “any
    intended or adapted for any indecent or immoral use or nature”; and “any article or thing
    designed or intended for the prevention of conception or procuring of abortion.” 1873 Act
    § 2, 17 Stat. at 599. Before Congress enacted title 18 into positive law in 1948, the
    provision that is now section 1461 was codified at 
    18 U.S.C. § 334
     (1925–1926).
    Section 3 of the 1873 Act prohibited all persons “from importing into the United
    States” any of the “hereinbefore-mentioned articles or things”—referring to the items
    prohibited by sections 1 and 2. 1873 Act § 3, 17 Stat. at 599. One year later, see Act of
    June 20, 1874, ch. 333, 18 Stat. pt. 3, at 113–14, Congress codified section 3 of the
    Comstock Act as section 2491 of the Revised Statutes and, in doing so, replaced the
    section’s reference to the “hereinbefore-mentioned articles or things” with a list of articles
    and things pulled from the other provisions of the Comstock Act, see Rev. Stat. § 2491
    (1st ed. 1875), 18 Stat. pt. 1, at 460; see also Rev. Stat. § 2491 (2d ed. 1878), 18 Stat.
    pt. 1, at 457. In supplying content to these words, Congress prohibited the importation of
    articles or things “for causing unlawful abortion,” reflecting the language of section 1 of
    the original Comstock Act. Rev. Stat. § 2491 (1st ed. 1875), 18 Stat. pt. 1, at 460. Con-
    gress consistently retained the words “unlawful abortion” in follow-on versions of this
    restriction, including in subsequent Tariff Acts through 1930, after which the provision
    was codified at 
    19 U.S.C. § 1305
    .
    4
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    express company or other common carrier or interactive computer ser-
    vice” for “carriage” of such items “in interstate or foreign commerce.” 7
    Over the course of the last century, the Judiciary, Congress, and USPS
    have all settled upon an understanding of the reach of section 1461 and
    the related provisions of the Comstock Act that is narrower than a literal
    reading might suggest. This construction occurred long before the Su-
    preme Court’s decisions in Griswold v. Connecticut, 
    381 U.S. 479
     (1965),
    and Roe and thus was not dependent upon the Court’s recognition of
    constitutional rights regarding the prevention or termination of pregnancy.
    Beginning early in the twentieth century, federal courts construed the
    provisions not to prohibit all mailing or other conveyance of items that
    can be used to prevent or terminate pregnancy. By the middle of the
    century, the well-established, consensus interpretation was that none of
    the Comstock Act provisions, including section 1461, prohibits a sender
    from conveying such items where the sender does not intend that they be
    used unlawfully. USPS accepted that construction and informed Congress
    of it. On several occasions, Congress reenacted and amended the Com-
    stock Act against the backdrop of the judicial precedent in a manner that
    ratified the federal courts’ narrowing construction.
    A.
    Since early in the twentieth century, federal courts have agreed that
    section 1461 and related Comstock Act provisions do not categorically
    prohibit the mailing or other conveyance of items designed, adapted, or
    intended for preventing or terminating pregnancy.
    In 1915, in Bours v. United States, 
    229 F. 960
     (7th Cir. 1915), the U.S.
    Court of Appeals for the Seventh Circuit reversed the conviction of a
    doctor who had mailed a letter addressing how a woman might procure an
    “operation” from him. The court noted that Congress enacted the provi-
    sion that is now section 1461 pursuant to its “national power of control-
    ling the mails” and held that, “[i]n applying the national statute to an
    alleged offensive use of the mails at a named place, it is immaterial what
    7 The importation prohibition—along with 
    19 U.S.C. § 1305
     (prohibiting the importa-
    tion into the United States of “any drug or medicine or any article whatever for causing
    unlawful abortion”)—derives from section 3 of the original 1873 Act, see § 3, 17 Stat. at
    599. The common-carrier prohibitions derive from an 1897 law extending the mailing
    prohibitions of the original Comstock Act to common carriers. See Act of Feb. 8, 1897,
    ch. 172, 
    29 Stat. 512
    .
    5
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    the local statutory definition of abortion is, what acts of abortion are
    included, or what excluded.” 
    Id. at 964
    . The court further held that
    “[t]hough the letter of the statute would cover all acts of abortion,” under
    a “reasonable construction,” the statute should not be read to prohibit the
    mailing of advertisements for a procedure a doctor would perform in
    order “to save [the] life” of the woman. 
    Id.
     Because the indictment had
    not drawn this distinction, the defendant had no opportunity to explain
    whether he had intended to perform the operation “only under such cir-
    cumstances as would make it the duty of any reputable physician to per-
    form the act.” 
    Id. at 965
    . Therefore, the court reversed the judgment and
    remanded the case. 
    Id. at 966
    .
    Fifteen years later, in Youngs Rubber Corp. v. C.I. Lee & Co., 
    45 F.2d 103
     (2d Cir. 1930), the U.S. Court of Appeals for the Second Circuit also
    reasoned in dicta that the statute could not be construed as expansively as
    its language might suggest. Youngs Rubber was a trademark infringement
    suit in which the defendants argued that the plaintiff’s business was
    unlawful because it involved sending Trojan condoms to druggists for
    retail sale via the mail and common carriage, a practice that—according to
    the defendant—violated the Comstock Act. 
    Id. at 108
    . “Taken literally,”
    the appeals court wrote, the Comstock Act’s “language would seem to
    forbid the transportation by mail or common carriage of anything
    ‘adapted,’ in the sense of being suitable or fitted, for preventing concep-
    tion or for any indecent or immoral purpose, even though the article might
    also be capable of legitimate uses and the sender in good faith supposed
    that it would be used only legitimately.” 
    Id.
     “Such a construction,” the
    court cautioned, “would prevent mailing to or by a physician of any drug
    or mechanical device ‘adapted’ for contraceptive or abortifacient uses,
    although the physician desired to use or to prescribe it for proper medical
    purposes.” 
    Id.
     The court observed that New York law did not prohibit
    supplying such articles to physicians “or by their direction or prescrip-
    tion.” 
    Id. at 109
     (quotation marks omitted). Reasoning that “[t]he inten-
    tion to prevent a proper medical use of drugs or other articles merely
    because they are capable of illegal uses is not lightly to be ascribed to
    Congress,” the court construed the statute’s contraception and abortion
    prohibitions to “requir[e] an intent on the part of the sender that the article
    mailed or shipped by common carrier be used for illegal contraception or
    abortion.” 
    Id. at 108
    .
    In 1933, the U.S. Court of Appeals for the Sixth Circuit embraced the
    same limiting construction of the Comstock Act. Davis v. United States,
    6
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    
    62 F.2d 473
     (6th Cir. 1933), involved a defendant who was convicted of,
    among other things, the sale of “rubber sundries” to druggists that were
    delivered by common carrier. 
    Id. at 474
    . Invoking the “rule of reasonable
    construction,” 
    id. at 475
    , the Davis court reversed the conviction because
    the district court did not permit the admission of evidence that the defend-
    ant had sent the items intending that they be used for “treatment and
    prevention of disease” rather than to prevent conception, 
    id. at 474
    . The
    court quoted with approval Youngs Rubber’s view that the statute should
    be read to “requir[e] an intent on the part of the sender that the article
    mailed or shipped by common carrier be used for illegal contraception or
    abortion or for indecent or immoral purposes,” 
    id.,
     and noted that the
    “soundness of its reasoning commends itself to us,” 
    id. at 475
    . The court
    accordingly rejected the district court’s conclusion that the statute “brings
    within the condemnation of each section articles or things that are capable
    of being used for the specified purposes without respect to their having a
    legitimate use, and without regard to the intent of the persons mailing
    [them],” 
    id. at 474
    , holding instead that “intent that the articles . . .
    shipped in interstate commerce were to be used for condemned purposes
    is a prerequisite to conviction,” 
    id. at 475
    .
    Three years later, the Second Circuit revisited the issue and adopted
    Youngs Rubber’s dicta as a holding in United States v. One Package, 
    86 F.2d 737
     (2d Cir. 1936). In that case, a New York gynecologist had im-
    ported vaginal pessaries from a Japanese sender who had asked the doctor
    to use them in her practice to assess whether they were useful for contra-
    ceptive purposes. 
    Id. at 738
    . At the time, New York law prohibited the
    sale or provision of articles for the prevention of conception, but it in-
    cluded an exception for the provision of such things to physicians “who
    may in good faith prescribe their use for the cure or prevention of dis-
    ease.” 
    Id.
     (citing 
    N.Y. Penal Law § 1145
     (Consol. Laws, c. 40)). The
    doctor testified that she prescribed the items only where her patient had a
    health-related reason such that “it would not be desirable for a patient to
    undertake a pregnancy,” which the court of appeals apparently understood
    to fall within the exception under New York law that permitted physicians
    to provide patients with contraceptives for particular purposes. 
    Id.
     8 The
    court quoted favorably, and at length, from the dicta in Youngs Rubber,
    and noted the accord of the Sixth Circuit in Davis. 
    Id.
     at 738–39. It then
    8 The court of appeals noted that the accuracy and good faith of the doctor’s testimony
    was “not questioned.” One Package, 
    86 F.2d at 738
    .
    7
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    dismissed the case because none of the relevant provisions should be read
    to prohibit the mailing or importation of items to prevent or terminate
    pregnancy with the intent that they be used for lawful purposes. 
    Id.
     at
    739–40. The court reasoned that it was appropriate to, in effect, imply the
    insertion of the adjective “unlawful,” which expressly modified the word
    “abortion” in some provisions of the Comstock Act, to modify the terms
    “prevention of conception” and “abortion” throughout the various provi-
    sions that derived from the Act. 
    Id.
     9 The court elaborated:
    [W]e are satisfied that this statute, as well as all the acts we have re-
    ferred to, embraced only such articles as Congress would have de-
    nounced as immoral if it had understood all the conditions under
    which they were to be used. Its design, in our opinion, was not to
    prevent the importation, sale, or carriage by mail of things which
    might intelligently be employed by conscientious and competent
    physicians for the purpose of saving life or promoting the well being
    of their patients. The word “unlawful” would make this clear as to
    9 The case involved the “prevention of conception” prong of the Tariff Act of 1930—a
    descendent provision of the original Comstock Act—which prohibited importing articles
    “for the prevention of conception or for causing unlawful abortion.” One Package, 
    86 F.2d at 738
     (emphasis added) (quoting 
    19 U.S.C. § 1305
    (a) (1934)); see also supra
    note 6. The court noted that the original 1873 Comstock Act likewise used the adjective
    “unlawful” to modify “abortion” in one of its provisions (section 1—involving the sale
    and possession of abortifacients in federal territories) but not in others, and not as to
    articles for preventing conception. One Package, 
    86 F.2d at 739
    . The court reasoned that
    Congress could not reasonably have had the design to make the “unlawful” nature of the
    intended use an element of the offense under some of the abortion-related prohibitions but
    not others, or as to the importation of items used for abortion but not those used for
    contraception. See 
    id.
     (“[I]n the Comstock Act, . . . the word ‘unlawful’ was sometimes
    inserted to qualify the word ‘abortion,’ and sometimes omitted. It seems hard to suppose
    that under the second and third sections articles intended for use in procuring abortions
    were prohibited in all cases while, under the first section, they were only prohibited when
    intended for use in an ‘unlawful abortion.’”). Instead, the court reasoned, the adjective
    “unlawful” must in effect be read to modify all of the prohibitions. Id.; see also 
    id. at 740
    (Learned Hand, J., concurring) (“[I]t is of considerable importance that the law as to
    importations should be the same as that as to the mails; we ought not impute differences
    of intention upon slight distinctions in expression.”). The One Package court’s analysis
    that the adjective “unlawful” should be read to modify all of the provisions of the Com-
    stock Act is bolstered by the 1874 Congress’s understanding of the term “hereinbefore-
    mentioned articles” in section 3 of the Comstock Act to prohibit the import only of
    articles, drugs, or medicines “for causing unlawful abortion.” See supra note 6; Rev. Stat.
    § 2491 (1st ed. 1875), 18 Stat. pt. 1, at 460.
    8
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    articles for producing abortion, and the courts have read an exemp-
    tion into the act covering such articles even where the word “unlaw-
    ful” is not used. The same exception should apply to articles for pre-
    venting conception. . . . It seems unreasonable to suppose that the
    national scheme of legislation involves such inconsistencies and re-
    quires the complete suppression of articles, the use of which in many
    cases is advocated by such a weight of authority in the medical
    world.
    Id.
    The Second Circuit again reaffirmed this construction of the statute
    shortly thereafter in United States v. Nicholas, 
    97 F.2d 510
     (2d Cir. 1938),
    which involved the Comstock Act’s prohibition on mailing information
    about contraception. Citing Youngs Rubber and One Package, the court in
    Nicholas noted: “We have twice decided that contraceptive articles may
    have lawful uses and that statutes prohibiting them should be read as
    forbidding them only when unlawfully employed.” 
    Id. at 512
    . 10 Applying
    this reading, the court held that USPS was required to deliver a magazine
    containing contraception-related information to a magazine editor who
    might then distribute it to persons such as physicians who could use the
    information lawfully. 
    Id.
     The court further held that USPS should detain a
    book containing such information when it was addressed to an individual
    “about whom nothing” was known “except that he was not a physician,”
    
    id. at 511
    , but allowed for the recipient to “prove whether he is among the
    privileged classes” whose possession of the book “would be lawful,” 
    id. at 512
    .
    10 Although Nicholas described the relevant inquiry as being whether the articles were
    “unlawfully employed,” rather than whether the sender intended that they be used unlaw-
    fully—the touchstone the court had adopted in Youngs Rubber and One Package—this
    difference in phrasing does not reflect a departure relevant to our analysis. The court’s
    invocation of those two earlier decisions without qualification, as well as its further
    citation to Davis, indicates that it did not intend to deviate from the interpretation of the
    Act that the court had adopted in those decisions. Both the Historical and Revision Note
    to section 1461 and subsequent federal decisions understood Nicholas similarly. See 
    18 U.S.C. § 1461
     (Historical and Revision Note) (observing that Nicholas followed “[t]he
    same rule” as Davis, which held that “the intent of the person” that a mailing “be used for
    condemned purposes was necessary for a conviction” (emphasis added)); United States v.
    Gentile, 
    211 F. Supp. 383
    , 385 n.5 (D. Md. 1962) (citing, inter alia, Nicholas for the
    proposition that “contraceptive devices [must be] shipped and received with intent that
    they be used for illegal contraception or abortion”).
    9
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    In 1944, the U.S. Court of Appeals for the D.C. Circuit also narrowly
    construed the statute in the context of a report about contraceptive materi-
    als that a consumer group had published and mailed to individuals who
    submitted a signed certificate attesting, “I am married and use prophylac-
    tic materials on the advice of a physician.” Consumers Union of United
    States, Inc. v. Walker, 
    145 F.2d 33
    , 33 (D.C. Cir. 1944). The appeals court
    explained that it was “inclined to follow the interpretation [of the Com-
    stock Act] which has been adopted in other circuits,” citing to Nicholas,
    Davis, Youngs Rubber, and One Package. 
    Id.
     at 35 & n.11. It therefore
    concluded that “Congress did not intend to exclude from the mails proper-
    ly prepared information intended for properly qualified people,” and held
    that the report “was proper in character within the meaning of those
    decisions.” 
    Id. at 35
    .
    Subsequent judicial discussions of the relevant Comstock Act provi-
    sions recognized the narrowing construction upon which the courts of
    appeals had converged. See, e.g., United States v. Gentile, 
    211 F. Supp. 383
    , 385 n.5 (D. Md. 1962) (“It seems clear under the authorities that in
    order to make out an offense under this paragraph the Government should
    be required to allege and prove that contraceptive devices are shipped and
    received with intent that they be used for illegal contraception or abortion
    or for indecent or immoral purposes.” (citing Youngs Rubber, Davis, and
    Nicholas)); United States v. H.L. Blake Co., 
    189 F. Supp. 930
    , 934–35
    (W.D. Ark. 1960) (“It would seem reasonable to give the word ‘adapted’ a
    more limited meaning than that above suggested and to construe the
    whole phrase ‘designed, adapted or intended’ as requiring an intent on the
    part of the sender that the article mailed or shipped by common carrier be
    used for illegal contraception or abortion or for indecent or immoral
    purposes.” (quoting Youngs Rubber, 
    45 F.2d at 108
    )); United States v. 31
    Photographs, 
    156 F. Supp. 350
    , 357 (S.D.N.Y. 1957) (characterizing the
    appellate court decisions as “upholding importation of contraceptives and
    books dealing with contraception when sought to be brought into the
    country for purposes of scientific and medical research,” such that “only
    contraceptives intended for ‘unlawful’ use were banned” (citing, inter
    alia, One Package, Nicholas, Davis, and Walker)); see also Poe v.
    Ullman, 
    367 U.S. 497
    , 546 n.12 (1961) (Harlan, J., dissenting) (“[B]y
    judicial interpretation . . . the absolute prohibitions of the [Comstock] law
    were qualified to exclude professional medical use.” (citing Youngs Rub-
    ber, Davis, and One Package)).
    10
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    As the court in one of those later cases noted, the analysis in Youngs
    Rubber “has been cited many times and has become the law to be applied
    to the facts where the question of a violation of the statute . . . is before
    the court.” H.L. Blake Co., 
    189 F. Supp. at 934
    . Under that “law to be
    applied,” the court explained, “it is well established that the defendants
    should not be convicted unless it is established beyond a reasonable doubt
    that at the time they mailed the sample packages of prophylactics . . . they
    intended them to ‘be used for illegal contraception.’” 
    Id. at 935
     (quoting
    Youngs Rubber, 
    45 F.2d at 108
    ). 11
    B.
    Congress has amended the Comstock Act’s provisions numerous times
    since the federal courts’ decisions in Bours, Youngs Rubber, Davis, One
    Package, Nicholas, and Walker, each time perpetuating the wording of the
    Act’s abortion-related provisions. Moreover, as we explain in greater
    detail below, USPS accepted the courts’ narrowing construction of the
    Act in administrative rulings, and it informed Congress of the agency’s
    acceptance of that construction in connection with Congress’s amendment
    of the contraception-related provisions of the Comstock Act.
    We conclude that Congress’s repeated actions, taken “[a]gainst this
    background understanding in the legal and regulatory system,” Texas
    Dep’t of Housing & Cmty. Affs. v. Inclusive Cmtys. Project, 
    576 U.S. 519
    ,
    536 (2015), ratified the Judiciary’s settled narrowing construction. See 
    id.
    (“If a word or phrase has been . . . given a uniform interpretation by
    inferior courts . . . , a later version of that act perpetuating the wording is
    presumed to carry forward that interpretation.” (omissions in original)
    (quoting Antonin Scalia & Bryan A. Garner, Reading Law: The Interpre-
    11The leading cases that established this accepted construction—Youngs Rubber, One
    Package, and Davis—each involved items that could be used to prevent conception rather
    than to produce abortion. Nevertheless, the canonical passage from Youngs Rubber,
    repeated in each of the cases and in others thereafter, referred both to items designed to
    prevent conception and to those designed to induce abortions. Moreover, the court in One
    Package went to lengths to explain that all of the relevant Comstock Act prohibitions
    should be read consistently to require proof of a sender’s intent to facilitate unlawful
    downstream use. See supra note 9; see also Bours, 
    229 F. 960
     (construing narrowly the
    prohibition on mailing of information about how to obtain abortions). We therefore agree
    with your assessment that “there is no apparent reason why the case-law principles
    applicable to contraceptive articles (formerly) under Section 1461 would not also apply to
    abortion-inducing articles under the same provision.” USPS Request at 3 n.3.
    11
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    tation of Legal Texts 322 (2012))); Lorillard v. Pons, 
    434 U.S. 575
    , 580
    (1978) (“Congress is presumed to be aware of an administrative or judi-
    cial interpretation of a statute and to adopt that interpretation when it re-
    enacts a statute without change.”); cf. Bragdon v. Abbott, 
    524 U.S. 624
    ,
    645 (1998) (“When administrative and judicial interpretations have settled
    the meaning of an existing statutory provision, repetition of the same
    language in a new statute indicates, as a general matter, the intent to
    incorporate its administrative and judicial interpretations as well.”);
    Forest Grove Sch. Dist. v. T.A., 
    557 U.S. 230
    , 244 n.11 (2009) (holding
    that when Congress amended the Individuals with Disabilities Education
    Act without altering the text of a provision that the Supreme Court had
    previously interpreted, Congress “implicitly adopted [the Court’s] con-
    struction of the statute”).
    The conclusion that Congress ratified the longstanding judicial view of
    the Comstock Act is strongly reinforced by the Historical and Revision
    Note that was included in the 1945 report of the House Committee on the
    Revision of the Laws 12 when Congress enacted title 18 of the U.S. Code
    into positive law. 13 That Note subsequently was appended to the official
    U.S. Code entries for sections 1461 and 1462. See 
    18 U.S.C. § 1461
    (Historical and Revision Note). 14 It specifically “invited” the “attention of
    Congress” to the courts of appeals’ decisions in Youngs Rubber, Davis,
    Nicholas, and One Package, and quoted at length from Youngs Rubber,
    including its conclusion that the relevant provisions of the statute should
    be construed to require “an intent on the part of the sender that the article
    12 See H.R. Rep. No. 79-152, at A96–97 (1945).
    13 See 
    Pub. L. No. 80-772, 62
     Stat. at 768.
    14 The Historical and Revision Notes were written by a staff of experts hired by Con-
    gress to revise the U.S. Code in the 1940s, including the editorial staffs of the West and
    Thompson publishing companies, the former Chief of the Appellate Section of the
    Department of Justice Criminal Division, and other contributors from both inside and
    outside of government. See H.R. Rep. No. 79-152, at 1–7 (1945) (describing in detail this
    revision process and noting that “[t]he [House] Committee on Revision of the Laws has
    exercised close and constant supervision over this work through its general counsel . . .
    and its special counsel”). The Supreme Court has discussed or relied on Historical and
    Revision Notes numerous times, most frequently during the middle of the twentieth
    century. See, e.g., Ex parte Collett, 
    337 U.S. 55
    , 65–71 (1949) (discussing a revision note
    to 
    28 U.S.C. § 1404
     and concluding that the revision note was highly significant in
    determining the meaning of section 1404(a)); W. Pac. R.R. Corp. v. W. Pac. R.R. Co., 
    345 U.S. 247
    , 254–55 (1953); Muniz v. Hoffman, 
    422 U.S. 454
    , 471–73 (1975).
    12
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    mailed or shipped by common carrier be used for illegal contraception or
    abortion.” 
    Id.
     15
    Congress subsequently amended the Comstock Act four times (in 1955,
    1958, 1971, and 1994) without changing the language in any respect that
    suggested disagreement with the well-established narrowing interpretation
    that the Historical and Revision Note had specifically brought to its atten-
    tion. Congress made the third of these amendments in 1971—removing
    the Act’s references to contraceptives—after being informed by the Post-
    15   The Note’s complete discussion of the court of appeals decisions is as follows:
    The attention of Congress is invited to the following decisions of the Federal courts
    construing this section and section 1462 of this title.
    In Youngs Rubber Corporation, Inc. v. C. I. Lee & Co., Inc., C.C.A. 1930, 
    45 F. 2d 103
    , it was said that the word “adapted” as used in this section and in section 1462
    of this title, the latter relating to importation and transportation of obscene matter,
    is not to be construed literally, the more reasonable interpretation being to construe
    the whole phrase “designed, adapted or intended” as requiring “an intent on the part
    of the sender that the article mailed or shipped by common carrier be used for ille-
    gal contraception or abortion or for indecent or immoral purposes.” The court
    pointed out that, taken literally, the language of these sections would seem to forbid
    the transportation by mail or common carrier of anything “adapted,” in the sense of
    being suitable or fitted, for preventing conception or for any indecent or immoral
    purpose, “even though the article might also be capable of legitimate uses and the
    sender in good faith supposed that it would be used only legitimately. Such a con-
    struction would prevent mailing to or by a physician of any drug or mechanical de-
    vice ‘adapted’ for contraceptive or abortifacient uses, although the physician de-
    sired to use or to prescribe it for proper medical purposes. The intention to prevent
    a proper medical use of drugs or other articles merely because they are capable of
    illegal uses is not lightly to be ascribed to Congress. Section 334 [this section] for-
    bids also the mailing of obscene books and writings; yet it has never been thought
    to bar from the mails medical writings sent to or by physicians for proper purposes,
    though of a character which would render them highly indecent if sent broadcast to
    all classes of persons.” In United States v. Nicholas, C.C.A. 1938, 
    97 F. 2d 510
    ,
    ruling directly on this point, it was held that the importation or sending through the
    mails of contraceptive articles or publications is not forbidden absolutely, but only
    when such articles or publications are unlawfully employed. The same rule was fol-
    lowed in Davis v. United States, C.C.A. 1933, 
    62 F. 2d 473
    , quoting the obiter
    opinion from Youngs Rubber Corporation v. C. I. Lee & Co., supra, and holding
    that the intent of the person mailing a circular conveying information for preventing
    conception that the article described therein should be used for condemned purpos-
    es was necessary for a conviction; also that this section must be given a reasonable
    construction. (See also United States v. One Package, C.C.A. 1936, 
    86 F. 2d 737
    .)
    
    18 U.S.C. § 1461
     (Historical and Revision Note).
    13
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    master General that both the federal courts and USPS had adopted this
    narrowing interpretation. See H.R. Rep. No. 91-1105, at 3–4 (1970). 16
    Moreover, we have found no evidence that Congress disapproved of the
    interpretation. 17 Indeed, in 2007 Congress legislated regarding the FDA’s
    treatment of mifepristone in a manner consistent with the understanding
    that the Comstock Act does not categorically prohibit the covered modes
    of conveying abortion-inducing drugs. 18
    Congress’s several actions “perpetuating the wording” of the Comstock
    Act’s abortion provisions against the backdrop of a well-established,
    settled judicial construction that was brought to Congress’s attention
    16  See supra note 11 (explaining that the courts of appeals’ rationales applied equally
    to conveyance of items to prevent conception and to produce abortion).
    17 The House report stated at the outset of its discussion that “[e]xisting statutes com-
    pletely prohibit the importation, interstate transportation, and mailing of contraceptive
    materials, or the mailing of advertisement or information concerning how or where such
    contraceptives may be obtained or how conception may be prevented.” H.R. Rep. No. 91-
    1105, at 2. That introductory remark, however, plainly was a reference to the literal text
    of the provisions, as opposed to their settled meaning. The report proceeded to convey the
    Postmaster General’s description of the settled judicial and administrative narrowing
    construction of the statute, noting that it was in tension with the text of the contraception
    provisions, and neither the report nor any evidence in the legislative record of which we
    are aware expresses the committee’s disagreement with that construction.
    18 In approving a mifepristone product for certain abortions in 2000, the FDA imposed
    certain restrictions on distribution as a condition of approval, pursuant to its regulatory
    authority. See Letter for Sandra P. Arnold, Vice President, Population Council, from Ctr.
    for Drug Evaluation & Rsch., U.S. Food & Drug Admin., Re: NDA 20-687 (Sept. 28,
    2000). In the Food and Drug Administration Amendments Act of 2007 (“FDAAA”),
    Congress provided that any such restrictions, identified in the FDAAA as “elements to
    assure safe use,” were deemed to be a “Risk Evaluation and Mitigation Strategy” that
    would continue to be required under the new statutory regime unless and until the FDA
    determined that modifications were necessary. See 
    Pub. L. No. 110-85,
     tit. IX, § 909(b),
    
    121 Stat. 823
    , 950–51 (2007). In the debate preceding this amendment, critics of the
    FDA’s 2000 approval of mifepristone for abortion purposes acknowledged that the
    legislation would apply to that mifepristone approval. See 153 Cong. Rec. S5765 (daily
    ed. May 9, 2007) (statement of Sen. Coburn); 153 Cong. Rec. S5469–70 (daily ed. May 2,
    2007) (statement of Sen. DeMint). Yet neither those critics nor anyone else in the con-
    gressional debate mentioned the Comstock Act, even though it would have been natural to
    assume that the FDA’s 2000 approval had resulted in the distribution of mifepristone to
    certified physicians through the mail or by common carrier. Congress’s decision to carry
    forward the FDA’s regulatory conditions for mifepristone without addressing such modes
    of distribution suggests that Congress did not understand the Comstock Act to invariably
    prohibit the conveyance by mail or common carrier of drugs intended to induce abortions.
    14
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    establishes Congress’s acceptance of that narrowing construction. Inclu-
    sive Cmtys. Project, 576 U.S. at 536. That construction, as noted, does not
    prohibit the mailing of an item that is designed, adapted, or intended for
    producing abortion in the absence of an intent by the sender that the item
    will be used unlawfully.
    C.
    USPS has accepted the settled judicial construction of the Comstock
    Act—and reported as much to Congress.
    In 1951, the Solicitor of the Post Office Department, Roy C. Frank,
    wrote to an Arizona postmaster concerning a Planned Parenthood clinic’s
    mailing of diaphragms and vaginal jellies to its patients “for medicinal
    purposes.” Contraceptive Matter—Mailings—Physicians, 9 Op. Sol.
    P.O.D. 47 (1951) (No. 40). Citing “the decisions of the Federal courts,”
    Frank opined that a “mailing of contraceptives by a physician to a patient
    would not be regarded as a violation” of the Comstock Act. Id. Similarly,
    in 1963, when the St. Louis Postmaster detained 490 “contraceptive
    devices and substances,” the USPS General Counsel informed him that he
    should “dispatch” those items because “there is no available evidence that
    the items in each of these parcels were being distributed for unlawful
    purposes.” Letter for Harriet F. Pilpel, Greenbaum, Wolff & Ernst, from
    Louis J. Doyle, General Counsel, Post Office Department (Oct. 24, 1963)
    (on file with the Smith College Libraries). In a letter to the sender Emko
    Company’s counsel, the USPS General Counsel added that “should we
    obtain evidence in the future that [Emko] is distributing contraceptive
    devices and substances for unlawful purposes we will again look into the
    matter.” Id.
    Of particular importance, when Congress was considering amendments
    to the Comstock Act in 1970, USPS brought to Congress’s attention its
    acceptance of the Judiciary’s narrowing construction. The Postmaster
    General submitted a statement to Congress about his agency’s understand-
    ing that “the delivery by mail of contraceptive information or materials
    has by court decisions, and administrative rulings based on such deci-
    sions, been considered proper in cases where a lawful and permissive
    purpose is present.” See H.R. Rep. No. 91-1105, at 3–4 (1970). As a
    result, “[t]he lawful mailing . . . of contraceptive articles . . . is dependent
    on the interpretation given to the intended purpose.” Id. at 4. The Post-
    master General noted that “[w]hat is a lawful purpose within the meaning
    15
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    of the interpretations given, though vaguely identifiable, has with the
    passage of time also been considerably broadened” and that “many States
    . . . have adopted positive legislation to authorize or encourage public
    family planning services.” 
    Id.
     As a result, by the time the Postmaster
    General wrote to Congress in 1970—after the Court’s Griswold decision
    holding unconstitutional a state prohibition on the use of contraception—
    “it [was] quite clear that the cited law as presently written [was] unen-
    forceable.” 
    Id.
    The House Ways and Means Committee included the Postmaster Gen-
    eral’s statement in its report on the draft amendment and noted that “[i]n
    view of” that statement—along with statements supporting the draft
    amendment by the Departments of Labor and of Health, Education, and
    Welfare—the Committee on Ways and Means was “unanimous in recom-
    mending enactment of H.R. 4605.” 
    Id.
     Congress then amended the Com-
    stock Act to repeal most of the Act’s applications to contraceptives. See
    
    Pub. L. No. 91-662, 84
     Stat. at 1973–74. 19
    *****
    Thus, before the Court’s recognition of a constitutional right to contra-
    ception in Griswold and to abortion in Roe, the Judiciary, Congress, and
    USPS itself all understood section 1461 and the related provisions of the
    Comstock Act not to prohibit the conveyance of articles intended for
    preventing conception or producing an abortion where the sender lacks
    the intent that those items should be used unlawfully. We further note
    that, shortly after Congress amended the Comstock Act in 1971 to elimi-
    nate the restrictions on contraceptives, the Supreme Court’s decision in
    Roe effectively rendered unenforceable the restrictions on articles “de-
    signed, adapted, or intended for producing abortion.” For the past half
    century, courts have not had the occasion to elaborate further on the
    meaning of the Comstock Act as it relates to abortion, including regarding
    19 Although the 1971 Congress eliminated the preexisting broad prohibitions on send-
    ing contraception-related articles and information using the mails or common carriage, it
    added a narrower prohibition designed to prevent the mailing of unsolicited contraceptive
    items and advertising to private homes. See 
    39 U.S.C. § 3001
    (e); see also 
    18 U.S.C. § 1461
     (making it a crime to knowingly use the mails to mail anything deemed “nonmail-
    able” in section 3001(e)). In Bolger, the Supreme Court held that the ban on unsolicited
    advertisements of contraceptives violates the First Amendment. 
    463 U.S. at 61
    .
    16
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    the sources of law that inform whether an abortion would be “unlawful”
    for purposes of the established construction of the Act.
    II.
    In Part I we demonstrated that, in accord with the prevailing judicial
    construction Congress ratified, section 1461 does not prohibit the mailing
    of articles that can be used to produce abortion, including mifepristone
    and misoprostol, where the sender lacks the intent that those items should
    be used unlawfully. 20 We turn now to address the many circumstances in
    which a sender of these drugs typically will lack an intent that they be
    used unlawfully.
    Federal law does not prohibit the use of mifepristone and misoprostol
    for producing abortions. Indeed, the FDA has determined the use of
    mifepristone in a regimen with misoprostol to be safe and effective for the
    medical termination of early pregnancy. And, to the extent relevant, these
    drugs can serve important medical purposes and recipients in every state
    can use them lawfully in some circumstances. This is true even when the
    drugs would be delivered to an address in a jurisdiction with restrictive
    abortion laws, because women who receive the drugs in all fifty states
    may, at least in some circumstances, lawfully use mifepristone and miso-
    prostol to induce an abortion.
    We note that those sending or delivering mifepristone and misoprostol
    typically will lack complete knowledge of how the recipients intend to use
    them and whether that use is unlawful under relevant law. Therefore, even
    when a sender or deliverer of mifepristone or misoprostol, including
    USPS, knows that a package contains such drugs—or indeed that they
    will be used to facilitate an abortion—such knowledge alone is not a
    sufficient basis for concluding that section 1461 has been violated. We
    also recognize that USPS may have reason to consider adopting uniform
    policies or practices regarding the mailing of mifepristone or misoprostol.
    Cf. Smith v. United States, 
    431 U.S. 291
    , 304 n.10 (1977) (“[T]he nation-
    wide character of the postal system argues in favor of a nationally uni-
    form construction of [section] 1461.”).
    20 See supra note 3 (noting that the same test would apply to section 1462 and to recip-
    ients of the drugs to the extent those persons might be amenable to prosecution).
    17
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    We have not undertaken the challenging task of a detailed review of
    state abortion laws, but we can offer some illustrative uses for mifepris-
    tone and misoprostol that the law of a given state would not prohibit:
    • First, in most states—where a majority of the U.S. population
    lives—abortion continues to be lawful until at least twenty weeks’
    gestation. It is very unlikely that someone sending validly prescribed
    mifepristone or misoprostol into such states will intend for them to
    be used unlawfully.
    • Second, even some states that in recent months have enacted or be-
    gun to enforce more restrictive abortion laws continue to allow abor-
    tion for at least some number of weeks of pregnancy. Use of mife-
    pristone and misoprostol to terminate a pregnancy that falls within
    that period would be lawful.
    • Third, thus far, no state that has enacted or newly begun to enforce
    restrictions on abortion in the wake of Dobbs v. Jackson Women’s
    Health Organization, 
    142 S. Ct. 2228
     (2022), prohibits abortions
    that are necessary to preserve the life of the woman. 21 Many medical
    conditions that make pregnancy potentially life-threatening—for in-
    stance, certain heart conditions, pulmonary hypertension, or Marfan
    Syndrome 22—are known in the first trimester, when women most
    commonly use mifepristone and misoprostol to induce an abortion.
    Such a use of these drugs to terminate a life-threatening pregnancy
    would be lawful.
    • Fourth, some state abortion restrictions also include exceptions for
    cases of rape or incest, to protect the health of the woman, or where
    there are severe fetal anomalies. The use of mifepristone or miso-
    21 See Dobbs, 142 S. Ct. at 2305 n.2 (Kavanaugh, J., concurring) (“Abortion statutes
    traditionally and currently provide for an exception when an abortion is necessary to
    protect the life of the mother.”); see also Roe, 
    410 U.S. at 173
     (Rehnquist, J., dissenting)
    (“[I]f [a state] statute were to prohibit an abortion even where the mother’s life is in
    jeopardy, I have little doubt that such a statute would lack a rational relation to a valid
    state objective . . . .”).
    22 See, e.g., Inst. of Med., Clinical Prevention Services for Women: Closing the Gaps
    103–04 (2011); see also Burwell v. Hobby Lobby Stores, Inc., 
    573 U.S. 682
    , 737 (2014)
    (Kennedy, J., concurring) (noting that “[t]here are many medical conditions for which
    pregnancy is contraindicated”).
    18
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    prostol to produce an abortion in such cases would therefore be law-
    ful.
    • Fifth, some states that regulate the conduct of certain actors involved
    in abortions do not make it unlawful for the woman herself to abort
    her pregnancy. In those contexts, section 1461 might not prohibit the
    mailing of mifepristone and misoprostol to a woman in a state with
    restrictions on abortion, even if the sender does so with the intent
    that the woman use the drugs to produce an abortion.
    • Sixth, even if a state prohibits a pregnant person from ingesting mif-
    epristone or misoprostol for the purpose of inducing an abortion,
    such an individual has a constitutional right to travel to another state
    that has not prohibited that activity and to ingest the drugs there. 23
    Someone sending a woman these drugs is unlikely to know where
    she will use them, which might be in a state in which such use is
    lawful.
    • Seventh, federal agencies provide abortion services in some circum-
    stances without regard to contrary state law. 24 Mailings of abortion
    23  See Dobbs, 142 S. Ct. at 2309 (Kavanaugh, J., concurring) (“[M]ay a State bar a
    resident of that State from traveling to another State to obtain an abortion? In my view,
    the answer is no based on the constitutional right to interstate travel.”); id. (referring to
    the question as “not especially difficult”); see also Bigelow v. Virginia, 
    421 U.S. 809
    , 824
    (1975) (explaining that Virginia could not “prevent its residents from traveling to New
    York to obtain [abortion] services or . . . prosecute them for going there” (citing United
    States v. Guest, 
    383 U.S. 745
    , 757–59 (1966))).
    24 The Department of Veterans Affairs (“VA”), for example, recently has begun
    providing abortions to veterans and certain other VA beneficiaries without regard to state
    law when the life or health of the woman would be endangered if the pregnancy were
    carried to term or the pregnancy is the result of an act of rape or incest. See Reproductive
    Health Services, 
    87 Fed. Reg. 55,287
    , 55,288 (Sept. 9, 2022). “[S]tates may not restrict
    VA and its employees acting within the scope of their federal authority from providing
    abortion services as authorized by federal law, including VA’s rule.” Intergovernmental
    Immunity for the Department of Veterans Affairs and Its Employees When Providing
    Certain Abortion Services, 
    46 Op. O.L.C. __
    , at *10; see also 87 Fed. Reg. at 55,294
    (noting that state and local laws, including criminal laws, that “restrict[], limit[], or
    otherwise impede[] a VA professional’s provision of care permitted by” this new rule
    “would be preempted” (citing 
    38 C.F.R. § 17.419
    (b))). Also, the Department of Defense
    (“DoD”) has for many years provided service members, dependents, and other beneficiar-
    ies of DoD health care services with abortion services when a pregnancy is the result of
    rape or incest or when continuing the pregnancy would endanger the woman’s life, and
    DoD has indicated it will continue to do so without regard to contrary state laws. See
    19
    
    46 Op. O.L.C. __
     (Dec. 23, 2022)
    medications intended to be used pursuant to these federal authorities
    would be lawful under section 1461, because contrary state law
    could not constitutionally be applied.
    • Finally, individuals use mifepristone and misoprostol for medical
    purposes other than to induce abortions and the legality of those uses
    would remain unaffected by state restrictions on abortion. For in-
    stance, the same dosages of mifepristone and misoprostol that are
    used for medication abortion can be used to treat a miscarriage,25 and
    misoprostol is commonly prescribed for the prevention and treatment
    of gastric ulcers. 26
    Thus, no matter where the drugs are delivered, a variety of uses of mif-
    epristone and misoprostol serve important medical purposes and are
    lawful under federal and state law. Accordingly, USPS could not reasona-
    bly assume that the drugs are nonmailable simply because they are being
    sent into a jurisdiction that significantly restricts abortion. Nor would
    such an assumption based solely on the recipient’s address be reasonable
    even if it is apparent that some women in a particular state are using the
    drugs in question in violation of state law. Cf. Youngs Rubber, 
    45 F.2d at 110
     (although the volume of the plaintiff’s sales nationwide justified an
    inference that the drug stores to which the condoms were being delivered
    must have been selling at least some of them for purposes that were
    prohibited under state law—“and that plaintiff must know this”—that was
    insufficient to conclude that the company intended such illegal conduct by
    the recipients).
    In conclusion, section 1461 does not prohibit the mailing of mifepris-
    tone or misoprostol where the sender lacks the intent that the recipient
    will use them unlawfully. And in light of the many lawful uses of mife-
    pristone and misoprostol, the fact that these drugs are being mailed to a
    Memorandum for Senior Pentagon Leadership from Gilbert R. Cisneros, Jr., Under
    Secretary of Defense for Personnel and Readiness, Department of Defense, Re: Ensuring
    Access to Essential Women’s Health Care Services for Service Members, Dependents,
    Beneficiaries, and Department of Defense Civilian Employees (June 28, 2022).
    25 See, e.g., Honor Macnaughton, Melissa Nothnagle & Jessica Early, Mifepristone and
    Misoprostol for Early Pregnancy Loss and Medication Abortion, 103 Am. Fam. Physician
    473, 475 (Apr. 15, 2021).
    26 See Cytotec Misoprostol Tablets, U.S. Food & Drug Admin. 5–6 (Aug. 2016),
    https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/019268s051lbl.pdf (miso-
    prostol label).
    20
    Application of the Comstock Act to Drugs That Can Be Used for Abortions
    jurisdiction that significantly restricts abortion is not a sufficient basis for
    concluding that the mailing violates section 1461. 27
    CHRISTOPHER H. SCHROEDER
    Assistant Attorney General
    Office of Legal Counsel
    27 While this request was pending, we received a similar request from the Department
    of Health and Human Services (“HHS”) regarding the Comstock Act in connection with
    the Food and Drug Administration’s Risk Evaluation and Mitigation Strategy for mife-
    pristone. We conveyed our conclusions by e-mail to HHS on December 19, 2022, and we
    noted there that this memorandum was forthcoming. E-mail for Samuel Bagenstos,
    General Counsel, HHS, from Christopher H. Schroeder, Assistant Attorney General,
    Office of Legal Counsel, Re: Advice Regarding Comstock (Dec. 19, 2022, 8:31 PM).
    21