The US Abortion Ruling Is Already Blocking Life Saving Drugs

The far-reaching consequences of banning abortion became horribly clear this week. Patients in the US are reporting that they are struggling to access essential medicines amid concerns that their capacity to end pregnancies could fall foul of incoming abortion bans. 

People living with painful autoimmune illnesses such as lupus and rheumatoid arthritis say their doctors and pharmacies have stopped providing the drug methotrexate. First developed as a cancer treatment, methotrexate is sometimes used together with misoprostol in medical abortions and to treat ectopic pregnancies – a condition in which a foetus begins to grow outside the womb and cannot be carried to term. 

Some social media users have also said their pharmacies are refusing to dispense naltrexone, even though the evidence it causes miscarriages is limited at best. With reports emerging just days after the Supreme Court overturned Roe v Wade, the landmark 1973 ruling that established abortion as a constitutional right, the problem is an illustration of the ripple effect of restricting reproductive rights.

Hannah Jace Nurrieum, a 30-year-old carer from Clinton, Iowa, has been taking methotrexate since 2016 to treat the rheumatic arthritis and ulcerative colitis she has lived with since her teens. Concerned about the drug’s immunosuppressant effects, she took a break from it during the Covid-19 pandemic, but on 28 June she asked her doctor to restart her prescription because her symptoms were becoming unbearable. He refused. 

“I just asked [my doctor] directly, ‘Is this because of the heartbeat bill and the trigger laws in Iowa?’,” she tells Novara Media. “And he was like, ‘yes’.”

Iowa attempted to implement a ban on abortions after six weeks in 2018, but it was ruled unconstitutional by a local judge a year later. With Roe v Wade overturned and the Iowa Supreme Court reversing the decision that the state constitution guarantees the right to abortion, the state’s governor has attempted to reintroduce the restriction. 

Nurrieum’s town is on the border with Illinois, where abortion is likely to remain legal. But as a low earner who depends on state insurance companies, she can’t seek a different healthcare provider over the border. “I came from a desperate place of finally giving up [on taking a break from methotrexate] and wanting to go to the doctor, only to be met with, ‘wow, did I have bad timing’,” she said.

Methotrexate is one of the most commonly used drugs for treating autoimmune conditions, according to Kenneth Saag, president of the American College of Rheumatology. 

“It’s an essential medicine for many people, who have been using it, often, for years,” he says. “It’s been shown to retard the progression of joint damage in rheumatoid arthritis.” Rheumatoid arthritis is associated with a shorter lifespan, and there is evidence that the drug mitigates this. Indeed, methotrexate is on the World Health Organisation’s list of essential medicines.

“It’s a real problem if people have been on a medicine that’s doing very well for them and now they’re unable to access it,” Saag continues. “Stopping it may result in weeks or months of inability to control their symptoms.” 

The American College of Rheumatology tweeted that it was monitoring the issue to determine whether there was “widespread difficulty accessing methotrexate, or if any initial disruptions are potentially temporary and due to the independent actions of pharmacists trying to figure out what is and isn’t allowed where they practice.”

The problem isn’t limited to states that might potentially ban abortion. Becky Schwarz, a 27-year-old operations manager in Tyson’s Corner, Virginia, received an email from her rheumatologist a week after Roe was overturned, saying her methotrexate prescription would would not be refilled because her healthcare provider had paused all prescriptions for the drug while it implemented policies to comply with any possible regulations. 

“I’ve been in the process of weaning off [it], however I now need to accelerate that weaning due to the loss of access to the medication,” she told Novara Media by email. “This will no doubt cause an increase in disease activity and a severe flare as I’m no longer able to wean off on my own schedule, but rather a third-party decision to overturn Roe.” Schwarz has lupus, an autoimmune disease causing muscle and joint pain, stiffness, and limited mobility that sometimes leave her bedbound.

“I’m frustrated with the situation because I’m not in a relationship or looking to become pregnant any time soon. [I] feel like a second-class citizen to a potential future child over the option to be informed and educated and in control of my own body and decisions”. Abortion is legal in Virginia, and the state isn’t expected to bring in a post-Roe ban.

Refusals to dispense drugs such as methotrexate on the grounds that they can cause miscarriage do not appear to have any legal basis, according to Donald Miller, professor of pharmacy practice at North Dakota State University. “I would think it’s only fear,” he says. 

“I don’t think there’s any legal basis to say that a pharmacist shouldn’t dispense methotrexate for any indication, but […] in states that are progressively allowing people to sue healthcare providers who participate in abortion, a pharmacist could be afraid of getting in legal trouble under these state laws.”

Cheryl Crow, a patient educator with rheumatoid arthritis who has been collecting patient testimonials, echoed these concerns. “In states like Texas, Michigan and South Carolina, pharmacists are saying, ‘we don’t know what we’re allowed to do right now’,” she reports. “People’s rheumatologists are saying their entire offices, carte blanche, won’t prescribe”.

Jennifer Crow (no relation), a 48-year-old sociologist in Tellico Plains, Tennessee, missed her weekly methotrexate dose because her pharmacy cancelled her automatic refill. She takes the medicine for the neuromuscular disease myasthenia gravis and can’t become pregnant because she has had a hysterectomy. 

Her pharmacy ultimately dispensed her prescription, but her dose came two days late, and her joints were already starting to hurt. “This medicine means I can roll over in bed, it means I can put my pants on without screaming in pain,” she said. “Thinking that [I could lose access to] the drug that I use to keep myself bending and moving without pain because of the overturning of Roe v Wade was really, really frustrating.”

It isn’t clear how many drugs could be affected, or how quickly the problem will be resolved. Schwarz said her healthcare provider’s concern pertained to methotrexate specifically because of its use for treating ectopic pregnancies, and didn’t constitute a broad ban on any drug with the capacity to harm a foetus. However, Miller pointed out that methotrexate alone is “not a drug of choice at all for an abortion”.

The Lupus Foundation of America, the Crohn’s and Colitis Foundation and the Arthritis Foundation have also expressed their concern and urged patients struggling to access their meds to tell them about their experiences.

“It’s insulting that this has to happen,” Cheryl says. “If my doctor says I should take a medicine, that should be the end of the story.”