In the weeks following the cancellation of Roe v. Wade, people are already feeling the negative effects – and not just people who need reproductive health care. Recently, for example, people with certain autoimmune diseases, including rheumatoid arthritis and lupus, have come forward to say their access to crucial drugs has been restricted as a direct result of Roe’s reversal. Do you suppose rheumatoid arthritis is related to reproductive rights? Probably not. But according to people with rheumatoid arthritis and lupus, the problem lies with a prescription drug they take to manage their condition: methotrexate. Drugs maybe, maybe, potentially, could be used to terminate ectopic pregnancies, and because of this, some people who need it and who are “viably fertile” (i.e. theoretically capable of becoming pregnant) report that their doctors refuse to continue to prescribe them, lest they therefore be exposed to legal repercussions. Many patients have gone online to say they don’t understand how it’s considered “pro-life” for their rheumatologists to deny them this life-saving drug.
I take methotrexate to control my rheumatoid. I was told today that it can no longer be prescribed to me as I am viably fertile and it is a drug that can be used for abortion.
— Mortellus (@acrowandthedead) June 28, 2022
join the chorus of women who have now had their methotrexate (which i have to take to you know…not die) refills denied as it is considered an abortifacient and i am begging someone, anyone, to explain to me – like if i was a tiny lil fetus – how this fits into the pro-life narrative
– Taylor. (@_trashville) July 2, 2022
Rheumatoid arthritis (RA) and lupus are inflammatory autoimmune diseases that cause a person’s immune system to attack their joints, but lupus also affects organs, skin, and muscles. Both come with painful side effects that methotrexate can help treat.
POPSUGAR contacted several rheumatoid arthritis physicians for comment, but received only one response from the hospital’s Special Surgery. In an email, Noelle Carnevale, associate director of public relations and media, said: “Hospitals are encouraged to direct inquiries regarding methotrexate to the American College of Rheumatology, which is currently working on a statement of position regarding this issue.”
On July 14, under a title titled “Access to Care – ACR and Roe v. Wade Decision,” the American College of Rheumatology website stated, “The ACR opposes any action that interferes with the practice of evidence-based medicine or impinges on the doctor-patient relationship. Pregnancy often complicates the care of women with rheumatic diseases and can threaten the life of the mother. Rheumatologists and other rheumatology professionals need to be able to provide the best evidence-based care and advice to all of their patients. At press time, the CAB had not responded to POPSUGAR’s email requesting additional comment.
Learn more about methotrexate and why some doctors refuse to prescribe it to “viably fertile” people here.
What is methotrexate?
Methotrexate is a prescription drug that is typically used as a treatment for autoimmune diseases such as rheumatoid arthritis, lupus, and certain cancers. It works to calm the immune system and reduce inflammation. There is some hope that it could one day be used for other purposes as well: a recent study, for example, found that methotrexate is “a suitable treatment option for patients who require immunosuppressive drugs for the COVID-19 pandemic”.
What is the connection between methotrexate and Roe v. Wade?
According to patients speaking on Twitter, the dispute over this beneficial drug arose shortly after the Supreme Court overturned Roe v. Wade. Some health professionals refuse to prescribe it to anyone who might be pregnant because it is considered an abortifacient (more on this). Although methotrexate is FDA-approved for treating joint inflammation (and 90% of rheumatoid arthritis patients use it at some point), some states classify it as an abortion-inducing drug – because it is sometimes used to treat ectopic pregnancies, and because it carries a risk of miscarriage for pregnant women. And it’s caused “confusion and caution in drug distribution,” Steven Schultz, director of state legislative affairs at the Arthritis Foundation, told Bloomberg Law.
Worthless: The process of treating an ectopic pregnancy is not considered an abortion. The American College of Obstetricians and Gynecologists website makes a clear distinction: “Although the indication and treatment of ectopic pregnancies are distinct from the indication and provision of induced abortion, they are all two of the essential and critical aspects of health care.”
What is an abortifacient? And what is the legality surrounding it?
An abortifacient is basically any drug that could be used to perform a medically induced abortion. In the United States, the FDA has approved a combination of two drugs named mifepristone and misoprostol (this is commonly known as the “abortion pill”) to terminate pregnancies up to 70 days of gestation. Currently, the Biden administration’s executive order protecting access to reproductive health services has promised to expand protections for access to medical abortion for people seeking an abortion or experiencing loss of pregnancy. However, Slate reported that even before Roe v. Wade, medical professionals and pharmacists in states with restrictive abortion laws, such as Texas, were hesitant to prescribe abortion drugs for fear of criminal prosecution. Now, that hesitation can affect drugs like methotrexate, which are abortifacients even though they’re not primarily used for medical abortions.
Will people also be denied other drugs?
Time will tell us. But it’s worth noting that methotrexate isn’t the only drug garnering increased attention following Roe’s reversal. Refinery29 recently reported that people who take Accutane – a drug that treats severe forms of acne – have expressed concerns about how the abortion bans many states are enacting might affect them, although for a different reason than people who need methotrexate to manage their RA or lupus symptoms. Accutane is well known to cause fetal abnormalities, so much so that the The FDA says patients must prevent pregnancy before, during, and one month after stopping the drug, which also requires patients to sign an iPledge in an effort to minimize fetal exposure. According to Refinery29, drug users are terrified that if their regular contraception fails and they become pregnant, they may have no choice but to carry the pregnancy to term.
Health care at all levels is under intense scrutiny now that the 50-year precedent set by Roe v. Wade has been removed. For example, in late June, South Carolina Governor Henry McMaster signed the Medical Ethics and Diversity Act into law, making it legal for medical practitioners to refuse “non-emergency” care if it conflicts with their personal beliefs – whether religious, moral or ethical. While this law affects everyone, it specifically allows for discrimination against the LGBTQ+ community, especially trans people seeking gender-affirming hormone therapy.
Allen Chaney, director of legal defense for the ACLU of South Carolina, told NPR that he expects the law to be challenged because discrimination based on sexual orientation and gender identity prohibited by federal law: not make it lawful.”