Since Roe v. Wade was overturned, people who take a prescription drug called methotrexate-which is used to treat lupus, rheumatoid arthritis, and some cancers-say their access is being limited in some states with abortion bans, since the medication is used to treat ectopic pregnancies. Even though ectopic pregnancies, which are always fatal for the fetus, aren't treated with abortion, sweeping abortion bans in conservative states have healthcare providers, including pharmacists, nervous about distributing methotrexate to people capable of becoming pregnant.
People who aren't able to access their medication are speaking out on Twitter, and others who take methotrexate are joining the conversation, explaining how necessary it is to manage debilitating symptoms. "I take methotrexate to control my Rheumatoid. I was told today I could not be prescribed it any longer as I am viably fertile and it is a medication that can be used for abortion," one person tweeted. Another wrote, "I've taken #methotrexate for over 15 years. Without it, I probably would have a fused spine due to severe ankylosing spondylitis (like several generations in my family). I grieve for women losing access b/c [doctors] are scared to prescribe it in fear of losing their license." Another user said: "joining the choir of women who have now had their methotrexate (which i have to take to you know.not die) refills denied bc it is considered an abortifacient & am begging someone, anyone, to explain to me-like i'm a tiny lil fetus-how this fits into the pro-life narrative."
https://twitter.com/sadgorlzai/status/1544072032106823689
https://twitter.com/BeccaLizz/status/1542684741308145664
According to a May 24 report by Christina Cauterucci in Slate, some pharmacists in Texas were already unsure-even before Roe was officially overturned-if they should fill prescriptions for methotrexate now, in part because a Texas law has specifically named the medication as "abortion-inducing."
It's true that methotrexate is used to treat ectopic pregnancies, which occur when a fetus develops outside the uterus; they aren't viable pregnancies. But methotrexate is used primarily to treat people with debilitating conditions like rheumatoid arthritis, Cuoghi Edens, MD, an assistant professor of pediatrics and assistant professor of medicine at the University of Chicago Medicine, tells SELF. There are five million methotrexate prescriptions each year in the U.S. and only about 100,000 ectopic pregnancies, Dr. Edens notes, adding,"Methotrexate is really the standard of care."
In the context of rheumatoid arthritis, it's an extremely common drug: About 90% of patients take it at some point to manage symptoms, according to the Arthritis Foundation. It is often prescribed as pills; if these don't provide relief, a provider may suggest a shot of the medication under the skin.
Methotrexate also isn't new: It was developed in the 1940s as a cancer treatment, according to the Arthritis Foundation, and Dr. Edens says it's been used to treat both children and adults for decades. However, access may be limited in different ways as healthcare providers try navigating a post-Roe world. Doctors may be more hesitant to prescribe it to people capable of becoming pregnant-including children who are technically in this category-and pharmacists may be more hesitant to fill the prescriptions that do get written. Dr. Edens says she recently got a call from a colleague in Texas who told her about an 8-year-old girl who couldn't access methotrexate because a pharmacist refused to fill her prescription for it. "This is going to negatively affect children," Dr. Edens says, adding that patients who can't access their methotrexate may be in more physical pain as a result. Additionally, limiting access to methotrexate could cause problems with other treatment options, since insurance companies often require patients to try methotrexate first before they agree to cover other treatment options, Dr. Edens says.
One 27-year-old lupus patient in Virginia, Becky Schwarz, spoke with Newsweek after finding out methotrexate was no longer available to her. Shwarz says lupus takes a toll on her everyday life, making it difficult to walk for an extended period of time or stand for the duration of a shower. However, methotrexate provides relief for her symptoms: "I can go more consecutive days without pain than before [taking methotrexate], and on the days I am in pain, it isn't as severe as it was," she told Newsweek. In a June 30th tweet, Schwarz said: "Roe was overturned 6 days ago. in less than one week i lost access to healthcare that i need because the drug could be used to induce abortions."
The American College of Rheumatology (ACR) said in a statement to SELF that a "task force" has been assembled to ensure patients can continue to access methotrexate. "The ACR is aware of the emerging concerns surrounding access to needed treatments such as methotrexate after the recent decision in Dobbs v. Jackson Women's Health Organization," the statement says. "We are following this issue closely to determine if rheumatology providers and patients are experiencing any 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." Patients who have experienced difficulty accessing their medication need to reach out to advocacy@rheumatology.org, the statement says. The Arthritis Foundation also has a hotline for patients having trouble accessing methotrexate (1-800-283-7800).
Difficulty accessing methotrexate is only the latest in what is sure to be a slew of restrictions that will keep people who can, technically, get pregnant from the health care they need, in contexts far outside the realm of reproductive health.
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