- The overturning of Roe v Wade has led some states to pass laws that ban not only surgically induced abortions but also medication that is used to induce abortions.
- Methotrexate, which is widely used for the treatment of autoimmune disorders and cancer, is also an abortion-inducing drug used to terminate ectopic pregnancies.
- Pharmacists in states such as Texas have reportedly refused to refill methotrexate prescriptions because they’re afraid of legal repercussions.
- Methotrexate may cause birth defects, and the risk of accidental pregnancy in the absence of abortion has led rheumatologists who prescribe methotrexate to reconsider prescribing the drug for women of child-bearing years.
Recently, the United States Supreme Court overturned the ruling that established abortion rights. Wade, which protected abortion rights, was decided by the Supreme Court. The recent Supreme Court decision allows states to enact laws prohibiting or restricting abortion.
States with restrictions on abortion rights include Alabama, Arkansas, Georgia, Indiana, Iowa, Kentucky, Louisiana, Mississippi, and West Virginia. There are another 12 state legislatures where abortion restrictions may be passed or where existing abortion laws are being challenged in court. The overturning of anti-abortion laws has led clinics in some states to stop providing abortions.
Anti-abortion laws in states like Texas have also banned several medications that can be used for abortion procedures. Furthermore, these laws would allow states to prosecute healthcare providers and pharmacies for dispensing abortifacient drugs.
Among the medicines banned by these laws include drugs such as methotrexate, misoprostol, and mifepristone. These medications are also used for treating other conditions besides inducing abortions.
Recent reports suggest that restrictions on access to abortion services may also affect women who use these medications to treat other health issues.
Methotrexate is used to treat autoimmune disorders
A missed miscarriage or an incomplete miscarriage is when a pregnancy ends before 24 weeks. Fetal tissue may remain inside the uterus after a miscarriage. If you’re trying to get pregnant, a combination of Mifeprex (mifepristone) and misoprostol (also known as Cytotec) can soften the cervix and induce contractions of the uterus to help you miscarry.
Methotrexate is also used in combination to terminate ectopic pregnancies, but misoprostol is not. An ectopic pregnancy happens when a fertilized egg gets stuck somewhere else in the body and poses a threat to the mother’s life
States such as Texas have banned the use of certain medications for terminating pregnancies, but they allow the use of these drugs to induce miscarriages and ectopic pregnancies.
However, the fear that they may be prosecuted if they dispense these medications has resulted in some pharmacies refusing to dispense them for ectopic pregnancies and miscarriages.
Methotrexate can suppress the immune system and is used to treat autoimmune diseases, including rheumatology, scleroderma, and lupus. It is also approved by the FDA for treating ectopic pregnancy. Methotrexate may be used for the treatment of various types of cancer, including breast cancer, leukemia, lymphoma, and lung cancer.
Methotrexate has some advantages including its low cost and accessibility compared to other treatments. Methotrexate can cause birth defects, and female patients of childbearing age are advised to use 2 different types of birth control methods to avoid pregnancy.
Birth control failure can result in accidental pregnancies and exposure to methotrexate for the fetus.
Rheumatologists are wary of prescribing methotrexate to women of childbearing age because of the risk of birth defects and lack of access to abortions. “I think it’s important for people to know that there is no evidence that any of these treatments actually works.” an assistant professor of rheumatology at the University of Pittsburgh, told Medical News Today:
Methotrexate is one of the best medications for treating a variety of conditions, including rheumatologic diseases, psoriasis, SLE, myositis, or scleroderma.
“I expect that some rheumatologists will understandably worry about giving methotrexate to their patients because if the patient accidentally got pregnant, the fetus would now be exposed to this medication.”
Methotrexate is a very powerful drug that we rely on to manage a number of debilitating and life-threatening autoimmune diseases.
Disruption of access
Indeed, there are some reports of disrupted access to Methotrexate. Some reports indicate that rheumatologists have discontinued prescribing methotrexate to patients with autoimmune diseases. Patients with arthritis who live in states where abortion is illegal have also reported pharmacists not filling their prescriptions.
Zoe Rothblatt says that she believes that people who suffer from arthritis should be able to get access to medical marijuana.
“Patients have reached out with concerns about what’s next and wondering whether this will happen to them.” “This is a devastating problem because these are not decisions driven by medical interests and therefore put patients at risk of a flare-up and worsening of their condition.”
Many people who suffer from chronic illnesses have turned to social media to share how they’re being denied access to their medications. “A common story we’re hearing is that patients who’ve been stable on their methotrexates for years are now being told they cannot take them because they are of childbearing.
Dr. Ashima Makol, who specializes in rheumatology at Mayo Clinic, hopes this new limit to access is temporary amidst legal challenges., a rheumatologist at Mayo Clinic, said she hoped this limit to access was temporary amid legal challenges.
“The availability of medications for autoimmune diseases could be problematic at least temporarily.” “Unfortunately, this varies by state, but potentially physician-to-physician and practice-to-practice as the legal implications of prescription remain unclear to most at the current time.”
However, the extent to which these disruptions occur is not known. The American College of rheumatologists recently released the following statement.
“The ACR is aware that there are concerns regarding access to needed treatments such as methotrexate after recent decisions in Dobbs v. Reed and Glucksberg v. Jackson Women’s Health Organization. We’re monitoring this issue closely to see if rheumatologists and their patients are having any trouble accessing methotrexate. If there are any initial disruptions, we think it may be because pharmacists are trying to figure out what’s allowed where they practice.
“When prescribing medications, it may be important to ensure that the disease diagnosed or indication for prescription is clear to avoid denials.” It will be important to ensure patients understand the risks associated with medications like Methotrexate and ensure 100 percent compliance with contraception.
The ACR also announced that a special task force would be formed to determine the best course for ensuring patients are safe and have easy access to their treatments.
The wider implications
Non-teratogenic drugs are available for the treatment of autoimmune disorders. However, some individuals with these diseases respond better to teratogenic drugs such as mycophenolate and Cyclophosphamide.
The potential disruption of access to methotrexate and other teratogenic drugs in the wake of Roe v. Wade could complicate the care of pregnant women who need them for their own health.
“I fear that in this new age where abortion restrictions are becoming more common, women who have uteruses and are within reproductive age may suffer from under-treated diseases.” Dr Birru Talabi said.
“These abortion restrictions will further widen the already existing inequities in healthcare as women with autoimmune conditions will be disproportionately impacted by these restrictions compared to men.“
“This is particularly concerning for patients using medications with a fetotoxicity potential, such as mycophenolic acid (MPA) or cyclophosphamide.” “Will a patient with kidney-destroying lupus disease— lupus nephritis —be doomed to dialysis or the side effects of high-dose, long-term steroid use because no physician is willing to prescribe mycophenolate or cyclophosphamides?” added Dr. Birru Talabi.
There aren’t any safe alternatives during pregnancy
The lack of access to abortion could put women’s health at risk if they become pregnant with an autoimmune disorder or chronic gastrointestinal disease.
“Many of the medications used to treat rheumatoid arthritis (RA) during pregnancy are unsafe due to their potential to cause birth defects. Many biologic agents lack safety data for pregnant women,” says Dr. Makol said.
“Although women are counseled ahead and contraception is mandated, accidental pregnancies do occur from contraceptive failure.” Pregnancy Termination: Some diseases like Lupus may flare during pregnancy and need to be terminated for the safety of the mom.
Similarly, worsening inflammatory bowel disease symptoms during pregnancy could necessitate an abortion to save the mother’s health.
“Pregnant women with autoimmune diseases like lUPUS are much more likely to die during pregnancy than pregnant women without these conditions.” “I am deeply concerned that some of the people making legal and political decisions regarding abortion are so far removed both intellectually and emotionally from the impact of those policies on the health and well-being of women in this country.” Birru Talabi.
Doctor Birru Talabi says that she thinks more women might die from illegal abortions if abortion restrictions become more strict. And doctors would be the ones who have to deal with it, not the women themselves.
“[Legislators] may never have been called upon to pronounce the death of any woman who died during a complicated pregnancy.” Or heard the screams from children in the ICU when they’re told their mother has just passed away. As doctors, we often experience these clinical encounters—they haunt us, and we always remember them. “We are witnesses to the human impacts,” she said, “and we must act.