Some Patients Report Being Denied Autoimmune Drugs over Abortion Fears

Paralyzing caution reveals the risks of vague anti-abortion legislation.

In the wake of the U.S. Supreme Court overturning Roe v. Wade, a woman in Virginia and a doctor in Chicago say that access to a drug widely used for treating autoimmune disorders is being restricted over abortion concerns. 

Methotrexate is used to treat both cancer and various autoimmune disorders. The American College of Rheumatology describes it as "one of the most effective and commonly used medications in the treatment of rheumatoid arthritis and other forms of inflammatory arthritis, and also may be used to treat lupus, inflammatory myositis, vasculitis, and some forms of childhood arthritis." 

But it's also used in an obstetric context to terminate ectopic pregnancies, which are pregnancies that result from an embryo implanting in tissue outside the uterus. These nonviable pregnancies are "a significant cause of pregnancy-related mortality and morbidity" and the "leading cause of hemorrhage-related mortality," according to the American College of Obstetrics and Gynecology. 

Since the Supreme Court handed down its ruling in Dobbs v. Jackson Women's Health Organization, the decision that overturned Roe, one female lupus patient in Virginia and a rheumatology doctor in Chicago say that access to methotrexate has been hindered.

According to The Los Angeles Times, Becky Schwarz, a woman with the autoimmune disorder lupus, was denied her regular Methotrexate refill by her rheumatologist, who directly cited "the reversal of Roe v. Wade." Lupus can cause symptoms ranging from joint pains to a butterfly rash on the face, fevers, fatigue, hair loss, chest pain, and sores. To make matters more confusing, Schwarz lives in Virginia—a state where abortion is currently legal with no restrictions up to the end of the second trimester.

"i've never had an abortion but my access to healthcare has changed because Roe was overturned." Schwarz tweeted. "in less than one week i lost access to healthcare that i need because the drug could be used to induce abortions. it took 144 hours for me to have less safe healthcare because Roe was overturned."

It is not clear why Schwarz's doctor would no longer prescribe her the drug, or whether it's an isolated incident or an example of a trend. The Los Angeles Times piece reported only one other specific incident, shared with the reporter by Chicago physician Cuoghi Edens, regarding an 8-year-old girl in Texas whose pharmacist "initially refused to dispense" methotrexate because "Females of possible child bearing potential have to have diagnosis on hard copy with state abortion laws."

The American College of Rheumatology wrote on twitter that it is investigating whether and to what extent "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."

Reason reached out to the American College of Rheumatology for further comment, but did not receive a response by time of publication.

After her tweets drew media attention Schwarz wrote, "i would also like to clarify that this may be temporary in my state. i think some places are seeing large over corrections to avoid legal trouble." She continued, "if this is happening in a blue state with no trigger law, think of those in red states where abortion isn't even legal. and those states that have trigger laws causing extreme and immediate loss of access."

If these two cases are true, they tell us something important regardless of whether they are indicative of a larger trend: broadly written prohibitions create compliance confusion and impose unanticipated burdens on people who were not the intended targets of the ban. 

As more states work to ban or limit abortion, lawmakers will need to take seriously the risks of writing laws too broadly and too vaguely. When anti-abortion legislation promises to punish wrongdoing, but doesn't precisely explain who can be punished and for what, the rational response for an uncertain provider or pharmacist is to err on the side of caution, in these cases, at the expense of patients.