Methotrexate, a drug on the World Health Organization’s list of essential medicines, has many applications. It is prescribed for the treatment of rheumatoid arthritis and psoriatic arthritis, and for autoimmune diseases such as lupus, psoriasis, and Crohn’s disease. It is also used for several types of cancer, including breast cancer, leukemia, and lymphoma.
It is also a drug that is used to treat ectopic pregnancies, or pregnancies that happen outside the uterus, typically in a fallopian tube. Ectopic pregnancies aren’t viable, and put the mother’s health at risk. The only treatment is abortion, which is why methotrexate is used: the medication is an abortifacient, causing the end of pregnancy in women who take it.
Although about 5 million methotrexate prescriptions were filled in the US last year, some women currently report having trouble getting it prescribed, or having their prescriptions filled, in states with abortion bans.
The abortion bans going into effect in the wake of the US Supreme Court overturning Roe v. Wade have created confusion for healthcare providers. For instance, some pharmacies are unsure whether they can still sell Plan B, and have temporarily halted sales.
But it isn’t just reproductive health at risk. Patients have reported being denied medications that could cause abortion, even if they aren’t pregnant and need them for other conditions. The Lupus Foundation of America and the American College of Rheumatology both have confirmed reports of methotrexate being denied to women of childbearing age, and have made statements in support of continued access to the medication. “Pregnancy often complicates the management of women with rheumatic diseases and may threaten the life of the mother,” said the American College of Rheumatology in a statement published on their site.
Many states now only allow abortions for medical emergencies, and doctors fear legal repercussions if they intervene too soon in cases of pregnancy complications, or if they prescribe medications that could harm a fetus—even if the health of the mother, or her life, are in danger. Methotrexate is only one such medication. Drugs used in chemotherapy are often abortifacient or teratogenic (meaning they can cause malformations to the fetus, that are severe and incompatible with life), and could also be curtailed.
In some cases, patients might be given fewer options to continue treatment for cancer, for instance having to take chemo drugs with more severe side effects because they have fewer effects on pregnancies, or potentially even denied treatment.