An unintended consequence of the Dobbs v. Jackson decision overruling Roe v. Wade, is that some autoimmune patients are having difficulty accessing medication.

As you are likely aware, the U.S. Supreme Court recently issued Dobbs v. Jackson, which overruled Roe v. Wade. The court essentially sent the issue of the legality of abortions to the states, and multiple states had “trigger laws” immediately making abortions in those states illegal.

Certain medications that are commonly prescribed for chronic medical conditions like inflammatory arthritis may also be used for medical abortions, and have been wrongly restricted in the past week.

Methotrexate, for example, is a disease modifying anti-rheumatic drug (DMARD) prescribed for a variety of diseases such as rheumatoid arthritis, psoriasis, and lupus, as well as for the termination of an ectopic pregnancy. An ectopic pregnancy occurs when a fertilized egg implants outside of the womb, primarily in the Fallopian tube. As the pregnancy progresses, the tube grows and can rupture, resulting in severe internal bleeding and even death for the pregnant person if left untreated. Very rarely is the fetus able to survive, and thus abortion is usually indicated to reduce the risk of rupture, severe complications, and death.

The effects of the Court’s ruling on such medications is dependent on state laws. People with chronic illness are especially at risk in states with stricter regulations and outright bans, such as Texas, where legislation such as S.B. 4 restrict the distribution of medication that can be used for abortion, including methotrexate and misoprostol, which is classified as an “abortion-inducing drug” under state law.

The chronic illness community has been outspoken about the need for DMARDs in treating diseases, keeping health stable, and lessening the risk of flare-ups.

We spoke to rheumatoid arthritis patient advocate and occupational therapist Cheryl Crow about what these laws mean for patients like her. “Far too many patients with inflammatory arthritis in the U.S. already routinely spend hours overcoming insurance barriers to our medications. If we are now denied methotrexate, one of the most affordable and long standing ‘gold standard’ treatments for rheumatoid arthritis (which I personally have been on for 16 of the last 19 years), we are left with very few options for slowing down our progressive, systemic disease,” says Cheryl. “Rheumatoid arthritis might sound benign or like just joint pain, but if this disease is uncontrolled, it is associated with a significant reduction in lifespan – so yes, this is an issue of my right to live as well. My life matters and the lives of those living with rheumatic diseases matter. The issue of pharmacists not being sure whether it’s legal to fulfill methotrexate is just one more barrier to inflammatory arthritis patients getting the comprehensive care we deserve.”

Psoriatic arthritis patient advocate Madison Hartson reminds us to take care of mental health during this news and how exhausting it is to continue advocating. “I am sick and tired of our community having to fight through ableism, medical trauma and gaslighting, a global pandemic, which has isolated many and now this: methotrexate banned in anti-abortion states. Your feelings of anger and exhaustion are valid. Take the time you need to rest because our fight isn’t over! I know it’s exhausting to be constantly advocating for our own healthcare and well-being, but our chronic illness community depends on your voice,” says Madison.

Take Action!

If you currently take a medication with alternate uses relating to abortion, talk to your providers:

• Doctors may have to go to extra lengths to verify that the prescription is not being written for a medication abortion
• Insurance agencies may require new prior authorization checks before covering a medication
• Pharmacists may deny filling prescriptions if the use of the medication is not clear or if there is a possibility that the medication, while prescribed for another medical condition, will be used by a pregnant person
• As a result, medications may be harder to acquire and you may experience delays in treatment that can result in worsening health conditions
• People of childbearing age taking such medications who do not wish to conceive should talk with their doctors about effective contraception
• Ask your doctor about requesting a 90-day supply of medication to reduce the risk of facing future delays

If you have a chronic illness or take medication and are trying to become pregnant, talk to your doctor to establish a plan for treatment while trying to conceive and carry a pregnancy to reduce risks to both you and your fetus.

Regardless of whether you use a DMARD, make your voice heard! Contact your local representatives and let them the importance of not restricting access to vital medications for chronically ill patients. You can find your representatives here: https://myreps.datamade.us/.

CreakyJoints and the Global Healthy Living Foundation understand how upsetting and frustrating it is to be in this position. If you would like to share your concerns or story about accessing medications as a result of abortion bans, please email Zoe Rothblatt, Associate Director of Community Outreach.

Want to Get More Involved with Patient Advocacy?

The 50-State Network is the grassroots advocacy arm of CreakyJoints and the Global Healthy Living Foundation, comprised of patients with chronic illness who are trained as health care activists to proactively connect with local, state, and federal health policy stakeholders to share their perspectives and influence change. If you want to effect change and make health care more affordable and accessible to patients with chronic illness, learn more here.