Overturning Roe v. Wade has far-reaching consequences for many communities — including access to needed medication.
I was diagnosed with rheumatoid arthritis (RA) when I was 20 years old. My doctor immediately prescribed methotrexate.
I’ve been on this medication to slow down the progression of RA for the better part of the last two decades. My medical team thinks it’s a key reason why I’ve been able to live such a full life despite having RA.
After the U.S. Supreme Court’s Dobbs v. Jackson decision to overturn Roe v. Wade this year, effectively removing the constitutional right to abortion, I started noticing that patients in states like Texas, North Carolina, and Michigan were facing new difficulties accessing methotrexate.
People were posting on social media trying to figure out why their pharmacist was denying their prescription. But how is this related to Roe v. Wade?
I’ll explain why access to methotrexate has changed and why it’s such an important drug for multiple communities, including those affected by rheumatic diseases and inflammatory conditions. Importantly, I’ll also share what you can do if you’ve been affected.
The following is Bezzy’s response to the overturning of Roe v. Wade from our Medical Director at Healthline Media.
“Many lives will be impacted by the decision, and the ripple effects of this decision will change generations of lives and cause unnecessary pain and suffering for many. At a time when we should continue to focus on improving the health and well-being of our nation, this decision will cause long-term ill effects both physically and mentally to generations of women and beyond, and will deepen inequalities in access to care for historically marginalized people. ” — Dr. Jenny Yu, Medical Director, Healthline Media
Methotrexate is often referred to as the “gold standard” when treating RA, and it’s a staple in treating other rheumatic conditions such as psoriatic arthritis (PsA) and lupus.
According to the American College of Rheumatology, the professional association for rheumatologists, methotrexate is “one of the most effective and commonly used medications in the treatment of rheumatoid arthritis and other forms of inflammatory arthritis.”
When used to treat rheumatic diseases, methotrexate is commonly referred to as a disease-modifying anti-rheumatic drug (DMARD). It can decrease pain, swelling, and long-term damage to joints.
For me, one of the most important benefits of using methotrexate is its effect on mortality for those living with RA. Historically, the lifespan for someone with RA has been 10 years lower than the average person. While more recent studies are needed, methotrexate has previously been shown to help prolong the lifespan of people with RA.
Methotrexate is also crucial for my treatment because, when taken in conjunction with a biologic medication, it can make me less likely to develop antibodies to the biologic — which unfortunately has happened to me in the past.
The importance of methotrexate can’t be underestimated.
When I spoke with my friend, Janah, she said “Methotrexate is probably the most important and most effective medication I have for my spondylitis.”
Methotrexate is used to treat a number of other conditions, including other inflammatory diseases such as psoriasis and Crohn’s disease. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. For Crohn’s, it helps to reduce irritation and inflammation in the intestines.
At higher doses, methotrexate is also prescribed to treat cancers. It’s a type of chemotherapy that slows the growth of cancer cells.
According to the American College of Obstetricians and Gynecologists, methotrexate is also the most commonly prescribed medication to treat ectopic pregnancies. By stopping the cells from growing, methotrexate effectively ends a pregnancy.
Even in small doses, like those used for RA, methotrexate is a teratogenic medication, meaning it can cause birth defects. That’s why, for example, I was counseled to stop using methotrexate for 3 months prior to getting pregnant and continued to stay off it during my pregnancy.
At higher doses, like those used to treat an ectopic pregnancy, some states define methotrexate as a drug used for abortion.
Since overturning Roe v. Wade on June 24th, 2022, individual states are now able to ban abortions, including treatment of ectopic pregnancy and hence methotrexate. While the laws should only apply to the treatment of ectopic pregnancy, in states like Texas, some pharmacists are avoiding distributing methotrexate since they could be criminally prosecuted if they unknowingly give it to someone pregnant.
I have heard numerous stories on social media detailing how access to methotrexate has become difficult.
For example, Twitter user @BeccaLizz who lives in Virginia was told by her rheumatologist that the clinic will no longer prescribe methotrexate for her lupus “because it is used as an abortifacient.”
Another Twitter user @JenMichelleCrow received an automated call informing her that any refills of methotrexate would be denied for treatment of her autoimmune disease, despite her not having a uterus.
Prominent patient advocacy organizations have been gathering data to respond to this issue.
The following articles contain further information and resources, as well as contact information for where to share your story:
Make sure to stay up-to-date and informed by following tags #methotrexate and #MXT. If possible, share your stories so that organizations and advocacy groups can build a greater picture of the situation for citizens across different states.
After living with RA for almost 20 years and connecting to hundreds of patients through social media, I’ve heard far too many stories of patients who have had to suffer unnecessarily due to a lack of accommodations from employers, not always being believed by friends and family, and a number of different insurance barriers, such as “fail first” policies.
After the challenges of the pandemic — which required many of the immunocompromised to stay isolated for extended periods of time and resulted in new limitations to medication access — it’s heartbreaking to face yet another barrier.
I know I’m not the only one who’s feeling down about this issue. When I spoke with artist Savannah Magnolia, @meltingmagnolia, she said: “Regardless of what they are, pharmacy nightmares are already hard to deal with. I can’t imagine trying to fight with a pharmacist to get my medication filled just because they’re trying to protect their license.”
We’ve already been through so much. The last thing we need right now is for a safe, effective medication to be taken away from us.
On a personal level, it’s insulting and demoralizing to learn that my doctor, who has known me for 20 years, can be overruled by an entity that has no idea who I am or what’s best for me medically.
I personally live in Washington state which doesn’t look like it will be affected, but my heart still breaks for those facing stress, fear, pain, and disease progression due to policy changes after the overturning of Roe v. Wade. We must fight for our right to access healthcare and these important medications!
*All quotes from friends and personal messages were shared with permission.
Medically reviewed on July 08, 2022
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