Intended for healthcare professionals


US anti-abortion laws may restrict access to vital drug for autoimmune diseases, patient groups warn

BMJ 2022; 378 doi: (Published 06 July 2022) Cite this as: BMJ 2022;378:o1677
  1. Elisabeth Mahase
  1. The BMJ

Patients are reporting trouble accessing drugs for autoimmune diseases in light of some US states banning abortion inducing drugs, charities have warned.

The problem has arisen in the wake of the US Supreme Court’s ruling on 24 June to overturn Roe v Wade, which had given women the right to abortion.1 Since then, 15 states have banned abortion, or severely limited the circumstances under which it can happen.2

These bans have already begun causing problems for people trying to access drugs that are considered “abortion inducing” for other conditions, patient groups have reported. One key example is methotrexate, which can be used to terminate a pregnancy but is also approved for the treatment of rheumatoid arthritis, lupus, and cancer. Additionally, it is used to treat patients after an early pregnancy loss, including ectopic pregnancy and miscarriage.

The non-profit Arthritis Foundation said in a statement,3 “Unfortunately, arthritis patients who rely on methotrexate are reporting difficulty accessing it. At least one state—Texas—allows pharmacists to refuse to fill prescriptions for misoprostol and methotrexate, which together can be used for medical abortions. Already there are reports that people in Texas who miscarry or take methotrexate for arthritis are having trouble getting their prescriptions filled.”

The foundation stressed that methotrexate is “critical” for those who take it, especially for infants with juvenile idiopathic arthritis for which the drug can be “life changing, getting the disease into remission so the child can live a full and pain free life.”

Commenting on the situation, Donald Miller, professor and chair of the pharmacy practice department at North Dakota State University, said, “This is a terrible situation since so many patients depend on methotrexate. It’s very sad that pharmacists must protect themselves from going to jail for filling a prescription.”

Other patient groups and charities have also been quick to highlight their concerns. Lupus Foundation of America said,4 “We are aware of reports that some people are having difficulty accessing methotrexate in the wake of the Supreme Court’s ruling. We are working with our Medical Scientific Advisory Council to guide our efforts so we can help ensure that people with lupus have access to the treatments they need.”

Meanwhile, the Crohn’s and Colitis Foundation has flagged the matter to those with inflammatory bowel disease and said it is “proactively investigating this situation.”5