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A woman is prescribed pills to terminate her pregnancy

A resident gives a 25-year-old woman medication to terminate her pregnancy on June 23, 2022 in Albuquerque, New Mexico. (Photo: Gina Ferazzi/Los Angeles Times via Getty Images)

In Post-Roe US, Patients Already Denied Care for Wide Range of Medical Concerns

"I have gotten some reports where children have been denied methotrexate for their juvenile arthritis until they've proven they're not pregnant," said one physician.

Julia Conley

The chilling effect of abortion bans that have entered into force in at least 10 states since Roe v. Wade was overturned in late June is already reaching patients who need medication for a variety of health concerns, including pain management during IUD insertions and arthritis.

Dr. Alexandra Weiss Band, an obstetrician and gynecologist in New Orleans, filed an affidavit in the New Orleans Civil District Court on July 5 in a case challenging Louisiana's law banning nearly all abortions, regarding her experience trying to fill a prescription for a patient who has having an IUD inserted.

"Roe's repeal undermines Americans' healthcare in far broader ways than most realize."

As The New Orleans Advocate reported Sunday, Band prescribed Cytotec, a brand name of misoprostol, which is one of two pills prescribed for medication abortions. The drug softens the cervix, making it effective for inducing labor and inserting an IUD as well as for abortions.

The pharmacist at the Walgreens location where Band called in the prescription refused to dispense the medication even after the doctor told them what it was for.

"The response from Walgreens was that it would still not be filling the prescription because they could not be sure we weren't prescribing this for an abortion, and so they will no longer dispense the drug," Band's affidavit read. "For obvious reasons, this is interfering with the best, medically appropriate care I can give to my patients."

Band's patient was just one person whose medical needs were not met due to the overturning of Roe. In addition to millions of people who no longer have access to abortion care unless they cross state lines—which Republicans also want to bar them from doing—autoimmune patients across the country are facing threats to their access to a commonly used medication.

Methotrexate is used by millions of people to treat lupus, arthritis, Crohn's disease, cancer, and a number of other conditions. It can cause miscarriages in high doses, and about 2% of patients it's prescribed to each year take it to treat ectopic pregnancies, in which the fertilized egg implants outside the uterus.

Embryos cannot survive an ectopic pregnancy, and the condition can be fatal for a pregnant patient if left untreated. Even though the abortion bans proposed in nearly two dozen states include exceptions for patients whose lives are at risk, medical experts say the legislation is so vaguely written it's likely to cause doctors to hesitate before providing abortion care that is ostensibly still legal.

As the Advocate reported:

Already, more doctors are "charting defensively" to document every step of their decision-making process. Some are having other doctors sign off that a dangerous or failed pregnancy requiring a late-stage abortion known as an evacuation is necessary.

"We are going to have to document very clearly and very carefully," said Dr. Jennifer Avegno, an emergency room physician and director of the New Orleans Health Department. "Many providers believe there is a target on their back and that in this climate, as has happened in other states, there is a desire to make an example of providers someone thinks might be violating the law."

For patients who rely on methotrexate for conditions that have nothing to do with pregnancy or abortion, access to the medication has already been reduced because of pharmacists' and doctors' fears of prosecution.

As the Los Angeles Times reported Monday, one pharmacist in Texas refused to dispense the medicine to an eight-year-old girl for juvenile arthritis, writing, "Females of possible child bearing potential have to have diagnosis on hard copy with state abortion laws."

"I have gotten some reports where children have been denied methotrexate for their juvenile arthritis until they've proven they're not pregnant," Dr. Cuoghi Edens, an assistant professor of internal medicine and pediatrics at University of Chicago Medicine, told the Times.

Sarah Blahovec of Alexandria, Virginia, who has Crohn's disease, told the Times that she is waiting to find out whether her prescription will be refilled.

"I've tried all the options," she told the newspaper. "Anything weaker, I'll go out of remission. And anything stronger, I'll get these infections."

Eric Levitz of New York magazine called on Democrats to take action to address the chilling effect the end of Roe is already having on a wide variety of healthcare treatments.

"Roe's repeal undermines Americans' healthcare in far broader ways than most realize," Levitz tweeted. "Democrats should be doing more to raise awareness of these problems (like, say, by trying to pass legislation that addresses them)."

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