Medical Associations Warn of 'Irreparable Harm' Without Clear Guidance on State Abortion Laws

Four nationwide medical associations on Thursday called on state officials to clarify anti-abortion laws that have gone into effect in the wake of the U.S. Supreme Court's overturning of Roe v. Wade, noting that a "confusing legal landscape" has resulted from the patchwork of state-level restrictions--and has already led to patients being denied care.

"As physicians and pharmacists, we view patient wellbeing as paramount and are deeply troubled that continuity of care is being disrupted."

Pharmacists and doctors have been left with "many questions about how broadly state laws will be interpreted and the impact of these actions on physicians' and pharmacists' ability to serve the needs of their patients," said the American Medical Association (AMA), American Society of Health-System Pharmacists, National Community Pharmacists Association, and American Pharmacists Association in a statement.

More than half of U.S. states have either already restricted access to abortion care or are likely to, and states including Indiana and Texas have banned medication abortions at specific points in pregnancy. Lawmakers in South Dakota and Montana have also proposed restrictions on medication abortion but courts have temporarily enjoined the laws.

Uncertainty about the status of bans is compounded by the language in the restrictions, the groups said.

"In many states, these laws prohibit prescribing and dispensing an 'abortion-inducing drug,' or contain other comparable terms," they said. "This language is vague, and it is unclear whether it prohibits certain medications only when prescribed to induce abortion or whether a medication is prohibited entirely if it has the potential to induce abortion regardless of the condition for which it was prescribed."

Without clarifying guidance regarding what pharmacists and physicians are permitted to dispense and for what health conditions, the groups said, "we are deeply concerned that our patients will lose access to care and suffer irreparable harm."

The associations named the commonly prescribed drug methotrexate as a drug which was rendered off-limits overnight for some of the millions of people who rely on it to treat chronic conditions. Methotrexate is prescribed to patients experiencing ectopic pregnancies, which a fetus cannot survive and which can be fatal for a pregnant patient if left untreated. It is also taken by millions of people each year to treat lupus, Crohn's disease, and arthritis.

As Common Dreams reported in July, medical providers have learned of cases of children with juvenile arthritis who have been denied the drug in states with abortion bans. One eight-year-old suffering from the condition in Texas was identified by a pharmacist as a "female of possible child-bearing potential" who needed proof of her diagnosis to obtain the medication.

"Our members and our patients report that this uncertainty is disrupting care," said the organizations. "Patients who rely on these medications for reasons unrelated to pregnancy termination report new challenges in accessing these and other medications, and it is placing our patients' health at risk."

Access to mifepristone, which can be used for medication abortions as well as to relieve pain during an IUD insertion and for pregnancy-related conditions, has also reportedly been threatened in states hostile to abortion rights.

The groups noted several "examples that highlight reactionary steps taken by various stakeholders stemming from a lack of clarity in state policy," including:

• Reports of legal counsel, tasked with minimizing legal exposure for their institution and employees, prioritizing caution over access and advising against providing certain medications;
• The removal of emergency contraceptives (which are not abortifacients) from kits used by organizations to care for victims of sexual assault--compounding the trauma these victims experience--because the legal risk is too unclear; and
• Policies requiring pharmacists to reject prescriptions unless new, burdensome administrative processes are met, such as confirming a female patient's diagnosis with the prescriber for every potential abortifacient regardless of whether the medication has multiple uses, like methotrexate.

"Without access to medications proven to be safe and effective, our patients' health is at risk," the organizations said. "As physicians and pharmacists, we view patient well-being as paramount and are deeply troubled that continuity of care is being disrupted."

Two months after the AMA condemned the overturning of Roe as "a direct attack on the practice of medicine" and a violation of patients' rights, the groups called on state lawmakers to issue guidance or pass new regulations to ensure patients can access the medication they need.