Abortion ban affecting access to medicines

On July 13, the US Department of Health and Human Services (HHS) informed pharmacies that refusing to fill prescriptions for drugs containing ingredients that could induce abortion or prevent pregnancy could be in violation of federal civil rights law.

The new direction, which targets the approximately 60,000 retail pharmacies across the country, explains how withholding certain drugs would discriminate against customers because of their gender or disability. These drugs include contraceptives, treatments for miscarriage, and several non-abortive drugs used to treat conditions such as rheumatoid arthritis, ulcers, and multiple sclerosis.

[Related: The US can’t agree on what a life-saving abortion is]

Experts worry that some pharmacists in states that have adopted abortion restrictions are unwilling to dispense common drugs, even when they have been prescribed for purposes other than reproductive health care. “Reproductive rights are not just a women’s issue, nor just a [obstetrics] problem,” said Sara C. LaHue, assistant professor of clinical neurology at the University of California, San Francisco, in an email. “The restrictions on abortion will affect the care provided by the vast majority of medical specialties in the United States.”

Abortive drugs with multiple uses

The HHS document outlines several situations where refusing to fill a prescription can be discriminatory. These include prescriptions for mifepristone and misoprostol, which are used for both abortion and miscarriage care. Mifepristone blocks the hormones necessary for a pregnancy to continue, while misoprostol causes the cervix to soften and the uterus to contract and empty.

“Because these are the drugs also used for first-trimester abortion, some pharmacists reportedly do not dispense them to patients who miscarry, despite having a valid prescription, for fear of violating their country’s abortion laws. state,” Katharine O’Connell White, associate professor of obstetrics and gynecology at Boston University School of Medicine and gynecologist at Boston Medical Center, said in an email. “Restricting access to mifepristone and misoprostol deprives people who have a miscarriage of the choice to manage their pregnancy loss with medication and avoid intervention. This makes the already difficult experience of pregnancy loss even worse.

Misoprostol is also prescribed for people who experience very heavy bleeding during a miscarriage. If these patients are unable to fill a prescription for misoprostol at the pharmacy, White wrote, they are at higher risk of hemorrhaging, needing a blood transfusion, or dying.

Misoprostol was developed in the 1970s to treat stomach ulcers. It is still used to prevent ulcers related to long-term use of anti-inflammatory medications like ibuprofen, White explained. Drugs protects the stomach by reducing acid secretion, increasing mucus production and altering blood flow in the lining of the organ.

[Related: Aspirin has long been prescribed to prevent heart attacks. Now experts say it shouldn’t.]

Another drug with various uses is methotrexate. The drug was first introduced in the 1940s as a chemotherapy agent due to its ability to prevent cells from make and repair DNA, and is used today to treat a variety of cancers. Methotrexate also suppresses the immune system and is prescribed for multiple sclerosis, myasthenia gravis, rheumatoid arthritis, psoriasis and Crohn’s disease, LaHue explained.

Additionally, methotrexate can be used to terminate ectopic pregnancies, which occur when a fertilized egg grows outside the uterus—by disrupting folic acid metabolism to halt cell growth. “If a pharmacist does not release this drug, then a patient is forced to undergo surgery during which they will likely lose one of their fallopian tubes,” White wrote. Without surgery, an ectopic pregnancy can rupture and lead to bleeding and death. “Put simply, abortion care cannot be separated from the rest of pregnancy care,” she added.

According to a recent statement from the Arthritis Foundation, residents of states like Texas are reporting difficulty getting their methotrexate prescriptions filled. If a pharmacy refuses to fill a prescription for methotrexate because it will terminate an ectopic pregnancy, it may be discriminating on the basis of gender, according to HHS. And if the pharmacy refuses to fill a prescription for methotrexate to treat a customer’s rheumatoid arthritis because of its other uses, it may be discriminating on the basis of disability, department policy says. Similarly, if a pharmacy refuses to fill a customer’s prescription for mifepristone and misoprostol to manage a miscarriage, or misoprostol for severe and chronic ulcers, this could be discriminatory on the basis of gender and gender. disability, respectively.

Some pharmacies are also refusal to stock or distribute contraceptives based on misconceptions about how treatments work. Birth control pills, morning-after pills, IUDs and other contraceptives prevent pregnancies from occurring — they don’t cause abortions, White pointed out. If a pharmacy refuses to fill a prescription for emergency or hormonal contraception, but provides other contraceptives such as condoms, that could be considered gender discrimination, according to HHS.

Ripple Effects of Roe’s Inversion v. wade

The recent Supreme Court decision to end the longstanding right to abortion in the United States could also make certain non-abortive drugs that may affect fetal development less accessible, explained LaHue, who published an article in the newspaper JAMA Neurology earlier this month about how the decision will affect neurologists’ ability to properly care for their patients.

Several common drugs for neurological conditions have teratogenic effects, which means they can interfere with the development of an embryo or fetus. These include the drugs teriflunomide and fingolimod for multiple sclerosis and an anticonvulsant drug called valproate. Often, people who are able to become pregnant must use contraception to be prescribed teratogenic drugs, LaHue explained.

“However, no contraceptive is 100% effective, and some drugs (especially anticonvulsants) can even reduce the effectiveness of contraceptives. Thus, unwanted pregnancies with these drugs are realistically unavoidable,” he said. she wrote in her email, “Doctors may not want to prescribe them in states where abortion is banned, and we may also see an increase in serious birth defects in those states.”

“Put simply, abortion care cannot be separated from the rest of pregnancy care.”

Katharine O’Connell White, gynecologist at Boston Medical Center

Many cancer drugs can also be teratogenic. This raises the possibility that in some areas a sick patient who becomes pregnant may not be eligible for certain treatments. “Restrictions on reproductive health care will limit management options for women with life-threatening diagnoses during pregnancy,” LaHue noted.

An additional concern is with drugs that have not yet been shown to be safe in pregnancy. Many drugs lack data on this issue, LaHue said. “In these cases, it is safer for the fetus to avoid such drugs, but it may mean that the mother is denied treatment not because of evidence of harm, but because of a lack of evidence” , she added. “We need pharmaceutical companies to study teratogenic risk profiles to reduce disparities in care between medical specialties.”

Meanwhile, HHS stressed that it is committed to “vigorously enforcing” civil rights laws to protect the health of those who are pregnant or have miscarriages. Among its civil rights enforcement responsibilities, it is charged with protecting the rights of women and pregnant people in their ability to access care free of discrimination,” the agency wrote in its new guidelines for pharmacies. . “This includes their ability to access reproductive health care, including prescription drugs from their pharmacy, without discrimination.”

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