Mortellus is a 40-year-old author and mortician living in rural North Carolina. They are a practicing necromancer and witch, and they also have rheumatoid arthritis.
Recently, they shared on Twitter that their doctor is refusing to continue prescribing the common arthritis medication methotrexate to them because it can also be used for abortion. To be clear, they are NOT currently or planning to become pregnant.
I take methotrexate to control my Rhumatoid. I was told today I could not be prescribed it any longer as I am viably fertile and it is a medication that can be used for abortion.
And sadly, Mortellus isn't the only one running into this problem. In the replies, other users shared that they're also encountering difficulties acquiring this drug as an arthritis treatment, and similar threads have been popping up elsewhere on Twitter.
Others rightly pointed out that withholding these kinds of important medications on the basis that someone has the ability to get pregnant is deeply unjust.
Via email, Mortellus shared with BuzzFeed that although they live in North Carolina, a state where abortion is still legal, their rheumatologist is just across the border in South Carolina. In that state, a law banning abortions after six weeks is now in effect and doctors are also allowed to deny nonemergency care that conflicts with their religious beliefs, such as family planning, under the Medical Ethics and Diversity Act.
Mortellus also told BuzzFeed that they have been taking this medication for over a decade and have been a patient at the South Carolina practice for about five years without experiencing this problem.
And they said that the response to their post has been overwhelming. "I never imagined how many people this situation would resonate with." Additionally, they have a referral to see a new rheumatologist in North Carolina. In the meantime, they still have some of their medication so hopefully they don't have to experience a lapse in treatment.
NBC / Via giphy.com
To learn more about methotrexate and how decisions like this affect patient care, I reached out to Dr. Anisur Rahman, Professor of Rheumatology at University College London. Dr. Rahman explained that this medication can be used to treat many different conditions, including rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and myositis.
"It suppresses the immune system and that is why it is useful in treating these diseases, which are caused by the immune system attacking our body. It is very effective both in reducing symptoms and in stopping long-term damage." However, if a patient has to stop taking this medication and no alternative is prescribed, he says it can cause a flare-up of symptoms and may lead to long-term damage.
"Methotrexate is contra-indicated in pregnancy as it could harm the unborn baby," Dr. Rahman says. "In the UK, the general approach is that when starting a drug like that in a person who may become pregnant, we are careful to give them counseling that they must not get pregnant on the drug, and confirm that either they are not at risk of pregnancy because they are not sexually active at present or are taking a reliable method of contraception."
"If they are at risk of pregnancy because they're sexually active and not taking reliable contraception or they want to have a child soon, then methotrexate would not be started and an alternative drug would be used."
"I have always found that you can trust patients to take responsibility for their own health in this regard. So if a patient tells me that she is taking all precautions not to get pregnant, I would continue prescribing methotrexate."
"I have not had a case where someone got pregnant accidentally while taking methotrexate, but colleagues have and it does happen. In that case, in the UK, abortion is an option."
The American College of Rheumatology has issued a statement on social media after hearing patient concerns about how the recent Supreme Court decision is affecting their health. "We are following this issue closely to determine if #rheum [rheumatology] providers and patients are experiencing any widespread difficulty accessing #MTX [methotrexate] or if any initial disruptions are potentially temporary and due to the independent actions of pharmacists trying to figure out what is and isn’t allowed where they practice."
The ACR is aware of the emerging concerns surrounding access to needed treatments such as #MTX after the recent decision in Dobbs v. Jackson Women’s Health Organization.