Woman describes how she was 'humiliated' at a Walgreens as autoimmune patients become collateral damage in the US abortion crackdown

• One arthritis patient said she was "humiliated" when her medication was restricted.
• At high doses, the medication, methotrexate, can cause abortions.

The pain from Annie England Noblin's rheumatoid arthritis was so severe that she couldn't lift her hands above her head. Playing with her beloved children hurt. Even writing — her job — was painful.

Her rheumatologist prescribed her methotrexate pills twice a week, a drug that more than 1 million patients in the US take, and she started to feel better.

It wasn't the complete turnaround that many chronic-pain patients wish for, but it was helping.

But last month, when the Supreme Court repealed Roe v. Wade, some autoimmune patients in states with abortion restrictions started losing access to the essential medication.

While methotrexate is predominantly used to treat autoimmune diseases such as rheumatoid arthritis, psoriasis, and IBD, at very high doses, it can be used to cause abortions.

It is often used to end ectopic pregnancies, a pregnancy that forms in the Fallopian tubes that isn't viable but can be fatal to the mother.

In states that ban abortion, some patients are struggling to access their medications if the medication can be used to end a pregnancy — and autoimmune-disease patients are among those becoming collateral damage in the war on abortion.

Noblin, 40, discovered that when she visited her local Walgreens pharmacy to pick her regular prescription.

She was left waiting for over six hours at her pharmacy in rural Missouri, where abortion is now banned. Eventually, a pharmacist told her that "because of the overturning of Roe v Wade, we are now required to get more information from your doctor," Noblin said.

She asked what kind of information was needed, finding it hard to fathom what could stop a repeat prescription from being filled.

She was told the pharmacy needed to confirm that the methotrexate would be used for the "intended purposes" and wasn't being used to induce an abortion.

She was eventually given her medication, she said, after hours of fighting to get it.

"I was really, really angry," Noblin told Insider. "It was humiliating to be standing in front of a pharmacist begging for my medication."

"We've seen the pharmacist, and I know it's not her fault," Noblin said. "She's compelled to follow the policy, but to be told, essentially, 'We don't trust you to make the appropriate decisions for your health' is horrible."

She said it made her feel like she was doing "something illegal simply for taking medication to keep me alive."

In a statement to Insider, Walgreens said, "Trigger laws in various states require additional steps for dispensing certain prescriptions and apply to all pharmacies, including Walgreens. In these states, our pharmacists work closely with prescribers as needed to fill lawful, clinically appropriate prescriptions."

Insider has also spoken to women in Virginia and South Dakota who have found it difficult to access their methotrexate prescriptions.

Becky Schwarz, a Virginia-based lupus patient, told The Los Angeles Times earlier this month that within a week of the Supreme Court overturning Roe v. Wade on June 24, her rheumatologist refused to refill her methotrexate prescription.

"This is a notice to let you know that we are pausing all prescriptions and subsequent refills of methotrexate," read a message Schwarz received from her rheumatologist, The Times reported. "This decision has been made in response to the reversal of Roe vs. Wade."

"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, a rheumatology expert and an assistant professor of internal medicine and pediatrics at the University of Chicago Medicine, told The Times.

'This is what happens when politicians start interfering in medical decision-making'

"We have patients who are showing up at pharmacies to get their methotrexate prescription filled or refilled, and are finding pharmacies that are no longer stocking it or are not willing to dispense it, because they are worried about getting caught up and prosecuted due to the impact of these restrictive laws," Dr. Jack Resneck, the president of the American Medical Association, said.

Resneck said this raises concern for patients receiving "delayed care," and "if they're stable on a medication, potentially not being able to get a refill in time makes their condition worsen."

Describing a "web of conflicting laws that are creating this chaos," Resneck said that "this is what happens when politicians start interfering in medical decision-making that really is best between a patient and their physician."

Donald Miller, a professor of pharmacy at North Dakota State University, told Insider that there should be "no concern at all" dispensing methotrexate as an oral tablet.

"Methotrexate, to be used in an ectopic pregnancy, has to be used in pretty large doses and by injection, because you simply can't tolerate that much by mouth. So if you get a prescription for a tablet, there should be no concern in dispensing that," Miller said.

He also added that "at retail pharmacies, in particular, it's almost inconceivable that you would be filling a prescription for an ectopic pregnancy."

Some patients take methotrexate as an injectable, and in this instance, Miller said, "then it's coming down to knowing your patient. Most of the time, if a patient has been on methotrexate for six months, then nothing's going to change now."

Miller did note that "pharmacists have a duty to ensure any prescription is legitimate."

Resneck said it's a "dangerous time" for healthcare because of the political interference. "You end up with all these downstream consequences. So it's something we're struggling with."