A Moncton woman says she feels she’s not in control of her own reproductive decisions after losing access to her addiction treatment because she and her doctor don’t agree on the birth control method she’s chosen.
Rebecca Billard has been battling opioid addiction for a few years, but said things began to turn around last month, after she received her first dose of a medication called Sublocade (its generic name is buprenorphine).
When someone stops taking opioids, they can experience severe withdrawal, which is something Sublocade, a relatively new treatment, helps manage.
Rather than taking a pill or a dose at a pharmacy every day, the medication is given through a monthly injection.
This has helped Billard focus on recovery and returning to her full-time job, while other treatments, such as Suboxone, made her sick and were difficult to afford.
“Because of that steady level [of buprenorphine] and no routine or ritual to take a daily medication, you almost forget about the compulsion of the addiction,” Billard said in an interview.
“It gives you more time to think about things you can do to improve your outlook and your happiness and your routine to get back into the swing of things.”
According to the product monograph, the treatment, which was approved by Health Canada in 2018, may pose a risk to an unborn baby should a woman become pregnant while taking it.
“Given the high degree of uncertainty in terms of safety to both the mother and unborn child, Sublocade use should be avoided in women of childbearing potential who are not using an effective and reliable method of contraception or are judged not able to comply with contraceptive methods,” the product monograph says.
Health Canada hasn’t posted any adverse event reports for Sublocade that are “linked to pregnancy or birth defects,” according to the federal agency.
A spokesperson with Indivior Inc., the manufacturer of Sublocade, said its product monograph doesn’t “recommend or stipulate a specific method or recommendation for contraception.”
‘I haven’t been heard’
When Billard received her first dose, she said she had to provide proof that she’s taking birth control and a negative pregnancy test, both of which she did.
But things changed last week, when Billard said she found out she couldn’t get her second dose unless she changes her method of birth control. Billard is taking the patch form of birth control to help treat a medical condition.
Her physician, Dr. Frank Lord, told her the options of “effective and reliable contraception” are “quite limited.”
“Either a woman does not have a uterus or no ovaries, or tubal ligation is also quite effective,” Lord said, according to a recording obtained by CBC News.
“But in terms of reversible contraception, there are just two options that are deemed effective and reliable. Those are hormonal implant or an IUD, intrauterine device. As far as I know, you do not fit those criteria right now. So with the current guidelines and very new information, Sublocade is not an option for you anymore. So the way to proceed at this time will be to ensure you can meet those criteria for contraception or we’ll have to switch you over to Suboxone again, or maybe another suggestion.”
“It was quite a letdown,” Billard told CBC News. “I do feel like I’ve had to jump through some hoops and that I’ve done everything I can to comply and get the proper help. However, getting that news did cause me a great amount of anxiety and panic about my future.”
Billard, who is 32, said she doesn’t plan to have children and doesn’t date men. She feels her chances of becoming pregnant are extremely low and doesn’t want to switch to one of the birth control methods her doctor mentioned.
“I find they’re quite invasive and with my condition and my form of birth control, I do feel it’s sufficient,” Billard said.
Despite this, she agreed to provide regular negative pregnancy tests to continue taking the treatment.
But she said her physician still decided he would not provide her second Sublocade injection, which is due in a week.
Without the treatment, she said she worries about illness, withdrawal and relapse. She’s concerned it will affect her ability to work and recover.
In her mind, it’s a life-or-death situation.
WATCH | Rebecca Billard says she hasn’t been trusted ‘with my own reproductive health’:
“Right now, it’s my life that is on the line, and the benefit will outweigh the risk to me to take this medication,” she said. “So I do feel that I haven’t been heard and that I haven’t been trusted with my own reproductive health here and my own choice to choose what medications work best for me and my situation.”
Health authority declined comment
CBC News requested an interview with Lord through Horizon Health Network, which runs the clinic where Billard sees him. Horizon declined to provide an interview with Lord or comment on Billard’s case.
Billard said Lord told her his opinion about Sublocade changed after attending a recent conference held by the Canadian Society of Addiction Medicine.
Dr. Suzanne Turner, an associate professor at McMaster University’s department of family medicine, gave a presentation at the conference that discussed some of the risks associated with Sublocade.
Turner told CBC News she couldn’t comment on the specific case. But in an email, she said the caution when it comes to Sublocade is related to a component of the medication that “has been shown in rats to be fetotoxic,” meaning it could poison or cause degenerative problems for a fetus.
She said doctors should have a conversation with patients about the potential harms, the importance of avoiding pregnancy while taking Sublocade and the effectiveness of long-acting reversible methods of contraception.
“The conversation about the most appropriate contraceptive agent for a given patient will rely on specific patient factors and joint decision-making between the patient and the physician,” Turner wrote in an email.
Treatment can be ‘freeing’ for those struggling with opioid addiction
Dr. Jennifer Brasch is an addiction psychiatrist in Hamilton and president of the Canadian Society of Addiction Medicine, which organized the conference Billard’s doctor attended.
She said some patients find Sublocade to be “freeing,” because they don’t have to worry about taking medication every day.
Brasch said taking having to take a dose or a pill each day can be a reminder of their opioid use disorder.
“With the once-monthly injection, they can go to work, they can go away for a weekend,” Brasch said.
She also hasn’t treated Billard and couldn’t comment on some of the specifics of her case.
But in general, Brasch says she would discuss the potential risks and benefits with a woman of child-bearing age when prescribing Sublocade. She wasn’t aware of specific guidelines that require a certain method of birth control.
“I would need to focus on encouraging her to … request a second discussion or another appointment with the physician to discuss the risks and benefits, and if there is any way to review that decision,” Brasch said.
“Because it’s not written in any guidelines … or requirements, that I’m aware of.”
While there are risks associated with the medication, Brasch said uncontrolled opioid use is also bad for an unborn baby, citing “shifting levels of opioids within the body of a woman potentially experiencing withdrawal symptoms erratically and unpredictably.”
Time running out
Billard has tried to find an alternative provider in order to continue with Sublocade, but has been told there aren’t many health-care providers in the Moncton region who are trained to provide it.
One place she has looked to for help is Ensemble Moncton, a harm reduction organization.
Debby Warren, executive director of that organization, said she hopes Billard is able to find a solution. She applauded her for taking the steps toward recovery.
“We have a responsibility for our health, and clearly this person is trying to take charge and be their own advocate and do what works for them,” Warren said in an interview.
“Let’s just hope that the other side of the spectrum can sit with her and work with her and help to find a solution that will help her to be able to go on to that next step.”
While Billard finds it difficult to talk about her battle with addiction, she felt she had to speak up for other women who might find themselves having to make the same difficult choice.
As time runs out before her next injection is due, she would like to see doctors be more understanding that each person they treat is different.
“My voice is for me, but it’s also for the other women trying to receive access or anyone that feels that they’re being treated differently due to their gender or situation or status, and finding it hard to navigate the system and get fair treatment or equal treatment and access to medication,” she said.