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Moncton woman able to resume opioid addiction treatment after birth control dispute with doctor

Until she had a confirmed appointment for the next dose of her opioid-addiction treatment, Rebecca Billard felt on edge.

But after she got her second injection of Sublocade last week, she felt a wave of relief.

“It eliminated so much stress and panic,” Billard said. “It makes me happy, and hopeful for the future.”

Earlier this month, Billard, 32, spoke out about losing access to her opioid-addiction treatment after she and her doctor disagreed on her chosen method of birth control.

Sublocade, a medication delivered via a monthly injection rather than a daily dose, helps with the powerful withdrawal symptoms users often feel when they stop taking opioids.

According to the product monograph, Sublocade, 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.

Billard’s doctor told her that she wouldn’t be able to continue with the treatment unless she switched to what Billard felt were “invasive” forms of birth control. The doctor suggested long-acting, reversible contraceptive methods, such as an intrauterine device (IUD) or a hormonal implant, would be required for her to continue treatment.

Billard takes the patch form of birth control and had to provide proof of a negative pregnancy test before getting her first injection. Horizon Health Network, which runs the previous clinic Billard attended, did not respond to a request for comment this week.

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.”

Informed consent

After hearing Billard’s story, Dr. Christopher Levesque got in touch with Ensemble Moncton, a harm reduction organization Billard has been consulting, to offer his help.

“I reached out and said, ‘Look, I’ll sit down and talk with you and we’ll discuss it and we’ll come to a decision between the two of us,'” said Levesque, who works at the Cameron Street Clinic in Moncton.

When treating patients with Sublocade, Levesque said he makes sure to explain the concerns and potential risks to them.

“The patient should understand what the risks are associated with any form of treatment and then with that understanding, make an informed consent as to whether they wish to continue with the treatment or not continue with the treatment,” Levesque said.

“I think the company who provides the medication in their product monograph says there should be an appropriate form of birth control. I think the appropriateness of the form is up to the patient, so long as it’s consistent with good medical care.”

Billard got her second monthly injection last week, and hasn’t had to make changes to her method of birth control.

Debby Warren is executive director of Ensemble Moncton, an organization that helped Billard navigate finding another option to continue her treatment. (Pierre Fournier/CBC)

“One of the things that impressed me was, this was a young lady who was well informed, had done her research, understood the issues and with all of that, she was in a position to make that decision,” Levesque said.

“Not every patient would necessarily be a good candidate for Sublocade, because of the nature of their circumstances. But Rebecca was, as I said, very well informed and I felt very comfortable saying that I was willing to participate in her treatment, given my discussion with her.”

‘People listened’

A nurse practitioner at Ensemble Moncton also volunteered to help Billard, giving her another option for care, according to executive director Debby Warren.

“Now she has a team of two health-care professionals, plus our organization there to support her and help her along the way,” Warren said.

She commended Billard for speaking out.

“We are responsible for our own health care, but it’s challenging when you get barriers put in the way and you’re made to feel like you’re not part of the process if you don’t agree with everything,” Warren said.

“[Billard] demonstrates when you do speak up, and you advocate for yourself, there can be positive outcomes — and people listened.”

With her second injection, Billard said she was able to return to her job earlier this week.

She said the medication takes away the compulsion of addiction, which allows her to focus on her recovery. Now, she feels she can make plans for her future.

“I’m hoping between six and 12 months, I will feel at a point where I’ve done enough recovery work that I can stand on my own two legs without the medication,” Billard said.

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