What Is Sublocade? How Does Sublocade Work?
Sublocade is a monthly injectable medication that helps to suppress opioid cravings and opioid withdrawal symptoms. The Sublocade shot, which contains the drug buprenorphine, is given just under the skin. It is also known as a subcutaneous buprenorphine injection. Some experts believe that extended release buprenorphine injections are the best way to reduce overall opioid abuse.
Buprenorphine is an excellent medication for treating patients who are addicted to heroin, fentanyl, or any type of prescribed opioid medicine. Opioid pain medicine may include drugs such as oxycodone, OxyContin, Percocet, Vicodin, Norco, Dilaudid, and many more. Buprenorphine, as a partial opioid agonist, is less likely to cause severe drowsiness or respiratory depression, compared to other opioid agonist drugs, particularly mu opioid receptor agonists.
Buprenorphine is a unique drug that both blocks and activates the opioid receptors at the same time, blocking opioid withdrawal symptoms and opioid craving.
It is known as a mixed partial agonist/antagonist. Healthcare providers with a special waiver are allowed to prescribe buprenorphine-containing meds to treat opioid dependence as part of a comprehensive medication assisted treatment plan.
Some people refer to Sublocade as the Suboxone shot, because both Sublocade and Suboxone contain the same active ingredient, buprenorphine. Additionally, both Sublocade and Suboxone are manufactured by the same pharmaceutical company, Indivior. Suboxone differs from Sublocade in being an oral buprenorphine that is combined with naloxone.
When Sublocade is injected by qualified healthcare practitioners, just beneath the skin, it goes in as a liquid from a prefilled syringe and needle. As the subcutaneous solution enters the living tissue, it forms into a solid structure.
The solid form of injected, activated Sublocade can be felt beneath the skin. It is injected in one of four quadrants around the umbilical region. Sublocade feels almost like a peanut M&M in shape and size.
Is Sublocade an Implant?
While we think of Sublocade as an injectable buprenorphine, a liquid that is injected subcutaneously, beneath the skin, it does function as an implant. It becomes a solid matrix which releases medication steadily throughout the month.
Before Sublocade treatment for opiate addiction was approved by the FDA, there was already an available buprenorphine implant on the market, used to treat addiction to opiate drugs and opioid medication. It was named Probuphine. The Probuphine buprenorphine implant may still be available in other countries, but it is no longer available in the United States as a treatment for opioid drug use problems.
The probuphine implant lasted a full six months, but it had several drawbacks. First, it was only equivalent to 8 mg of buprenorphine daily. While many buprenorphine patients taper down to 8 mg during their first year of treatment, most start at a higher dosage in the first few months.
Another drawback is that Probuphine had to be surgically implanted.
The doctor had to be trained in a specially designed surgical procedure to place the four Probuphine rods deep, in the tissues of the tender upper, inner arm. Probuphine had risks of infection, scarring, nerve damage, pain, and allergic reaction. To make matters worse,
Probuphine also had to be surgically removed after six months. With the removal, there was a risk that the rods might break or migrate, making them difficult to find, requiring emergency medical attention.
If the healthcare provider removing the rods could not locate all pieces, the patient had to go for ultrasound or MRI immediately to locate the missing Probuphine pieces. With removal, the patient again risked nerve damage, scarring, pain, or serious infection.
Sublocade, on the other hand, is an implant that is injected as a liquid, becomes a solid, and then dissolves over time. There is no surgery required at all.
In addition to these advantages, Sublocade is equivalent to a daily Suboxone dosage of 16 mg, which is the starting point for the majority of opioid use disorder patients. Sublocade solves many of the problems of Probuphine.
You might think that the shorter time period of Sublocade’s activity compared to Probuphine’s full six months would be a disadvantage. Yet, visiting with the doctor on a monthly basis is recommended for ideal support and counseling. Psychotherapy and group therapy are also helpful components of a strong MAT program to help people recover from addiction to opioid medicines and street opioids.
With Probuphine, there was the risk that patients might not return for re-evaluation for six months, knowing that they already had medication in their system. The need for a monthly shot helps to reinforce the need for monthly medical visits.
How does Sublocade turn into a solid implant in the body and release medication for a full month?
Sublocade uses a special, patented technology that is licensed from a company named QLT. The delivery system provided by QLT is called Atrigel. The Atrigel delivery system is what makes the Sublocade injection work as a monthly buprenorphine treatment.
Atrigel is what makes Sublocade turn into the solid, egg-shaped medication delivery system, once it comes in contact with living tissue. It also works to release the medication contained within at a steady pace over the period of a month.
Actually, the Sublocade shot works for over a month. When a patient returns for their next shot, their previous Sublocade injection is still working. The overlap of one buprenorphine injection wearing off as the next one is given makes it possible for the patient to maintain steady levels of buprenorphine in their system throughout the month.
Some addiction specialists, and patients, are excited about the possibility of Sublocade being used for a buprenorphine taper. When a patient is ready to reduce their buprenorphine dosage, they may be able to get a single Sublocade shot, rather than measuring out smaller Suboxone Film or tablet pieces over time.
So far, the experience of Sublocade doctors and Sublocade patients shows that the Sublocade taper may actually work for some patients. Of course, further research is required to see how well the buprenorphine/Atrigel combination might work for helping patients to taper and complete buprenorphine therapy.
Is Sublocade the only available subcutaneous buprenorphine injection?
Currently, in the United States, Sublocade is the only available monthly buprenorphine shot. There is injectable short-acting buprenorphine, known by the brand-name, Buprenex, but it is not approved for treating opioid dependence, and even if it was, it would be no more effective than sublingual buprenorphine films or tablets.
A short-acting, daily buprenorphine injection may have been considered at one time as a viable way to treat opioid addiction. Before Subutex sublingual pills, and Suboxone sublingual strips were invented, the Buprenex shot was already available as an injectable buprenorphine.
Why would doctors want to avoid prescribing or administering a short-acting, daily shot instead of Suboxone films under the tongue? One issue is that injections hurt and they introduce the risk of infection with each shot.
Another significant issue is that many opioid users associate needles and injections with illicit opioid use. For example, many heroin and fentanyl users shoot up their drug of choice with a syringe and needle.
Addiction experts would consider injecting buprenorphine regularly to reinforce unhealthy addiction-related behavior. Needles and syringes should be avoided in addiction treatment, particularly opioid addiction treatment.
You might say that Sublocade uses a syringe and needle, so why is that fine to use with opioid-addicted people? The difference is that Sublocade is administered by a doctor in a medical setting, and it is only once per month.
What about that other Suboxone shot?
There is another buprenorphine subcutaneous injection that is long-acting.
It is named Brixadi. Brixadi is a shot that lasts either a week or a month, depending on the dosage and administration. Brixadi has many advantages over Sublocade. For example, it can be injected at multiple sites on the body, and not just the periumbilical region. Also, it does not have to be kept at cold temperatures.
Why is Brixadi not available in the United States? It has passed part of the FDA approval process. For the past couple of years, addiction experts have promised that Brixadi approval is coming very soon.
It is likely that Indivior, the company that makes Suboxone and Sublocade, is undermining the approval process. It is unfortunate that they are so concerned about their financial status, that they would deprive the public of a potentially life-saving alternative therapy.
Is sublocade better than suboxone?
Suboxone, whether it is prescribed in the form of a pill or a strip, is always dissolved under the tongue. While the manufacturer drug information asks that doctors prescribe Suboxone as once-daily dosing, it tends to work better when dosed at least twice daily, for better 24-hour coverage.
This means that Suboxone patients must place a medication under their tongue every day, at least twice, and wait for it to dissolve. While most patients are fine with this routine, it does cause issues for some patients.
For a patient with small children, it can be difficult to find a few minutes at the same time each day to engage in the daily routine of keeping their mouth closed for several minutes, waiting for the buprenorphine to dissolve fully. Also, patients with busy work schedules who are surrounded by coworkers may have trouble getting away for those few minutes needed to take their medication.
In most cases, it is possible to work around nearly any busy schedule. The patient can figure out what works best in their individual situation. Maybe the best time to take Suboxone is just after waking up in the morning. Or, it could be during a bathroom break.
Another complication that comes up is traveling. How much Suboxone should a person bring on a trip with them? Just enough to get through the trip, or a bit extra just in case?
Unfortunately, Suboxone is not easily replaced when it is lost.
Doctors are wary of patients calling about a lost or stolen Suboxone prescription, films, or tablets. Pharmacists often will not fill an emergency prescription for Suboxone early, no matter what the excuse.
What about dealing with the police? If a person is pulled over by a police officer and is found to have Suboxone films or Suboxone pills in their possession, will they get in trouble?
This situation will vary in outcome based on the location and the individual officer. In some cases, police officers can be difficult when they find any kind of controlled medication on a person whom they have stopped.
Sometimes, the officer wants to see the entire prescription in boxes or a bottle, with the full amount contained within, minus what would have been used up to that time. Cops have been known to do roadside pill counts and arrest people if the pills do not add up.
Should people be paranoid about this potential situation? The best way to handle it may be to plan to take Suboxone only in the privacy of a person’s home, so there is no need to have it in the car.
Sublocade does have a significant advantage over Suboxone in this situation. Because Sublocade is a monthly injection, there is no concern about carrying medication around ever.
Once the Sublocade shot has been given at the doctor’s office, the patient is covered for a full month. There is never a concern about waiting for a pill or strip to dissolve under the tongue.
Additionally, there is never a concern about carrying Suboxone around and worrying about losing it or having it get stolen. There will be no desperate trips to the doctor or pharmacy, asking for an emergency early refill.
Not having to worry about getting stopped by the police in possession of Suboxone is also a relief for many patients. Suboxone patients often have a difficult past that they want to put behind them, which may have involved unpleasant interactions with the police.
Where does Sublocade come from?
Unfortunately, you cannot walk into your local Walgreens and pick up your Sublocade prescription. While this would be convenient, it is not currently possible.
If Sublocade is not dispensed at the local pharmacies, how does a patient get it? Sublocade is shipped directly to the doctor’s office, straight from one of a handful of specialty pharmacies.
Specialty pharmacies are pharmacies that deal in specific medications that are very expensive, and must be administered in a doctor’s office. Some of the specific pharmacies that ship Sublocade include Express Scripts Specialty, Briova Specialty Pharmacy, Accredo Specialty Pharmacy, and Walgreens Specialty Pharmacy.
When a doctor’s office calls to order Sublocade, the pharmacy must verify the patient’s insurance coverage, copay assistance program, and they must verify the doctor’s eligibility to receive a shipment of Sublocade.
They check to see that the doctor has an active medical license and DEA registration, and that the DEA registration is registered to the same practice address where the Sublocade shot is being shipped. In fact, they use several different verification portals to confirm eligibility of the Sublocade doctor.
After the patient has paid their copay and agreed to have their Sublocade shipped to the doctor, and the doctor has submitted to the extensive vetting which occurs each time the one Sublocade shot is ordered for that patient for that month, the delivery may commence.
Sublocade is usually shipped overnight, via FedEx or UPS. Does the pharmacy take any measures to ensure that the drivers and pilots who work for the shipping company are qualified to transport a controlled drug? Not likely.
Are there many doctors who give Sublocade shots?
Currently, there are not likely many doctors who administer the Sublocade monthly injection. In our area, prospective Sublocade patients have complained that doctors who were previously registered as Sublocade doctors are no longer giving the subcutaneous buprenorphine injections.
In fact, there is a doctor who was hired by the Indivior corporation in our area to give a lecture about Sublocade, shortly after it came out. This particular doctor stated during her lecture that she would be switching all of her Suboxone patients over to Sublocade.
She explained that Sublocade has a lower risk of abuse and diversion, compared to Suboxone. She implied that doctors who do not switch all Suboxone patients to Sublocade are possibly in favor of Suboxone abuse and Suboxone diversion.
The word these days is that the particular doctor who gave that lecture is no longer providing Sublocade! Of course, it would be interesting to find out why, but suffice to say, many doctors are dropping out of the Sublocade program.
Why would doctors not want to offer their patients Sublocade injections?
Sublocade Vs Suboxone: Is Sublocade the Same Thing as Suboxone?
It was at one time around $1500 per shot, regardless of whether the patient was getting the 300mg shot or the 100mg shot. Now, the price is closer to $2000 per shot.
Compared to a month of sublingual buprenorphine costing under $200, and possibly under $100, Sublocade is very costly. Insurance companies do not want to pay so much for a subcutaneous bupe shot when the advantage is mainly patient convenience.
Also, the ordering and shipping process is difficult and time consuming. For a busy Sublocade clinic, there would likely have to be a dedicated, full-time person who manages pharmacy ordering and shipping coordination.
While the Sublocade shot is expensive, doctors are expected to not charge more for a Sublocade patient than they would for a Suboxone patient. Doctors are also expected to accept insurance for Sublocade visits, if possible.
The time and expense involved in managing a Sublocade clinic are excessive for many medical practices. It is easier for them to simply stop providing Sublocade services.
Is there any hope for Sublocade making a comeback?
While many doctors are not currently offering Sublocade service, they are hopeful that Brixadi will bring along some changes, when it is finally approved in the US. Brixadi is also a monthly buprenorphine shot that is given just under the skin.
The advantages of Brixidi include the shot not needing to be kept cold. Sublocade must be kept refrigerated, which complicates shipping and storage.
Also, Brixadi is available in many more strengths compared to Sublocade only being available in two strengths. Brixadi can be given as a weekly shot or a monthly shot. Also, Brixadi can be given in more locations on the patient’s body compared to Sublocade.
In addition to all of these advantages, addiction experts are hopeful that there will be price competition between the manufacturers of both Sublocade and Brixadi. They hope that the competition will lead to one or both of the shots being offered at a lower price.
While historically, competing brand name pharmaceutical products have not helped much with price competition, maybe it will happen between Sublocade and Brixadi. More likely, when Sublocade becomes available as a generic, and made more readily available at a lower cost, it will be more widely offered by doctors.
How can I find a Sublocade doctor near me?
While many Sublocade doctors are no longer providing the Sublocade service, there are still some who are. If a patient who currently takes Suboxone is interested in Sublocade, it may be worth their time to call around.
A good starting place is to look at the Sublocade main website and use their physician locator. The website provides lists of Sublocade providers by city, state, and zip code.