Will there still be a choice to get Suboxone Films and Tablets after Sublocade comes out?
Sublocade is a new monthly injection. It contains the medication buprenorphine. This monthly shot will be used for the treatment of opiate and opioid dependence and addiction. Another name for the medical condition is opioid use disorder. Currently, the gold standard treatment for opioid addiction is daily sublingual buprenorphine combined with therapy. Sublingual buprenophine is available as Suboxone films, Subutex and ZubSolv tablets. What will happen to the tablets and films after Sublocade is available?
Will Sublocade lead to new legislation to limit treatment options?
I am certain that there will be no change initially when Sublocade is released in March. It will take time for doctors and treatment facilities to become accustomed to the procedure of getting the shot and giving it to patients. There will be a lot of details to work out, including cost and insurance coverage. Also, when it comes to a long acting injectable, it will be preferable to start with a short acting medicine to ensure that there are no serious side effects. Yet, long term, it is possible that Sublocade will encourage limits on the films and tablets.
The current state of Suboxone treatment
Suboxone and other forms of buprenorphine are a safe and effective medical treatment for opioid dependence. Lives are being saved from the deadly risk of overdose due to heroin, fentanyl and carfentanyl. However, not everyone agrees. In some U.S. states, there is a feeling that Suboxone clinics are the new pill mills and a new source of addiction. They are concerned about rogue doctors treating addiction. This is unfortunate. Limits are already in place in some states and will likely become even more strict.
Injectable Medical leashes
There is already a currently available monthly injection used to treat opiate and opioid addiction. This medication is Vivitrol, a monthly shot containing naltrexone. Vivitrol has become very popular with parents and spouses of people suffering from opioid use disorder. It is also popular with judges, prison wardens and law enforcement officers. They see it as a way to keep an eye on the addict from a distance. It is, in a sense, a chemical leash. This is not necessarily a bad thing. Especially early in recovery from active addiction, the addict can not trust their own thinking. Vivitrol has been proven to be very effective, nearly as effective as sublingual suboxone. It will be interesting to see how Sublocade measures up to Vivitrol.
If Sublocade is a success, what happens next?
While I strongly doubt that sublingual tablets and films will be discontinued, it is very possible that in some states, there will be new legislation to limit how doctors can prescribe these medications. Sublocade may be seen as a way to ensure that the patient takes their medication. Parents and police alike will be happy to know that medicine has been administered and not diverted to be sold on the street.
What about the good patients? Why punish everyone?
While there has always been an issue with diversion, most patients are responsible and take their medication as directed. How is it fair to limit available treatment options for them? Why does everyone get punished for a few bad apples?
Let us hope that we remain free to choose.
The contents of this article have been speculation. Yet, it is based on current events in the world of addiction treatment. Doctors and prescription medication are viewed with suspicion by the media, politicians and law enforcement in states that have been affected by the opioid epidemic. Still, I am hopeful that in much of the U.S., there will be no change in existing treatment options. In fact, I predict that we will see better access to treatment with cheaper and more readily available forms of sublingual buprenorphine. It has been proven to save lives, so this makes the most sense.