Sublocade Injection in Sacramento
Sublocade Injection
- Medically Reviewed By: Dr. Justin Altschuler
- June 12, 2023
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- ADDICTION TREATMENT
- SUBLOCADE
Sublocade is an injection form of buprenorphine and is used as part of an overall treatment plan for opiate use disorder.
Sublocade treatment overall has similar risks and benefits to other buprenorphine maintenance therapy. However, compared to oral formulations of buprenorphine, it has a few key advantages.
Planning to Relapse
Patients do not generally enter treatment with a plan to relapse. However, relapses are common and are a part of addiction.
One of the challenges with treatment is that our minds change— sometimes, patients are committed to our recovery, and at other times, there are cravings or situations that come up and suddenly relapse becomes a possibility— or happens.
This is the reality of living with opioid dependence and addiction, and it is because of this reality that Sublocade is an effective treatment.
Once a patient receives a sublocade injection, the medication (buprenorphine extended-release) is present in the patient’s body for a month (or more).
This means that even if one of those moments comes up when relapse seems like a concern, the patient has already made the decision to continue recovery— the shot ensures continuous delivery during the entire month.
This makes the likelihood of relapse much lower, and therefore, increases the likelihood of recovery.
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How Sublocade Works
Sublocade is an injection that is given by a healthcare provider (like doctors, nurse practitioners, or physician assistants) in the abdomen once per month.
The injection contains buprenorphine extended-release (buprenorphine that has been formulated to last a long time). Some patients experience some injection site pain (and may need a small amount of additional analgesia at the injection site), and most people on Sublocade can feel a small, solid mass at the site of injection.
After the injection has been given, buprenorphine from the injection is slowly released into the body, and there is little variation in detectable levels of buprenorphine over the course of the month.
Because sublocade is just another form of buprenorphine it effectively treats withdrawal symptoms and opioid cravings, which are common in people with opioid use disorder. Patients taking sublocade are at much lower risk for an opioid overdose, while they are on the medication.
Sublocade Is an Effective Treatment For Opioid Use Disorder
However, treatment with sublocade is not, by itself, treatment for opioid use disorder. Instead, Sublocade is part of a complete treatment program, which has other elements and also includes counseling.
However, usually, patients do not start on Sublocade treatment immediately. At the first appointment, healthcare providers assess the patient and come up with a complete treatment program to help combat opioid addiction.
This typically involves understanding the unique circumstances of a patient’s substance use (including the degree of opioid dependence), coming up with a strategy to manage withdrawal symptoms, engaging family members (if applicable), and starting medications.
During that initial appointment and the first few days, the goal is for patients to manage any symptoms of opioid withdrawal, and start taking buprenorphine.
Then, prescribing information about Sublocade treatment is reviewed, and the medication is ordered. It must be administered by a healthcare provider. Usually, it takes 1-3 weeks between the initial appointment and when you start taking sublocade.
Sublocade and Pregnancy
Sublocade is generally not recommended in pregnancy; there are other medication choices that are better for opioid-dependent women who become pregnant. So, if a woman does become pregnant while on the medication, it’s important to report the pregnancy to your healthcare provider.
How Are Withdrawal Symptoms
Managed Before Taking Sublocade?
There is no one answer to this, but generally, withdrawal symptoms are managed using oral (sublingual) buprenorphine before patients are started on treatment with sublocade.
Sometimes other medications are also given to address specific symptoms, such as diarrhea, trouble sleeping, or anxiety.
Such medications are sometimes called “comfort medications” and they help make the transition from moderate to severe opioid dependence to treatment easier. We don’t just focus on medication assisted treatment, though.
Does Sublocade Treatment Get You High?
Sublocade is extremely unlikely to produce any euphoria or feeling high. Treatment with sublocade does effectively lower the risk of harm or death from opioids. It effectively treats opioid withdrawal and cravings.
What is the Sublocade REMS Program?
REMS stands for risk evaluation and mitigation strategy and is a program put in place for medications that carry particular risks. Sublocade is intended to be injected under the skin, where it forms a small, solid mass.
However, the FDA is concerned that a patient could try to inject Sublocade into a vein like is sometimes done with heroin. This would be potentially life-threatening. To mitigate this risk, the FDA asked Indivior UK Limited, the company that makes Sublocade, to develop a program called the sublocade rems program, to minimize this risk.
This restricted program called “The Sublocade REMS program” basically ensures that only a healthcare provider who is trained to administer the medication appropriately will do so.
This is also why it cannot be obtained at a retail pharmacy but instead is always shipped directly to the office of a treatment provider, where the sublocade injection is administered.
Our standard of care is to take care and support our patients how we would want someone to care for and support our family members if they were struggling with addiction.
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What Is Involved in a Complete Treatment Plan For Opioid Use Disorder?
This is difficult to say with confidence, as everyone’s story, everyone’s history, is unique, and an effective treatment plan needs to be tailored to the individual.
Nearly everyone enters treatment physically dependent on opioids (at least to some degree), but beyond that, everyone is coming from a different place. Understanding what a complete plan looks like starts with asking questions, with assessing the starting point.
For example, that might include risk evaluation— how likely is someone to relapse? Or thinking about other types of risk evaluation— how likely is someone to suffer harm or death from ongoing opioid use?
Understanding what a person is using, and how much harm opioids have caused, includes an assessment of the severity of the opioid addiction— is it moderate? Severe opioid addiction?
What other resources does a person have, and what other support? What are the triggers to relapse, and what risk mitigation strategy could be effective for these triggers?
What happens when something comes up? Is emergency help available, in the form of friends or family? These questions, and others, form the basis of developing a holistic plan and tailoring an approach to treatment that is based on a unique human, not on a number.
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How Much Does
Sublocade Treatment Cost?
There are two parts to the cost of sublocade treatment, and to consider when trying to find a treatment provider. One part is the cost of the sublocade injection itself— and this is quite expensive, though is often covered by insurance.
The second cost is the cost of the treatment provider you are seeing (see link). We often need to get authorization from insurance to pay for the treatment with sublocade.