What Is Sublocade? How Does Sublocade Work?

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May 18, 2022

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Sublocade is the brand name for extended-release buprenorphine-monotherapy subcutaneous injection.[1]

The medication is usually prescribed to individuals who have been stably treated for opioid use disorder (OUD) with daily Suboxone films/tablets and who prefer a form of the medication that does not require daily administration [2,3].

Sublocade must be injected, so it needs to be administered by a healthcare provider. The initial dose of buprenorphine (Sublocade) consists of two injections, amounting to a total of 300 mg of buprenorphine.

After this initial injection, a regular monthly injection will be administered of 100 mg of buprenorphine. Depending on the patient, continuing dosages can range between 100 mg and 300 mg of buprenorphine each month. Some medications for opioid use disorder (OUD), like Suboxone or Zubsolv, are a combination of buprenorphine and naloxone.[4,5] In contrast, Sublocade is a buprenorphine-monotherapy. Buprenorphine-monotherapies do not combine ingredients. Sublocade is strictly composed of buprenorphine.

Some medications for opioid use disorder (OUD), like Suboxone or Zubsolv, are a combination of buprenorphine and naloxone.[4,5] In contrast, Sublocade is a buprenorphine-monotherapy. Buprenorphine-monotherapies do not combine ingredients. Sublocade is strictly composed of buprenorphine.

What Is It Used For?

Sublocade is injected once per month to treat OUD. [6] It can help to keep opioid cravings and withdrawal symptoms at bay while simultaneously eliminating the hassle of having to take a daily medication.

As a partial opioid agonist, buprenorphine does not create the same euphoric feelings or “high” that full opioid agonists do.

Sublocade is to be taken after stopping all full opioid agonists and after usually at least a week of taking an oral buprenorphine medication in a sublingual or buccal film form. Usually the patient should have tried Suboxone for several days to a week prior to receiving the injection in order to make sure they tolerate Suboxone well and do not experience any side effects.

Sublocade Shot & Injection

Sublocade is an abdominal subcutaneous injection, meaning it is injected through the abdomen right below the skin. The medication is injected as a liquid and forms into a gel beneath the skin. This gel steadily releases buprenorphine into the body over the course of a month.

Sublocade can be taken once per month as an extended-release medication instead of needing to take it daily, which many patients prefer.

The dosage is dependent on the person. It can be tapered down and reevaluated throughout recovery as needed.

How Does Sublocade Work?

Since Sublocade is an extended-release medication, the dosage is released slowly throughout the month following injection.

Buprenorphine is one of the three FDA-approved medications used to treat OUD.[6] It is available in a variety of forms, including as a buccal film, sublingual film or tablet, or injection (Sublocade).

Buprenorphine is a “partial” opioid agonist. A partial opioid agonist helps to reduce opioid cravings and withdrawal symptoms in individuals with OUD while avoiding the risks of excessive sedation, overdose and other worrisome side effects seen with “full” opioid agonists such as oxycodone, heroin, fentanyl, or methadone.

Unlike a “full” agonist, buprenorphine does not fully activate the opioid receptors. Buprenorphine has a “ceiling effect” because it only partially activates opioid receptors.[7] This ceiling effect means that it is nearly impossible for those with OUD to get “high” or experience euphoric effects or excessive sedation/respiratory depression. Buprenorphine is a medication that can be used temporarily or as a long-term treatment for patients with OUD.

Potential Side Effects

The most common potential side effects of Sublocade are fatigue, gastrointestinal issues (such as nausea, vomiting, and diarrhea), headache, dizziness, sedation, and drowsiness.[8]

Since Sublocade needs to be injected by a health care provider into the subcutaneous tissue of the abdomen, issues can occur if this is done incorrectly. If it is injected intravenously, it can be potentially life-threatening.

Buprenorphine is also a central nervous system depressant that can cause significant respiratory depression when combined with other sedative or depressant medications or alcohol. Take Sublocade exactly as medically directed, and follow all of your health care provider’s instructions while taking it.

Where Can You Get Sublocade?

Sublocade needs to be administered by a qualified healthcare professional, so it is not available in retail pharmacies like other forms of MAT and buprenorphine medications.

You can only get Sublocade through the Sublocade REMS (Risk Evaluation and Mitigation Strategy) Program.[9] Qualified health care professionals can enroll in this program and then administer Sublocade to you. Check with your treatment provider to find out if they are able to inject Sublocade at their location.

Costs

The list price for Sublocade is $1,829.05 per month, but the majority of people will not pay this full amount.[10]

Indivior, the manufacturer of Sublocade, offers the inSupport Copay Assistance Program that can offset the cost of the medication. You may not even have to pay anything at all out of pocket based on eligibility. You will need to have private insurance that is not government-based and be prescribed Sublocade for medically necessary on-label use.

Private insurance, Medicare, and Medicaid also cover much of the cost of Sublocade, leaving patients with a much smaller monthly copay amount. Check with your insurance provider to find out if you need a prior authorization before obtaining Sublocade. Make sure to inquire about exactly what is covered under your plan.

Bicycle Health provides Suboxone therapy for opioid use disorder. Bicycle offers educational resources on Belbuca, Subutex and Sublocade, but does not currently offer those therapies.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Sublocade (Buprenorphine Extended-Release). U.S. Food and Drug Administration (FDA). https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/209819s000lbl.pdf. Accessed January 2022.
  2. Suboxone (Buprenorphine and Naloxone). U.S. Food and Drug Administration (FDA). https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020733s007s008lbl.pdf. Accessed January 2022.
  3. Subutex (Buprenorphine Sublingual Tablets). U.S. Food and Drug Administration (FDA). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/020732s018lbl.pdf. Accessed January 2022.
  4. Buprenorphine. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine. May 2021. Accessed January 2022.
  5. Naloxone. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naloxone. July 2021. Accessed January 2022.
  6. MAT Medications, Counseling, and Related Conditions. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions#medications-used-in-mat. November 2021. Accessed January 2022.
  7. Clinical Pharmacology of Buprenorphine: Ceiling Effects at High Doses. Clinical Pharmacology and Therapeutics. https://pubmed.ncbi.nlm.nih.gov/8181201/. May 1994. Accessed January 2022.
  8. A Systemic Safety Profile Consistent With the Known Safety Profile of TM Buprenorphine. Indivior. https://www.sublocadehcp.com/clinical-results-safety?utm_campaign=BR%20%7C%20HCP%20%7C%20Sublocade&utm_source=google&utm_medium=cpc&utm_term=sublocade%20problems&gclid=CjwKCAiA3L6PBhBvEiwAINlJ9BHcBD0BHJ0VwUi0jjuRJZlgkCWnj9wdXdwgsW_5odHLjd8SpJD_URoCcjUQAvD_BwE&gclsrc=aw.ds. Accessed January 2022.
  9. Risk Evaluation and Mitigation Strategy (REMS). Indivior. https://www.sublocaderems.com/. Accessed January 2022.
  10. Sublocade Pricing. Indivior. https://www.sublocade.com/cost-savings
  11. Sublocade Cost Savings. Indivior. https://www.sublocade.com/cost-savings?utm_campaign=BR%20%7C%20PAT%20%7C%20Sublocade&utm_source=google&utm_medium=cpc&utm_term=sublocade%20copay&gclid=CjwKCAiA3L6PBhBvEiwAINlJ9BmRSqGBSu4zzcgh0-sN-vaqxEf44nB6xOW8A3DezaZItigm4hU4lxoC-IwQAvD_BwE&gclsrc=aw.ds. Accessed January 2022.

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