The Other Injection: What's the deal with Sublocade?
Even though Sublocade has been on the market for several years there is limited utilization of the medication in our community. Even our office was not an early adopter of this new form of buprenorphine. But, after three years of experience using this injection with dozens of our patients, our office is expert on the product and how and when to use it.
Below we will share some of the most helpful information that we have learned and that we typically tell our patients before they choose to proceed.
What is Sublocade?
Sublocade is a once-a-month injection of extended-release buprenorphine. Buprenorphine is used for medication treatment of opiate use disorder. This is the same ingredient as found in the more commonly known medications Suboxone and Subutex.
After several years of clinical trials, this injectable medication received FDA approval in 2017.
What do you need to know about Sublocade?
Before starting the Sublocade injection patients need to be stabilized on a sublingual form of buprenorphine for seven days before they receive their initial Sublocade injection. It is recommended that patients be on at least 8mg of sublingual buprenorphine before starting Sublocade.
Sublocade is dosed with 300 mg injections in month #1 and month #2. From month #3 on the injection is for 100 mg each. This regimen is in place regardless of the previous buprenorphine dose. The medication is loaded with the first few injections. In studies, they found the serum level increased after the second and third injection and remained stable after assuming monthly injections were continued.
The Sublocade injection releases buprenorphine into the bloodstream at a steady-state throughout the entirety of the month. According to the manufacturer, the serum level decrease between weeks four and six after an injection is negligible. This makes it an excellent choice for people who travel for work or have inconsistent schedules. It gives them the freedom to come in for their injection at their convenience without risking running out of medication.
Sublocade can be used as a maintenance medication. People can stay on the monthly injection for as long as they feel it is providing value. The benefit of this is that the medication is always with them without the hassle of having to manage films or tablets.
The extended-release nature of this product means it takes several months to completely clear from their system. After a single injection patients can expect to test positive for approximately 5 months with some people still showing buprenorphine at 12+ months.
This has led some stable patients wishing to discontinue treatment to try utilizing the extended-release injection to taper their dose gradually over time. There is no manufacturer-approved protocol for doing this, so it is important to discuss it with your doctor before proceeding.
How to get Sublocade
Sublocade has good medical coverage by insurance, and it is covered by Kansas Medicaid. The manufacturer of the injection has a patient assistance program that aids in identifying the specialty pharmacy that the patient’s insurance prefers. They also have a co-pay assistance program to make the out-of-pocket expense more manageable.
The first step would be to establish with a doctor who provides treatment for opiate use disorder and who utilizes Sublocade specifically. You can use to provider locator on Sublocade.com, but it's important to call in advance to inquire if the provider utilizes Sublocade.
After the patient is stabilized on sublingual buprenorphine and they and their doctor has decided Sublocade is right for them the medication is ordered from the specialty pharmacy and shipment is received by the doctor’s office. The injection will be administered by the office staff. The medication is injected into the subcutaneous tissues of the abdomen. The area is usually pre-treated with a cold pack to numb the skin, but lidocaine may also be utilized if desired.
Any treatment decisions should be made in concert with your medical professional. We have greatly enjoyed having this additional treatment product available for our patients. If you would like to schedule an appointment for a consultation please call or email our office.