What is so great about Sublocade treatment compared to Suboxone treatment?
What is the difference between Sublocade and Suboxone? How are these two addiction treatment medications the same, and how are they different?
Sublocade is the brand name for the monthly buprenorphine injection. One monthly injection is about equal to taking 16 mg of sublingual buprenorphine (Suboxone) every day for the entire month.
Suboxone is available as a film or a tablet that is placed under the tongue, usually once or twice daily. Suboxone contains the same drug as Sublocade, buprenorphine.
Sublocade is a subcutaneous injection, which means that it is injected just under the skin. The monthly shot has several clear advantages over the Suboxone film or tablet.
For people who travel, they do not have to worry about carrying their addiction treatment medication with them. There is no fear of losing their meds or having them stolen.
Additionally, with Sublocade, there are no concerns over airport security or customs officials questioning a supply of Suboxone found in a suitcase or carry-on. A person who gets their buprenorphine treatment by monthly shot does not have to carry Suboxone with them.
Even though buprenorphine is only a partial opioid agonist, it is still classified as an opioid drug. Since it activates the opiate receptors, it is categorized as a controlled substance.
Do law enforcement officers arrest people who have Suboxone in their possession?
While Suboxone and similar drugs used for medication assisted treatment are used to save lives from the dangers of opiate addiction, these drugs are still misunderstood by many people, including law enforcement. A routine traffic stop may lead to serious problems for a person who has Suboxone in the car.
Why would someone drive around with Suboxone Films in their car? While the medication guide that comes with Suboxone states that the medication should be taken once daily, many patients get the best results taking it twice daily.
Additionally, taking Suboxone at specific times during the day may provide better coverage for certain individuals. While Suboxone does have a long half-life, optimal levels of the medication occur during a period of several hours after taking it.
Because of these issues, Suboxone patients often find themselves taking some of their Suboxone with them to work. If a person takes two doses daily, they may carry two films or tablets along with them.
During a traffic stop, the cop may ask to see the pharmacy bottle or packaging. Or, they may ask to see a pharmacy printout. They want evidence that the medication was prescribed to that person, and that it was not sold to them as a street drug.
In some cases, a cop may demand to see the entire amount of medication that should be remaining. For example, if a person is prescribed thirty Suboxone films for the month, and the prescription is three days old, they should have 27 remaining films.
Does this seem outrageous and unreasonable, that a person should carry all of their medication with them, everywhere they go? As crazy as it may sound, this is the policy of some police departments, regarding controlled drugs.
Is there a correct way to carry Suboxone to avoid legal issues?
A person once told me that they were pulled over and made to stand against their car in the hot sun, while the cop verified prescription information over the radio or cell phone. It was a humiliating and tortuous experience, and hard to believe that it can happen in this country.
Another person once told me that their local police department expects to see controlled prescriptions sealed in an official pharmacy bag, stapled shut. In our region of South Florida, there is a sprawling metropolis that is made up of many counties, towns, and cities.
A person could drive for an hour and pass through many municipalities, ruled by many law enforcement offices. There are highway cops, city cops, county cops, state cops, and federal officers from a variety of agencies.
If each department has a different protocol regarding how to handle a person detained who has prescribed controlled meds on them, how can we possibly know how to leave the house with medication? Wouldn’t it be better to not carry narcotics meds at all?
Can people tell if you have had the buprenorphine extended release injection?
A person who has been given a Sublocade shot will test positive for buprenorphine, if the drug test includes a buprenorphine panel. Often, drug screen strips or cups do not test for buprenorphine.
Otherwise, there is no way to know that a person is getting Sublocade treatment. While there may be mild side effects, active treatment with buprenorphine typically does not cause sedation or any other side effects that would be easily noticeable.
Sublocade is injected around the umbilical area, and it does leave a lasting, small lump under the skin that eventually goes away. But, it is not something that the casual observer would be able to see.
With Sublocade, drug levels are stable throughout the month. There is no need to take Suboxone films or tablets throughout the day or at specific times. The Sublocade patient only has to think about their medication once monthly, when they go back for their shot.
They also do not have to worry about people finding their Suboxone. If a person is very private about their medication assisted treatment, they may not want people to see Suboxone films in their home. For a single person who is dating, they may want to keep their medication use private.
Sublocade has distinct advantages over Suboxone.
As discussed so far, Sublocade prevents all the issues that arise from having to have daily Suboxone films in your possession. If you are on Sublocade, you do not have to worry about explaining your medication to cops, family, friends, or anyone else.
Another advantage of the monthly shot is that you do not have to endure the bad taste of Suboxone. One of the biggest complaints about Suboxone therapy is the bad taste of the medication.
Also, for people who have mixed feelings about being on buprenorphine treatment, they do not have to worry about second guessing their treatment during the month. Should you take your Suboxone today? Was it the right choice to start taking it?
With Sublocade, there is little concern about second guessing treatment. The medication is there at all times, so you can forget about it, until the next appointment.
Does Sublocade contain naloxone, like Suboxone?
Naloxone is an opioid antagonist that is used to reverse opioid overdoses. When a person is overdosing, naloxone is given by injection or nasal spray.
The overdose victim will wake up with opioid withdrawal symptoms, but they will be alive. Respiratory depression, caused by overdosing on opiates, is reversed by naloxone.
Naloxone is also used in some opioid medications as an abuse deterrent. Suboxone contains buprenorphine and naloxone. Naloxone in Suboxone acts as an abuse deterrent.
What kind of abuse are they trying to prevent, by putting naloxone in the Suboxone film? They want to prevent opioid addiction patients from trying to melt down their medication, so they can shoot it up in a vein, like heroin.
While this type of misuse of Suboxone is not common, there are people with opioid use disorder who are in the habit of taking oral medications and injecting them. The process of melting a pill or strip into a liquid to draw up in a syringe becomes second nature.
How does naloxone help to prevent this type of intravenous abuse of Suboxone?
When a person uses the film under the tongue as directed, naloxone does nothing. However, if the person tries to inject it, IV, they will get immediate opiate withdrawal symptoms, due to the effects of naloxone. As you can probably imagine, it would not make sense for the manufacturer, Indivior, to put naloxone in Sublocade.
Sublocade does not present the same abuse potential as Suboxone, or any other opioid medication that a patient can hold in their hand. Sublocade is injected, and it solidifies under the skin.
In order to remove Sublocade and gain access to the buprenorphine it contains, a person would have to perform skin surgery on themselves, or have someone else do it. While it is conceivable that someone might try to remove Sublocade from under their skin, it is highly unlikely.
The risk of pain, infection, scarring, nerve damage, and other risks would scare many people off from trying to cut out their Sublocade. Additionally, they would no longer have the beneficial effects of long-acting buprenorphine provided by Sublocade.
After removing Sublocade, they might soon experience opioid withdrawal and opioid craving. I doubt that anyone has, or ever will try to cut Sublocade out from under their skin, but you never know.
What about Suboxone vs Sublocade? Does Suboxone have any advantages over Sublocade?
You might think, by now, that Sublocade should be the gold standard for opioid addiction treatment. Buprenorphine has unique activity on the opioid receptors, making it a superior choice over methadone.
Sublocade makes buprenorphine treatment more convenient for patients, and it is attractive to addiction specialists, policymakers, and law enforcement. The risk of diversion and abuse is far lower with Sublocade.
Yet, the risk of abuse with buprenorphine in general is already fairly low. Multiple studies have revealed that, even when Suboxone is sold on the streets by drug dealers, the primary use is for the user to quit opioids, not to get high.
People who are looking to get high rarely have any interest in Suboxone or other buprenorphine drugs. The fact is that they do not get high when they take it. They are far more likely to seek out heroin, fentanyl, or oxycodone, if their goal is to get an opioid high.
What are some specific advantages of Suboxone for treating opioid dependence?
If you are a healthcare provider who has tried to provide Sublocade treatment, you are aware of the difficulty in providing this substance abuse therapy reliably to your patients. The process of working with health insurance, specialty pharmacies, and shipping companies can be overwhelming.
Indivior reps come to the doctors’ office to tell doctors how great Sublocade is, and how easy it is to fill out pages of forms to help patients get the injection covered by insurance with a low copay. My thoughts, when they present this information, are that a billion-dollar corporation is presenting hoops for me to jump through to provide life-saving addiction recovery therapy for victims of drug abuse, opioid abuse, and addiction.
Why are they charging so much for Sublocade? It is about $2000 for a single injection. The price has risen significantly since it was released. A few years ago, Sublocade was around $1500 per injection.
Why is Sublocade so expensive?
The price is the same, regardless of dosage. The 100 mg strength costs the same as the 300 mg strength. Few patients can afford $2,000 monthly for their medication, not including doctor visits and therapy sessions.
While insurance companies will cover Sublocade, doctors must engage in the time-consuming and difficult prior authorization process, making an in-depth plea to the health insurance company to justify paying the inflated prices to Indivior.
Why do they charge so much? Indivior made a killing on Suboxone sales. The month that generic Suboxone films became available, Indivior immediately cut off the Here To Help Program that provided free Suboxone to economically disadvantaged people.
Around that time, Sublocade arrived on the market. Indivior hosted a lecture I attended in which the paid lecturer, a local pain doctor, argued that any doctor who does not switch all or their Suboxone patients to Sublocade is in favor of diversion and abuse of buprenorphine.
This gaslighting of medical professionals by a major pharmaceutical company, which has settled billion-dollar lawsuits over their practices in profiting from addiction patients, is unacceptable. Another issue is that Indivior has continued to block the approval of a competing subcutaneous buprenorphine product, Brixadi.
So, a major advantage of Suboxone is that there are generic brands, so doctors may prescribe an affordable buprenorphine product without involving Indivior, which has hijacked the industry for decades. Sublocade is a branded product, made by Indivior, and it is the only long-acting injectable buprenorphine product on the US market.
Are there other advantages of Suboxone?
Many patients who take Suboxone appreciate having control of their medication. They work with their Suboxone doctors to taper to lower dosages over time.
Sublocade introduces a large amount of buprenorphine into the system, which lasts more than a month. The monthly injections overlap, with the drug building up in the system.
Sublocade patients have buprenorphine in their system for months after stopping treatment. They may even still test positive a full year after completing treatment.
Suboxone makes it possible to take the medication at ideal times during the day and to have it wear off in a controlled manner for times when coverage is not needed at the same level. For example, a patient may be prescribed 8 mg in the morning, and 4 mg in the early evening, not too close to bedtime.
Sublocade lacks the flexibility that is possible with sublingual Suboxone strips or pills.
In some cases, when a patient goes for surgery, the surgeon requests that they reduce or stop their Suboxone.
It is not possible to temporarily stop taking Sublocade, even for planned surgery. It is also not easy to temporarily reduce the dosage.
Adjusting Sublocade dosages is like steering a giant cargo ship. You set the course from the beginning, and there is little opportunity to make adjustments along the way.
Suboxone can be adjusted as needed. It can be reduced to reduce side effects, or increased to address opioid cravings.
Is Suboxone better overall than Sublocade?
The question really should be about subcutaneous buprenorphine vs sublingual buprenorphine. The topic has more clarity, once we remove the issue of large, profit-seeking corporations from the equation.
In the end, there are clear benefits to the daily sublingual buprenorphine preparations, and there are also benefits to the long-acting subcutaneous buprenorphine injections.
The best situation will be when both types of products are available for doctors to prescribe and administer to their patients. When costs come down for the injection, and it is made more easily accessible, it will be a more attractive option for more patients.
Still, there will always be a place for the sublingual buprenorphine tablets and films. More flexibility and more choices will benefit patients who seek help in overcoming opioid addiction.
