All about Sublocade (Buprenorphine injection)
This is for informational purposes only. Do not use any information in this blog to guide your treatment. This was originally written as a reference for our patients. You must follow the instructions of your provider.
What is Sublocade?
For those who know what Suboxone is, the easiest way to think about it is that Sublocade (Buprenorphine injection) is a once-a-month injection of Suboxone. In actuality, Sublocade is a once-a-month shot of Buprenorphine where Buprenorphine is the active medication in Suboxone. More specifically, it is an extended-release formulation of Buprenorphine that was approved by the FDA on November 30, 2017.
How do you take the Buprenorphine injection?
The Buprenorphine injection is injected into the fat underneath your skin such as at your belly; this is done every 4 weeks with Sublocade (every 1 to 4 weeks with Brixadi). This injection must be done by a certified healthcare provider. If someone were to get a hold of the Buprenorphine shot and tried to inject it into their veins, this would cause a serious risk of death as the medication becomes a solid mass and could cause clotting including in the lungs. This is why the Buprenorphine injection must be injected correctly, subcutaneously (into the fat underneath your skin) by a health care provider. After injected, the medication is slowly released into your system at sustained levels throughout the month
The Buprenorphine injection underneath the skin
The Buprenorphine injection being released into your body
Starting the Buprenorphine injection
You do not have to stop taking Buprenorphine-Naloxone for any period of time before starting the Buprenorphine shot. That is, if you are taking Buprenorphine-Naloxone now, you can start the Buprenorphine injection. Per the manufacturers, in order to start the Buprenorphine shot you only need to have been taking Buprenorphine-Naloxone underneath your tongue for at least a week. The standard approach is for a patient to have been taking at least one or more Buprenorphine-Naloxone 8/2 mg films or tabs for at least a week where the first Buprenorphine injection may be given.
How does the Buprenorphine injection work?
The Buprenorphine shot is similar to Buprenorphine-Naloxone in that the Buprenorphine injection is used to treat opioid use disorder also referred to as opioid addiction or opioid dependence. The medication works by attaching to opioid receptors. In this way, it prevents cravings, prevents opioid withdrawal symptoms, and also decreases the ability of other opiates or opioids to attach to your opioid receptors. This type of treatment has been shown to prevent relapses.
Using the Buprenorphine injection to come off of Buprenorphine-Naloxone
The Buprenorphine injection is not FDA-approved or indicated for this reason though there are many stories of people using the Buprenorphine shot in order to stop taking Buprenorphine-Naloxone. People take advantage of the fact that the Buprenorphine injection is such a long-acting medication as it takes such a long time to come out of your system. Though it differs from person to person, there are a number of people reporting having very mild to no withdrawal symptoms after stopping the Buprenorphine injection. In fact, the Buprenorphine injection medication may stay in your system for 6 months, 12 months, and possibly even longer after your last shot where Buprenorphine may continue to show on drug tests for this period of time. For those who are stopping the Buprenorphine injection or any form of treatment, it is necessary to have a relapse prevention plan and support systems in place.
What are the Advantages of the Buprenorphine injection over Buprenorphine-Naloxone?
as already described, the Buprenorphine injection is released into your system all month with no daily ups and downs
there is no need to remember to take the medication every day, this may be easier for many
no more bad taste with the Buprenorphine shot. Many people do not like the taste of Buprenorphine-based products that have to be put underneath your tongue such as Buprenorphine-Naloxone and Buprenorphine SL.
opiates and opioids are bad for your teeth. Many consider Buprenorphine-based products like Buprenorphine-Naloxone that sit in your mouth to be especially bad for your teeth. As the Buprenorphine injection is an opioid, it too is considered to be bad for your teeth, but perhaps not as bad as Buprenorphine-Naloxone as it is not sitting in your mouth every day
What are the disadvantages, side effects, and potential risks of the Buprenorphine injection?
As with all medications and treatments, there are a number of important potential side effects and risks, these include but are not necessarily limited to:
the injection is painful
reaction leaving a large bump at the injection site that may last for longer than months
injection site reaction including pain, itching, redness, and/ or bruising
as the Buprenorphine injection is an opioid, it causes physical dependence in the same way that Buprenorphine-Naloxone does. If you stop the Buprenorphine injection you may have opioid withdrawal symptoms similar to when other opiates or opioids are stopped
headache
nausea, vomiting
decrease blood pressure
constipation
respiratory depression
itching
drowsiness
dizziness
increased sweating
fatigue
increased liver enzymes
may make you tired
injection site bleeding
problems with coordination
irregular heartbeat that can lead to death
soft tissue atrophy/ deterioration
moderate to severe liver damage
difficulty treating pain
opioid withdrawal
insomnia
anxiety
weakness
numbness
flu-like symptoms
upset stomach
allergic reaction
overdose
Does the Buprenorphine injection work?
Yes. Remember, the Buprenorphine shot is a once-a-month injection of Buprenorphine, the same medicine as Subutex; this is the active medicine in Buprenorphine-Naloxone. Studies have shown the Buprenorphine injection’s ability to block the subjective effects of opioids. After your first injection, the medication starts working, the Buprenorphine injection levels peak within 24 hours before decreasing to a maintenance level after several days that is maintained throughout the month where you should not have the ups and downs that some patients complain about with Buprenorphine-Naloxone taken underneath your tongue.
While the Buprenorphine shot works after the first injection, there are some people who feel that during the first month, it does not work as well as Buprenorphine-Naloxone underneath the tongue. Although this can happen, it is not expected. This is good to know in case you have this experience. Although not considered a usual approach due to concerns for increased risks, after the very first Buprenorphine injection, a provider may prescribe Buprenorphine-Naloxone to be continued at the same time. Insurance will often continue to pay for the Buprenorphine-Naloxone prescription in this situation. However, as this is not a usual approach, some insurances will not pay for Buprenorphine-Naloxone directly after a Buprenorphine injection (for at least 4 weeks, the amount of time the Buprenorphine shot is expected to work). To be clear, if you feel that the Buprenorphine injection is not right for you, after a month, you can choose to go back to Buprenorphine-Naloxone regardless. Depending on a number of factors, there is a possibility that you may or may not need a higher Buprenorphine-Naloxone dose.
I want to start the Buprenorphine injection
If you have questions or want to start treatment with the Buprenorphine injection, call 219-850-4490 or schedule an appointment online. You can get started with treatment now. Many insurances including Indiana Medicaid do cover the Buprenorphine injection. We can work with your insurance to have the Buprenorphine shot delivered to our office where the injection will be performed.
This is for informational purposes only. Do not use any information in this blog to guide your treatment. This was originally written as a reference for our patients. You must follow the instructions of your provider.
