Sublocade

This is the brand name of an Indivior (the makers of brand name Suboxone) product. Generically we would call it a depot buprenorphine. Depot medications are injected under the skin or into muscle every few weeks or months  The first depot medication was an antibiotic in the 1950’s. Now we see psychiatric medications like fluphenazine which is usually monthly, hormones like testosterone – typically every 2 weeks and medroxyprogesterone which can provide up to 9 months of birth control. There is also a depot insulin. The advantages of depot medications is a more constant blood level and not having to remember to take your medication. For people on opioid replacement without carries it can free them up from daily pharmacy visits. It can be an option for people with transportation issues or people who get called out of town for work.

Depot buprenorphine is given as a once a month subcutaneous (under the skin) injection. The first 2 months the injection is 300mg of buprenorphine. After that most people transition to 100mg shots but some people do better staying at 300mg. Your doctor would have this discussion with you before the start of month 3 or during month 3 if you start to develop mild withdrawal. Depot buprenorphine is covered by company drug plans, Ontario Drug Benefits (Ontario Works or Disability) and NIHB (First Nations coverage).

Depot buprenorphine does not contain naloxone (all sublingual and film buprenorphine’s in Canada do) but is has Atrigel – a proprietary biodegradable polymer solvent mix that serves as the delivery system for the buprenorphine. The buprenorphine is dissolved in the Atrigel which is liquid in the syringe but as it is injected under your skin (abdominal skin) it starts to turn in to a putty-like solid. This gradually is absorbed over the next 3-4 months however the consistent blood levels required are only good for the first 4-5 weeks. The 300mg doses are only 1.5 ml. The 100mg doses are 0.5ml. For comparison a teaspoon is 5ml.

What do you have to do to get depot buprenorphine? First, it is only indicated for opioid use disorder. Second, make sure you are covered. If not you should talk to our pharmacist – many people would feel it is too expensive. If you are already on buprenorphine you have to be on a dose between 8 and 24mg per day. If you have been in that dose range for a week you are eligible – talk to a BMC physician.

If you are not currently on opioid replacement book an intake and talk to a BMC physician. If both of you feel depot buprenorphine is a reasonable goal you will be started on buprenorphine, stabilized and then after a week of at least 8mg you could get your first injection,

If you are currently on methadone you would have to transition to buprenorphine first. Talk to a BMC physician about the options.

Below are the manufacturers recommendation for who should not take Sublocade:

SUBLOCADE may not be right for you. Before starting SUBLOCADE, tell your healthcare provider about all of your medical conditions, including:

• Trouble breathing or lung problems
• An enlarged prostate gland (men)
• A head injury or brain problem
• Problems urinating
• A curve in your spine that affects your breathing (scoliosis)
• Liver problems
• Gallbladder problems
• Adrenal gland problems
• Addison’s disease
• Low thyroid hormone levels (hypothyroidism)
• A history of alcoholism
• Mental problems such as hallucinations (seeing or hearing things that are not there).
• Are pregnant or plan to become pregnant. Opioid-dependent women on buprenorphine maintenance therapy may require additional analgesia during labor. If you receive SUBLOCADE while pregnant, your baby may have symptoms of opioid withdrawal at birth.
• Are breastfeeding or plan to breastfeed. SUBLOCADE can pass into your breast milk and may harm your baby. Talk with your healthcare provider about the best way to feed your baby during treatment with SUBLOCADE. Watch your baby for increased drowsiness and breathing problems.