Sublocade: Directionally Positive, But Not A Panacea
Buprenorphine has been used for nearly two decades to treat addiction to opiates, such as prescription pain pills, heroin, and fentanyl.
In fact, Buprenorphine has been very successful as it not only provides relief from withdrawal symptoms, it also mitigates cravings.
Physicians prescribe buprenorphine, which comes in Listerine-like strips, to patients and they are instructed to ingest them in certain doses at given intervals.
Buprenorphine is the generic name for the medication, which is also sold under brand names such as Suboxone, Subutex, and ZubSolv.
However, all is not rosy! Some patients hoarded this medication and used it to “detox” themselves after partying or running out of money to buy drugs on the street.
Even worse, they sold some of their buprenorphine strips to drug dealers on the streets to finance their drug habit or obtain food or sex. In the DEA’s language, this is called “diversion” of the medication as a tightly controlled medication becomes available on the black market on the street.
Not only was the medication used as currency on the street or on a contingency basis (as needed), it did not fully serve its purpose – help people come off and stay off opiates!
In November 2017, the FDA approved a newer version of buprenorphine, called Sublocade. This medication is an injectable, extended release form of buprenorphine which is released at a controlled rate into the bloodstream for a period of a month. Like, other forms of buprenorphine, Sublocade is effective in providing relief from withdrawal symptoms and addressing cravings.
Dr. Cidambi, the country’s leading addiction expert, is positive on the medication as it helps with compliance. Sublocade stops the games patients played with Suboxone previously. However, it is not a panacea.
The patient has to be brought down to a steady dose of Suboxone before Sublocade can be administered. It cannot be used in the early stages of treatment for Opioid use disorder when the dose needs to adjust up or down. Introducing Sublocade early may be detrimental, as the patient may turn to illicit drugs if the Sublocade released into the bloodstream is not sufficient to mitigate withdrawal symptoms or cravings.
Sublocade is a monthly injection, so the patient does not need to see the physician for a period of one month. The danger is that the patient is not monitored for weeks and unless the patient engages in regular therapy, the physician will be unaware I the patient tries to co-abuse other drugs while on Sublocade, which would increase the risk of respiratory depression.
Co-abuse of benzodiazepines and alcohol with opiates (before being treated with Sublocade) is common and their use is contraindicated with Sublocade also.
Despite these concerns, Sublocade does mark an advancement in the treatment for addiction to opiates, as it adds to the arsenal of drugs and therapies available to combat this epidemic.
For more information about opioid addiction, or the use of buprenorphine to address opiate use disorders, please don’t hesitate to contact us.