Recently, the FDA gave its approval to a new treatment for patients with an opioid substance use disorder. It is a monthly injection of an old medicine - buprenorphine. The new treatment is called Sublocade® and it reliably gives a steady dose of the buprenorphine for a whole month.
Buprenorphine is the active ingredient in Suboxone, Bunavail®, and Zubsolv®. It is a long lasting partial agonist which means that it partially turns on the brain's opiate receptors. But, it does this in such a slow and controlled fashion that people don't get high when they take it. Indivior, the manufacturer of Sublocade, has now taken the buprenorphine and put it into a slow release formula which lasts a month - at one of the highest prescribed doses of Suboxone.
There are number of reasons why this may be a very useful treatment. It should reliably decrease cravings. Because it is a monthly injection by a healthcare provider, it will be impossible for the addict to sell the medicine or swap it for other addictive drugs - which happens more than we would like to think. It will likely help patients in a psychological way, too. Receiving a once-monthly treatment allows patients to focus on their recovery instead of always thinking and wondering if the dose is correct, or if they need more medicine. We see this pattern with our two-month naltrexone implants. Patients relax and don't focus on their medicine, and instead, focus on the changes they need to make to stay in long-term recovery.
One more place that Sublocade® may be very helpful is in the ER, right after a near fatal overdose. Some studies are underway to see whether it may be helpful to put patients onto Sublocade® at a time when patients have come face to face with the reality that they have a disease that almost killed them. One shot of Sublocade® can provide 30 days or so of protection from another overdose while helping patients proceed with counseling and treatment.
Of course, one of the challenges with Sublocade® is that it is still an addictive opioid. Patients can use it to stabilize their opioid problem, but if they chose to be abstinent and on naltrexone, they will have to go through a detox process.
Fortunately, here at the Coleman Institute, we have an Accelerated Detox program to support long-term abstinence. Currently, we are seeing more and more patients who have done well with Suboxone but are unable to stop on their own. Our program can shorten the detox process from an 18-month taper, down to an 8-day outpatient treatment with a 98% completion rate.
Sublocade® is an interesting new treatment option. It may well be a very helpful addition to available treatment options for opiate dependence or addiction. With over 120 fatalities per day, we certainly need continue to develop all treatment options.
