“That stuff’s poison,” he said to me.
He was talking about buprenorphine. A medication that had already saved many lives. His reasoning was simple…..it’s difficult to stop. And sometimes people feel like they went from one addiction to another.
But that doesn’t make it a poison. For most people, it’s much safer than their previous life of drug use and addiction. And how long they should continue treatment is an ongoing question.
(Buprenorphine is difficult to stop. So be aware. See below for how to effectively taper off)
To many people struggling with opioid use disorder….. buprenorphine can be a miracle.
I’ve seen people get their lives back. Families reunited, steady jobs, and money in the bank. I’ve seen people go from death’s door to living happy and fulfilled lives.
A new medication has been approved for opioid use disorder. It’s called Sublocade. And it’s an injectable version of buprenorphine. It has been shown to effectively reduce “drug liking” or what I call cravings to use.
Buprenorphine has already been used for opioid use disorder in the form of sublingual medications: Suboxone, subutex, zubsolv. It is used in a patch form for people with chronic pain.
Buprenorphine is a partial opioid agonist which means it acts like an opioid in some ways and doesn’t in others. That’s a simplification, but you get the point.
So how would a monthly injection be beneficial over the previous forms of this medication?
A monthly injection, given in a doctor’s office, is going to improve compliance with treatment. It will help ensure stable dosing across the month. And it can take some of the pressure off the patient to always take their medications the right way.
Many of my patients work long shifts and erratic hours. They don’t want to have to bring medication with them to work. For many of these patients, a monthly injection could be beneficial.
There is also concern about tablets and strips getting stolen. But with this medication, the patient doesn’t have to worry about that. The doctor administers the medication in the clinic.
Sounds good right?
But wait.
It’s not for everyone. Let me explain.
The standard dose of injection is 300mg the first and second month and 100mg per month after that. This is good unless you want to taper down the dose and stop it altogether. If you stop cold turkey, you will have withdrawal symptoms and these are not pleasant. So, from what I can tell, if you want to reduce your meds and eventually stop them, then you will need to change over to a sublingual form.
Also, since it’s a new medication, cost will be an issue. Treatment is still probably more cost effective than no treatment, but either way, people worry about the cost of medication. (And rightly so)
What about side effects?
Side effects are going to be similar to any other buprenorphine product (constipation, nausea, headaches, etc) with one exception and that is injection site reaction. (Make sure you let someone know if you have any side effects from your meds)
Medications can often be helpful. But they aren’t a cure-all. And they definitely aren’t an adequate substitute for a qualified physician that cares about your recovery and overall health.
Could Sublocade help you? Possibly. But maybe it’s not the right treatment for you.
Talk to your doctor and find out.
p.s.
This is meant as information. Not medical advice. Thanks for reading.
p.p.s.
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p.p.p.s.
If you’re having difficulty tapering off buprenorphine, I made this video to help. Please talk to your doctor before making any changes.
I am the first person in the state of Montana to get Sublocade. It has been for the most part, a miracle, but just for the fact that I’m off of Heroin, haven’t injected any opiates for almost 5 months. Huge, especially after being a hardcore IV opiate addict for 35 years. I should have died several times. For that miracle, I am forever great full.. However, I’ve never been told how long or what’s going to happen when I decide that I don’t want to do this anymore? To think of experiencing ANY withdrawal symptoms is terrifying and to think about going back to active addiction is impossible for me. The doctor that is giving me the sublocade seems to, after considerable thought and reflection,….doesn’t really care. I’m being used to further his status, income. Any thoughts on this I would welcome and appreciate very much. Sincerely, Marianne Wildin
First of all, CONGRATULATIONS! Now, the question of how long to stay on medication assisted therapy is the million dollar question. I usually work with my patients to come up with some goals and think long term. Make sure you’ve worked on relationships, your vocation, your faith, and all the other things that may have been neglected when on heroin. And then think about the process of weaning off meds. With Sublocade, some have advocated just not getting another injection and the med tapers itself off. But I don’t have any experience with this, it’s just what’s been told to me by another patient. One thing though, is sometimes people try to taper too quickly. What I mean is….you’re just getting started with your recovery. Embrace that. And I think you’ll know when it’s time to taper off. If tapered correctly, you can have have minimal withdrawal. It should not be like the way you remember it with Heroin withdrawal. There is a thing called “Post Acute Withdrawal Syndrome”. Which can be different symptoms, often fatigue and depression, after tapering off all drugs/meds. I made a vide about it and you can watch that here: https://www.youtube.com/watch?v=M14GfIqtzv8&t=24s. Good luck with your journey and let me know if you have any more questions. Remember…..this isn’t medical advice for you, just general information that you can discuss with your doctor. God speed and God bless
Hi, I just wanted to let you know that as a sublocade patient with the veterans administration after stopping the injection I haven’t had major withdrawal symptoms. There have been minor 1/10 scale sweats. None of the usual restless leg syndrome, extreme hot and colds, or anything like that. I did notice some broken sleep as well that got better over time. Compared to the films and tablets the sublocade was easy to come off of. You still need to change your life habits and your way of living to avoid relapse.
How long off the shot I started WD at month 5
My name is Sam I got my sublcade shot 2 days ago and am going through horrific withdrawal idk if they injected it wrong into me but I have an appointment today I told them I was sick I hope they will put me back on my 12mg suboxone it worked much better for me considering I crave heroin again after i got my shot I dosed a sub the say I got the shot and 24 hours afer that sub i became very very I’ll I was hoping this would work for me so I could remove the drug taking ritual from my life but I’m happy for the other people this works for
I’ve now had 3 injections of Sublocade, all of them 300 mg. My upcoming 4th injection will be 300 mg. as well. Anyhow, for high dose high tolerance addicts like me, Sublocade (eventually) works a charm — but it’s a slow go at first. It actually takes 2,3 or 4 injections before the buprenorphine is at a high level in the system. It’s not like the 1st, initial shot puts you at a high level of Bupe — it doesn’t. Therefore I had to be Rx’d additional Suboxone strips, even right up to that 3rd injection. But that might not be everyone’s case.
Thanks for sharing your experience. Glad it’s working well for you now. Good luck!
Sorry, I meant Samuel. I am thinking about getting the shot but what do you say to people when they hear things like what happened with Samuel? You can’t just take the shot out.
Thank you for the article. This information is right on the money as far as my experience goes. I was an opiod abuser for 20 plus years (herion and pills). After a near fatal overdose, I was in intensive care for 5 days where I went through horrific withdrawals. I wanted to blow my brains out. I was transefered to a treatment facility and given suboxone strips. That was a lifesaver and a game changer for my recovery. It smoothed out my withdrawals and cravings to let me focus on recovery tasks.
I have been clean for 2 years and 6 months now. Best time of my life and I owe it largely to this medication and a strong desire to live.
I was on dosages of suboxone from 16 to 24mg per day. 3 months ago I switched to the injection. I cut over cold turkey mostly. I continued the strips for 1 week after the first injection then stopped. It was seamless. I had no side effect whatsoever.
After 2 1/2 of sobriety and suboxone I feel I am ready to quit altogether. I am going to ask my doctor to discontinue my treatment at my next appointment. This gives me some anxiety since I know what the withdrawals could entail. I only hope I can do it slowly and painlessly. I feel I am ready to live drug free.
I continue to attend support meetings twice a week and see a therapist once a week which I will continue. I would be very interested to hear any feedback as to whether you think it’s a wise choice to get off this medication after 2 1/2 years? Thank you.
Clean for 2.5 yrs!!! That’s awesome! Some patients have reported that after their last injection, the med slowly faded out of their system. Kind of like a built in taper. I’m sure everyone is different but hopefully you won’t have any withdrawals or that they will be minimal at most. Good luck and keep me updated!
Is it normal to have anxiety I went from 24 mg to 12 mg an I was on 24 for 4 months bin on 12 for 1
Week I’m having bouts of anxiety heart racing ?
Yes it can be normal to have anxiety when tapering. Especially if you taper quickly. I am not saying that’s why you are having anxiety though. You’d need to discuss with your doc so he/she can do a full history and physical. How quickly did you jump from 24 to 12?
“Heart Racing”, a really elevated pulse, is par for the course in any type of opiate withdrawal. I remember, many years ago, when I attempted to quit Percocet — suddenly my pulse shot up to 151 bpm (and in those whereabouts), to where my doctor admitted me to the hospital. Anytime I quit or lowered opioid doses, my pulse would go though the roof.
I got started on sublocade 3 days ago and I am bedridden.. I am so sick I can’t even barely move. What do you suggest I do? It sort of feels like too much bupe. Nausea is terrible. I have been on subutex for 2 years at 8mg a day.
I hate to hear that. I had a patient that had some issues with it and we felt it was too strong for him as well. Are you bedridden due to nausea or headaches? Does it feel like withdrawal or severe fatigue? Just curious. Talk to your doc about your options. They may want to evaluate you and/or get you something for the nausea or whatever else you need. Or they may want to remove it from under the skin. Good luck.
I am worried about my ole man who is on his 4th month of the shot. He is going to the city and giving subs from others. He is taking around 3 a day. He started subs in 2011 to replace Vicodin. We are in Michigan and I don’t know what to do We can’t get to you. Any advice?? Daily I worried I will awake with a dead man next to me. I don’t know how to help him. I’ve been doing research for many months to no avail.
I was on subs for 12 yrs I got 2 shots then walked off I thought I was in the clear then at 5th month I started to get WD I unfortunately had to star micro dosing suboxone 1/8 to 1/16 of a strip usually helps
Dr, I have a question. I’m on 2mg for for about 4 years. My dr. recommend sublocade in a few weeks. My hope is to take the shot and I will forget a out taking the 2 mg I used to take forever. Because I’m on a low dose, is that possible. Will I be able to stop the 2 mg after the first shot. I understand your not my dr and information is not medical advise. Please. I hate having to take this every morning.
In general this medication is intended so you don’t have to take the Suboxone or subutex any more. If done correctly there shouldn’t be any withdrawal. Your doctor may have you take 2mg a day (as needed) for a few days after the first shot while it starts to kick in. Good luck.
So it may work out that I will not need to take the shot again after the first shot? And I won’t need to take the 2mg daily either? I been on subs for more than 10 years. Thank you.