By Stevie Duncan, Practice Management / Addiction Recovery Consultant, North Dayton Addiction and Recovery Services, East Indiana Recovery
Suboxone is a medication that has saved countless lives since FDA approval in 2006. Many of those who have struggled with the withdrawals and cravings from opiate addiction have found that a medication assisted treatment program has been the sole reason they were able to change their life around. While Suboxone has many benefits, it is not always without risk. This life saving medication can also be abused when in the wrong hands, diverted on the street, and it does cause physical dependence. For these reasons, as addiction medicine has evolved, there has been astounding progress with making buprenorphine an even safer, more effective choice for medication assisted treatment: Sublocade, a monthly injection of Suboxone.
Have you used Suboxone in the past, and had a positive outcome? Many people experience immediate relief of their cravings and withdrawal symptoms, as well as gain an overall sense of well-being. With certain symptoms under control, one may begin to repair the brain and restore their lives. The problem with addiction is that there is little room for error when maintaining your recovery. Like all medications which must be taken daily, there is a possibility that you may not always adhere to dosing instructions. This could be caused by forgetting it at home, not taking the medication at its full dose, or not maintaining the frequency of mandatory office visits to receive the prescription. When you purchase Suboxone from the street, you may not have the finances to keep affording it, or the person you’re getting it from may not have enough to give you this time. Or worse, they could offer you an opiate instead. (Don’t forget that purchasing Suboxone on the street is not only illegal, but it is not a therapeutic remedy for long term recovery.) When you have learned that Suboxone tablets work for you, but have struggled with maintaining its required daily dosing instructions for whatever reasons causing intermittent relapse, Sublocade could be your best option.
Is Sublocade Right For You?
If you’re wondering if this next step is right for you, ask yourself the following questions. Do you:
-Struggle to take your prescribed dose at the same time, everyday?
-Relapse in between Suboxone doses?
-Have an intolerance to naloxone?
-Regularly overuse your prescribed Suboxone?
-Unable to detox on your own long enough to receive Vivitrol?
-Hate the “highs and lows” of daily dosing Suboxone? (waking up in withdrawal or dose wearing off too quickly)
-Have other opiates users around you or have opiates readily available to you?
-Not have reliable transportation to maintain regular, frequent office visits to stabilize onto Suboxone?
-Have limited or no income, or a history of dealing illicit street drugs and/or Suboxone?
Does this sound like you? If so, Sublocade may be an appropriate medication-assisted treatment option for you.
What is Sublocade?
Sublocade is an FDA approved, subcutaneous injection of extended release buprenorphine that lasts for 28 days and is administered by your physician. It’s for patients diagnosed with moderate to severe opiate use disorder. Sublocade works by delivering a steady stream of buprenorphine to your mu (opiate) receptors, the ones that pain pills, opiates and fentanyl bind to and would otherwise give you the high.
Once you receive the injection (you must be on Suboxone tablets for 7 days prior to the injection) you will stop taking the pills daily. You’ll feel stable, and comfortable around the clock. With Sublocade, there are no highs and lows with medication wearing off. If you have a bad day, or find yourself in a sticky situation, you’ll likely manage through it better if on Sublocade. Your cravings will nearly be extinct because the receptors are covered 24/7. You’ll have no withdrawal. You won’t feel high. If you do in fact relapse, you likely won’t feel anything other than frustration (because it will not work!) The buprenorphine, a partial opiate agonist, will win that battle every time.
Because Sublocade is a once-a-month injection of extended release buprenorphine, you don’t have to worry about taking your medication every day. It’s just there. You don’t wake up every morning and immediately need to dose, or risk overusing your medications at night when Suboxone can potentially start to wear off. If you are in an environment where others are using opiates, it may be difficult or nearly impossible to make the choice of taking your medications versus using “just one last time.”
If you have an intolerance to naloxone, you’ve likely dealt with provider hesitancy and/or flat out refusal to prescribe Subutex. Sublocade is buprenorphine only- so you could consider it a “Subutex injection”. Sometimes, when your income is limited or nonexistent, your brain may urge you to share, sell or trade your medication for other things. In the beginning of recovery, your brain is still in survival mode and engaging in addictive behaviors. But you have to cease these behaviors in order to properly recover, therefore Suboxone may not be in your best interest.
Even though you have made the right choice to begin your recovery, in the beginning your brain is still broken. It will continue in survival mode, trying to push you to do the same things you know aren’t good for your recovery. Early in the process, it’s important to change your life so it becomes one where using is NOT easy.
When you decide you can no longer maintain an appropriate Suboxone regime (because, yes, there is a right and a wrong way to do it), you’re able to focus your time, efforts and energy into the stuff that really matters. These include changing your people places and things, participating in counseling, therapy and other recovery work efforts, learning relapse prevention and how to manage your stress and triggers in a positive way, getting to the underlying issues which may have caused your addiction to begin, earning your families trust back and rebuilding healthy relationships. When you have finally chosen to get the month-long Sublocade injection versus the traditional daily dose of Suboxone, you’re making a choice to remove nearly every factor that can hurt your future self and almost any possibility of a potential relapse that could literally be your last. It’s that simple.
Sublocade Gives Us Hope
Don’t get me wrong, Suboxone, when utilized properly, is nothing short of a miracle. Many people can successfully maintain stability, and live normal, productive substance free lives where addiction is no longer an issue. But due to the nature of the beast, many people are simply unable (not by choice!) to follow the appropriate treatment protocols for Suboxone maintenance to effectively work. This is why we’re thrilled for Sublocade! It gives us more hope and more realistic expectations for that group of patients who might otherwise fail at Suboxone, or recovery in general.
Once you’ve received your injection, and the buprenorphine has fully attached to all of your receptors in the brain, they’ll be content. However, if you so choose to use anyway (like so many do) that burprenorphine is blocking those receptors ands won’t allow any other opiates attach. You won’t feel high. You won’t get any feel good feelings at all. The buprenorphone will win that battle. So the chances of that “just one more time” incident turning into full blown use again will dramatically decrease. Using simply doesn’t make sense anymore. That, coupled with the steady stream of buprenorphine day in and day out will greatly increase the success rate of MAT treatment outcomes in the patient types listed utilizing a buprenorphine product.
North Dayton Addiction & Recovery provides Sublocade injections as part of an individualized program tailored to fit your specific recovery needs. If you have struggled in the past with remaining compliant with your medication regimes, give us a call to see if Sublocade may be an appropriate medication to introduce into your recovery program.