Sublocade information

[Lillyval]

I found out a couple of really interesting things about Sublocade, but unfortunately I’m not able to cut & paste off of the manufacturer’s website. Here is the link:

http://indivior.com/wp-content/uploads/ ... -Sheet.pdf

What troubles me is that the dosages seem really high. For instance, their study data says that the average steady state blood serum level for someone on 24mg sublingual Suboxone per day is 2.91 ng/ml. On the 300mg Sublocade injection the average blood serum level is 6.54 ng/ml. That is more than DOUBLE...and 24mg is already a very high dose, imo. Even the lower dose Sublocade injection, 100mg, results in a higher blood serum level than 24mg sublingual.

Interestingly, their study said that the 300mg injection blocked the subjective (“liking”) effects of 18mg hydromorphone (dilaudid), while 8-24 mg sublingual Suboxone did not. This is significant, because I’ve had a lot of patients tell me that they “successfully” shot heroin while on what was supposed to be a blocking dose of Suboxone.

So it sounds like Sublocade is potentially very effective, and cannot be removed by the patient like the buprenorphine implant (Probuphine). However, the dose is so high, what if someone has debilitating side effects? There would be no alternative but to ride it out for a month or more.

[docm2]

When I first heard that this was in development I was pretty excited. Then I found out that it is being marketed by Indivior. (they also make and market Suboxone) In 5 years I have seen the rep twice and had to call with a specific request before she would grace me with her presence.
Did you see the price? $1580 per dose (month) Wholesale! I thought Vivitrol was outrageously priced. They claim that they will have a program to reduce costs for specific patients but having tried to jump through their hoops for the free Suboxone for 2 patients I am not hopeful at all that this will be a boon for treatment.
Hopefully the company that will be coming out with the weekly injection will be to market soon.

I get your point about the high doses, but a person is to stabilize on oral products first so hopefully unbearable side effects would have emerged. I found it interesting that studies are still using 24 mg a day of sublingual buprenorphine as part of the protocol. Thought it would have been dropped to 12-16 mg a day to reflect current practice.

Hope someone that gets it will post their experience!

[jennjenn]

$1580 a month?? Goodness gracious! That seems so ridiculous and makes me wonder how they expect the normal person suffering from addiction can afford that.

[TeeJay]

My countries Pharmaceutical Benefits Scheme is usually pretty good with medication like this. And given our coroner's court has recently railed against take-away doses of Suboxone and methadone, I'm sure they'd be more than happy to foot the bill for something like Sublocade. I'm genuinely grateful to be living in a country like mine with universal health care that covers things like these.

But you're right Lilly about the high blood levels. It's concerning especially for those of us who experience side-effects on higher doses of Sub.

What might be interesting is how Sublocade, with its very gradual tapering of plasma concentration over a period of many months, might facilitate people coming off. One or two injections might help a person taper off. It's hard to tell exactly how effective it will be. It's very new ground.

[razor55]

Plus ther ever present risk of needing pain relief in surgery or in the ER...

[TeeJay]

It's the same for vivitrol. People are often given ketamine instead of narcotic painkillers in that situation. Also Dr. J has talked about prescribing agonists on top of buprenorphine for pain, so maybe that's another avenue.

Here's some information on the Camarus Pharmaceuticals CAM2038 depot injection, which seems to have many more dosage options available than Sublocade:

https://www.fda.gov/downloads/AdvisoryC ... 582594.pdf

[docm2]

Thanks TeeJay,
I had not realized that this product was going to be marketed by Braeburn. The same company that brought us Probuphine and its $1000 per month charge. So, I don't look for them to be much better than Sublocade. But it will offer more flexibility in dosing.
PAX

[suboxdoc]

The price is an example of why healthcare costs always go up, even as technology reduces costs for many other parts of the economy. The main driver for injectables is the expected approval of generic 'Suboxone Film', which is expected in 2018. So Indivior is repeating the process they used in 2010 or so, when generic tablets came out. Back then, Indivior (Reckitt Benckiser) tried to get insurance companies to approve only the film, saying that tablets (the ones they had been selling for 7-8 years) were not safe. Now they are saying even the film isn't safe, in order to get governments to restrict pills and film and cover injectables.

So right now, generic buprenorphine is readily available at a retail cost of $120 per month (for 16 mg per day.) Generic film will probably be a bit more than that, but we are talking about going to a medication that costs ten times more, but offers marginal benefits over the cheaper drug. Instead of having the government (i.e. taxpayers) pay for free injectable buprenorphine, I'd rather hav people realize that most 'diverted' buprenorphine goes to people trying to quit on their own, and harm or death from buprenorphine is very rare.

I expect all sorts of attempts from the companies making injectables to highlight the 'risks of diversion', as they try to turn the market away from strips and tablets.

[TeeJay]

In my country, I have to pickup my Suboxone from the chemist at least once a week. When people start out, they are dispensed from the chemist their dose daily, and have to take it in-store.

The depot injection for people in our situation is hugely beneficial. All you have to do is go to the doctor once a month, which we have to do anyway to get a script. And it will make travelling a lot easier. It will make life, in general, a lot easier. No more yucky film, no more waiting for it to dissolve and being unable to talk. Going overseas, especially to countries where buprenorphine is considered a narcotic on par with heroin (Thailand, Indonesia etc), will finally be possible.

[Nly4]

I was given my first injection of Sublocade yesterday. I’ve been on 16mg of Subutex/Suboxone for 4 years. I have a really bad migraine today and I couldn’t figure out why until I realized it could be from the injection. No OTC stuff will make it go away. Does anyone know if this will subside? My doc is kinda hard to get ahold of. THANKS!!

[Nly4]

I also noticed that everyone here is a doctor. I guess that makes me the test subject lol. Does anyone know if there is a patient forum for this stuff yet? Also, my doc is using the Sublocade to get me off Suboxone. He said to come back for the lower dose shot in maybe 2 or 3 months. From what he has seen, using this method has worked to get several other patients off the Subs.

[jennjenn]

Everyone here isn’t a doctor. We have two doctors here on the forum but most of the members are ppl like yourself who are patients of buprenorphine. We have ppl who’re just newly starting this medicine and ppl who are maintaining on it and ppl who are even tapering off it. It’s a great place to meet ppl in MAT.

We haven’t received a lot of ppl doing the sublocade but there is someone just starting it that’s recently started a thread. If you search the word sublocade then it should pop up for ya. I think you two could really really help each other!

[Subjourney]

Hi I am an opiate addict who was taking 160 mg of OxyContin every 3-4 hours when in active addiction. I am now 52 days clean from oxy’s and got help for my addiction. I am also now on MAT as part of my recovery. My doctor initially started me on 8mg of suboxone and we increased to 16mg within the first few weeks due to me still having the effects from PAWS. As of last week I opted to switch over to the sublocaide 300mg shot. It’s been exactly 7 days since having the injection and I am not having any side effects. I feel completely normal, no drowsiness, no euphoria, no impairment whatsoever. I’m finally beginning to feel much better! Honestly if it wasn’t for my MAT Program I would have probably relapsed due to not being able to get past the PAWS and having the urge to just feel normal ... which is what kept me in my addiction for over 10yrs. So if anyone has any questions in regards to my journey please feel free to ask.

[rule62]

What a great story to read. Success is so often achieved with MAT and it doesn't get its fair share of credit.

Enjoy your new journey of life!

[Johnsonlee]

Hey
Tks for sharing about your sub locate experience. I'm getting the shot any day. Waiting on insurance. You gave me so much hope when saying you are feeling normal. How normal, though? Are you still dealing with constipation and unable to orgasm when having sex?
I'm on 24mg and thought I was a lifer until I read about sub locate. Man,I am praying it works