Dr. Sendi – at NOVA Addiction Specialists can evaluate you to see if Sublocade will work for you.
http://www.suboxonecenter.org/ Suboxone treatment – telemedicine also – 703-844-0184 24/7
Has anyone used much Sublocade yet? It seems that a lot of patients are pushing back against it. It seems crazy that this is the case. Some have said they don’t want any foreign substance in their body. That seems like a logical fallacy since most opioids are foreign substances as well. Really, the fact is that Sublocade takes the choice of relapse off the table. I think it is an excellent strategy for success to insure compliance.
The patient needs to be on a minimum steady dosage of Suboxone for 7 days before the first standardized 300 mg injection in the subcutaneous area around the navel area. It forms a gelatin blob due to the Atragel component of the injection. If injected into a blood vessel, it will solidify immediately. Only health professionals are allowed to handle the medication. The medication can be removed by excision in the first 15 days.
What is the cost? $1500 a month. Insurance may cover some of it.
I decided to do a literature survey of on-line google posts in the news about Sublocade below. None of what follows is original:
Recently, the U.S. Food and Drug Administration (FDA) approved Indivior’s Sublocade™ (buprenorphine), a subcutaneous injection for the treatment of moderate-to-severe opioid use disorder (OUD). Sublocade should be used as part of a complete treatment program that includes counseling and psychosocial support. The drug is injected under the skin (subcutaneously) in the abdominal region by a health care professional. The recommended dose is 300mg per month for the first two months, followed by 100mg monthly maintenance doses. The maintenance dose can be increased to 300mg monthly if the benefits are determined to outweigh the risks. Sublocade must be prescribed and dispensed as part of a Risk Evaluation and Mitigation Strategy (REMS) to ensure that the product is not distributed directly to patients.
The manufacturer, Indivior, plans on launching Sublocade 100mg/5mL and 300mg/1.5mL syringes during the first quarter of 2018; it will be available through a limited network of specialty pharmacies that includes Accredo. Pricing has not yet been released.
Several other dosage forms of buprenorphine are available, some of which have FDA indications for chronic pain, and others for substance abuse withdrawal. These include:
|DRUG PRODUCT||DOSAGE FORM||DEA SCHEDULE||APPROVED INDICATION(S):|
|Butrans®||Topical patch||C-III||Chronic pain|
|Belbuca®||Sublingual patch||C-III||Chronic pain|
|Subutex®||Sublingual tablets||C-III||Opioid dependence|
|Sublocade™||Injection||C-III||Opioid Use Disord|
Indivior announced the availability of Sublocade (buprenorphine extended-release) subcutaneous injection for the treatment of moderate to severe opioid use disorder (OUD) in adults who have initiated treatment with a transmucosal buprenorphine-containing product followed by a dose adjustment for ≥7 days.
Sublocade is intended for use as part of a complete treatment program that includes counseling and psychosocial support. It carries a Boxed Warning describing the risk of serious harm or death with intravenous (IV) administration. Sublocade is only available through a restricted program called the Sublocade REMS Program. Healthcare settings and pharmacies that order and dispense Sublocade must be certified in this program and comply with the REMS requirements.
The approval of Sublocade was supported by data from the Phase 3 RB-US-13-0001 study (N=504). The proportion of patients achieving treatment success (≥80% opioid-free weeks) was statistically significantly higher in both Sublocade 300mg and 100mg groups vs placebo (28.4%, 29.1%, and 2%, respectively).
Buprenorphine is a partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor.
Sublocade, a CIII controlled substance, is available in 100mg/0.5mL and 300mg/1.5mL strengths as single-dose prefilled syringes.
For more information call (877) 782-6966
Indivior announced that the Food and Drug Administration (FDA) has approved Sublocade (buprenorphine extended-release) injection for subcutaneous (SC) use for the treatment of moderate-to-severe opioid use disorder (OUD) in patients who have initiated treatment with a transmucosal buprenorphine-containing product followed by dose adjustment for ≥7 days. This approval makes Sublocade the first once-monthly injectable buprenorphine formulation for this condition.
Sublocade, a partial agonist at the mu-opioid receptor, provides sustained plasma levels of buprenorphine which blocks the drug-liking effects of opioids by taking up high receptor occupancy in the brain. It is a drug-device combination product that utilizes the Atrigel Delivery System in a prefilled syringe. It is injected as a solution and the delivery system forms a buprenorphine-containing depot that releases the drug as the depot breaks down.
In the 12-week Opioid Blockade Study (RB-US-13-0002), researchers assessed the ability of Sublocade 300mg to block the subjective effects of illicit opioids, including drug-liking. Data showed that the use of Sublocade resulted in complete blockade of drug-liking effects of hydromorphone for a full month in most patients.
In a 24-week, Phase 3 study (RB-US-13-0001), patients were randomized to 6 once-monthly Sublocade 300mg doses, 2 once-monthly Sublocade 300mg doses + 4 once-monthly 100mg doses, or 6 once-monthly injections of placebo. Both Sublocade regimens proved superior to placebo in achieving more illicit opioid-free weeks (P<0.0001). Regarding safety, Sublocade had a consistent profile with that of transmucosal buprenorphine, apart from injection site reactions; none of the reactions were deemed serious.
Sublocade is a CIII controlled substance and should be administered by a clinician as part of a complete treatment program that includes counseling and psychosocial support. It carries a boxed warning that includes the risk of intravenous (IV) self-administration that can result in occlusion, tissue damage, or embolus.
Sublocade will be available through a restricted distribution system. It is anticipated to launch in the first quarter of 2018 as 100mg/0.5mL and 300mg/1.5mL strength prefilled syringes.
For more information call (877) 782-6966 or visit Indivor.com
This one comes off of Optum Rx:
Sublocade™ (buprenorphine, extended-release) – New drug approval
• On November 30, 2017, the FDA announced the approval of Indivior’s Sublocade (buprenorphine,
extended-release) injection, for the treatment of moderate to severe opioid use disorder (OUD) in
patients who have initiated treatment with a transmucosal buprenorphine-containing product,
followed by dose adjustment for a minimum of seven days.
— Sublocade should be used as part of a complete treatment plan that includes counseling
and psychosocial support.
— Sublocade is a schedule III controlled substance.
• OUD is a chronic neurobiological disease characterized by a problematic pattern of opioid use
leading to significant impairment or distress and includes signs and symptoms that reflect
compulsive, prolonged self-administration of opioid substances for no legitimate medical purpose or,
if another medical condition is present that requires opioid treatment, the opioid is used in doses far
greater than the amount needed for treatment of that medical condition.
— Approximately 2.5 million American adults have been diagnosed with OUD.
• Regular adherence to medication-assisted treatments with buprenorphine reduces opioid withdrawal
symptoms and the desire to use opioids, without causing the cycle of highs and lows associated with
opioid misuse or abuse. At proper doses, buprenorphine also decreases the pleasurable effects of
other opioids, making continued opioid abuse less attractive.
• Buprenorphine is also available as a transdermal weekly patch, sublingual tablet, injectable solution,
Belbuca™ buccal film, Probuphine™ subdermal implants, and in combination with naloxone as a
sublingual tablet, Suboxone® sublingual film, Zubsolv® sublingual tablet, and Bunavail™ buccal film.
— Refer to individual drug labels for indication information.
• The approval of Sublocade was based on two studies: a 24-week placebo-controlled safety and
efficacy trial of 504 patients and a 12-week blockade study conducted in 39 patients.
— In the safety and efficacy study, Sublocade was shown to be superior vs. placebo in
achieving more illicit opioid-free weeks (p < 0.0001).
— In the blockade study, Sublocade fully blocked the drug-liking effects of hydromorphone.
• Sublocade carries a boxed warning for risk of serious harm or death with intravenous administration
and Sublocade risk evaluation and mitigation strategy.
• Warnings and precautions of Sublocade include addiction, abuse, and misuse; risk of respiratory
and central nervous system (CNS) depression; managing risks from concomitant use of
benzodiazepines or other CNS depressants with buprenorphine; neonatal opioid withdrawal
syndrome; adrenal insufficiency; risk of opioid withdrawal with abrupt discontinuation of Sublocade;
risk of hepatitis, hepatic events; hypersensitivity reactions; precipitation of opioid withdrawal in
patients dependent on full agonist opioids; risks associated with treatment of emergent acute pain;
use in opioid naïve patients; use in patients with impaired hepatic function; use in patients at risk for
arrhythmia; impairment of ability to drive or operate heavy machinery; orthostatic hypotension;
elevation of cerebrospinal fluid pressure; elevation of intracholedochal pressure; effects in acute
abdominal conditions; and unintentional pediatric exposure.
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• The most common adverse reactions (≥ 5%) with Sublocade use were constipation, headache,
nausea, injection site pruritus, vomiting, increased hepatic enzymes, fatigue, and injection site pain.
• The recommended dose of Sublocade following induction and dose adjustment with transmucosal
buprenorphine is 300 mg subcutaneously (SC) in the abdomen monthly for the first 2 months
followed by a maintenance dose of 100 mg SC monthly.
— The maintenance dose may be increased to 300 mg SC monthly who tolerate the 100 mg
monthly dose, but do not demonstrate a satisfactory clinical response.
— Only healthcare providers should prepare and administer Sublocade.
— There is no maximum recommended duration of maintenance treatment.
• Sublocade’s wholesale acquisition cost will be $1,580 per monthly dose of either strength.
• Indivior plans to launch Sublocade in the first quarter of 2018. Sublocade will be distributed through
a restricted distribution system. Sublocade will be available as 100 mg.
Here is from RxWiki:
Sublocade Drug Class
Sublocade is part of the drug class:
Side Effects of Sublocade
Serious side effects have been reported with Sublocade. See the “Sublocade Precautions” section.
Common side effects of Sublocade include the following:
- itching or pain at the injection site
- liver injury
This is not a complete list of Sublocade side effects. Ask your doctor or pharmacist for more information.
Tell your doctor if you have any side effects that bother you or that do not go away.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:
- medications that block a protein in the body (CYP3A4) such as some macrolide antibiotics (clarithromycin, telithromycin), some HIV protease inhibitors (indinavir, nelfinavir, ritonavir, saquinavir), some HCV protease inhibitors (boceprevir, telaprevir), some azole antifungals (ketoconazole, itraconazole, posaconazole, voriconazole), delavirdine (Rescriptor), and nefazodone
- medications that increase the activity of the enzyme CYP3A4 such as carbamazepine (Tegretol, Equetro, Carbatrol), phenobarbital, phenytoin (Dilantin), rifampin (Rifadin), and St John’s wort
- medications that could lead to serotonin syndrome such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), desvenlafaxine (Pristiq), nefazodone (Serzone), paroxetine (Paxil, Pexeva), sertraline (Zoloft), venlafaxine (Effexor), trimipramine (Surmontil), isocarboxazid (Marplan), amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl), protriptyline (Vivactil), and clomipramine (Anafranil), and linezolid (Zyvox)
- monoamine oxidase inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil). tranylcypromine (Parnate), selegiline (Emsam, Eldepryl, Zelapar), and rasagiline (Azilect)
- muscle relaxant medications including baclofen (Lioresal), carisoprodol (Somadril), cyclobenzaprine (Flexeril), methocarbamol (Robaxin), tizanidine (Zanaflex), gabapentin (Neurontin), andpregabalin (Lyrica)
- diuretics such as acetazolamide (Diamox), amiloride (Midamor), bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (Microzide, HCTZ), metolazone (Zaroxolyn), torsemide (Demadex), andtriamterene (Dyrenium, Dyazide, Maxzide)
- anticholinergics such as glycopyrrolate (Cuvposa, Robinul), trospium (Sanctura), oxybutynin (Anturol, Gelnique, Oxytrol, Ditropan), solifenacin (Vesicare), dicyclomine (Bentyl), propantheline (Pro-Banthine), and atropine (Atropen, Sal-Tropine)
This is not a complete list of Sublocade drug interactions. Ask your doctor or pharmacist for more information.
Serious side effects have been reported with Sublocade including the following:
- respiratory problems. You have a higher risk of death and coma from respiratory problems if you take Suboxone with other medicines that cause respiratory problems, such as benzodiazepines including diazepam (Valium(, alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and zolpidem (Ambien).
- hypersensitivity (severe allergic reaction). Tell your healthcare provider about any signs or symptoms of hypersensitivity, which include the following chest pain, rash, difficulty breathing or swallowing, or swelling of the face or mouth
- dependency or abuse.
- opioid withdrawal. Symptoms of opioid withdrawal may include shaking, excessive sweating, feeling hot or cold more than normal, runny nose, watery eyes, goose bumps, diarrhea, vomiting, and muscle aches
- a decline in liver function. Tell your healthcare provider about any signs or symptoms of liver damage, including loss of appetite, weight loss, nausea, vomiting, feeling tired, stomach pain, dark urine, light-colored stools, fever, rash, and yellowing of the skin or the whites of the eyes.
- neonatal opioid withdrawal syndrome (NOWS). NOWS is a treatable outcome of the long-term use of opioids when used during pregnancy.
- adrenal insufficiency. Tell your healthcare provider if you have any symptoms of adrenal insufficiency, including nausea, vomiting, anorexia, fatigue, weakness, and dizziness.
Sublocade can affect mental or physical abilities. Do not drive or operate heavy machinery until you know how Sublocade affects you.
Do not take Sublocade if you are allergic to Sublocade or to any of its ingredients.
Sublocade Food Interactions
Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of Sublocade, there are no specific foods that you must exclude from your diet when receiving this medication.
Before taking Sublocade, tell your doctor about all of your medical conditions. Especially tell your doctor if you:
- are allergic to Sublocade or to any of its ingredients
- have or have had adrenal problems such as Addison’s disease
- have liver problems
- have heart problems
- have any lung problems or trouble breathing
- have any head or brain injury problems
- have a history of alcoholism
- drink large amounts of alcohol
- are pregnant or plan to become pregnant
- are breastfeeding or plan to breastfeed
Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Sublocade and Pregnancy
Tell your doctor if you are pregnant or plan to become pregnant.
In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. There is a risk of neonatal opioid withdrawal syndrome (NOWS). NOWS is a treatable outcome of the long-term use of opioids when used during pregnancy. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.
Sublocade and Lactation
Tell your doctor if you are breastfeeding or plan to breastfeed.
Sublocade has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from Sublocade, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered. Advise breastfeeding women who take Sublocade to monitor their baby for an increase in drowsiness and any difficulty with breathing.
Sublocade comes in an injectable form that is given once a month just under the skin (subcutaneously) by a healthcare professional.
If you miss a dose of Sublocade, talk to your healthcare provider immediately. If a Sublocade dose is missed, you could become sick and have withdrawal symptoms because your body has become used to the medicine. Physical dependence is not the same as drug addiction. Your doctor can tell you more about the differences between physical dependence and drug addiction. To have fewer withdrawal symptoms, ask your doctor how to stop using Suboxone the right way.
The recommended initial dose of Sublocade for the treatment of opioid addiction is 300 mg once a month for 2 months. After 2 months, the recommended maintenance dose of Sublocade for the maintenance treatment of opioid addiction is 100 mg once monthly.
If Sublocade is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.
- Keep all appointments with your doctor.
- Do not try to mess with or attempt to remove the drug that is deposited under the skin.
Sublocade FDA Warning
RISK OF SERIOUS HARM OR DEATH WITH INTRAVENOUS ADMINISTRATION
- Serious harm or death could result if administered intravenously.
SUBLOCADE RISK EVALUATION AND MITIGATION STRATEGY
- Sublocade is only available through a restricted program called the Sublocade REMS Program. Healthcare settings and pharmacies that order and dispense Sublocade must be certified in this program and comply with the REMS requirements.
Late last year the FDA approved Sublocade, the brand name of a monthly buprenorphine injection, marketed by Indivior, the same company that sells Suboxone brand sublingual films. Sublocade is expected to be commercially available by February or March of this year.
This medication is indicated for patients with moderate to severe opioid use disorder who have stabilized on transmucosal buprenorphine products for at least seven days. Sublocade comes in a pre-filled syringe, and is injected into the subcutaneous tissue over the abdomen. This viscous liquid forms a solid deposit containing buprenorphine, and the medication is released over a month, giving therapeutic plasma levels of buprenorphine.
Thus far, we have two studies, one a randomized controlled trial and another that was an open-label study, that both show Sublocade, compared with placebo, was significantly more likely to result in fewer positive drug screens for illicit opioids and in fewer self-reports of illicit opioid use.
Of note, the manufacturer warns against attempts to inject this preparation intravenously, because the solid mass that forms can block a blood vessel, or travel in the vessel to the lungs, possibly causing death from a pulmonary embolus. To reduce the risk of this bad outcome, the medication will only be distributed to healthcare professionals, and not to patients.
Sublocade comes in two doses; a 300mg dose and 100mg dose. Patients should receive 300mg per month for the first two months, then drop to 100mg per month. This is the indicated dose for patients on the equivalent of sublingual buprenorphine 8 to 24mg per day. If patients have inadequate response after dropping to 100mg, the dose may be increased to 300mg in some patients, if the physician feels this is indicated. At the manufacturers website, they say Sublocade delivers a dose adequate to block opioid receptors to the degree that if other opioids are used, they will have no effect.
Steady state is established after 4-6 months of treatment. Steady state is a term describing the pharmacokinetic state where the drug’s intake is in dynamic equilibrium with the drug’s elimination from the body. Usually this occurs after four to five times the drug’s half-life. After steady-state has been achieved, buprenorphine may be detected in patients for up to 12 months after dosing stops. It is unknown how long buprenorphine will remain detectable in urine testing.
After this medication is stopped, the patient should be monitored for opioid withdrawal symptoms for several months, since blood levels will drop slowly.
Indivior recommend checking liver function tests at baseline, then monthly.
Because of the possible harm of intravenous use of this product, Indivior created a REMS (Risk Evaluation and Management Strategy) protocol. Healthcare settings seeking to dose Sublocade and pharmacies wishing to dispense Sublocade must be certified by the REMS program for this medication.
I tried to go to the website mentioned on the Indivior website regarding the REMS requirements, but the link wasn’t working for me.
I’m excited about this new option because it can reduce diversion of buprenorphine products. At the opioid treatment program, we have a fair number of patients who attempt to divert or misuse sublingual forms. At present, if I have unmistakable evidence a patient is trying to divert medication, I can no longer prescribe it. I can offer to switch the patient to methadone, but that’s unattractive for several reasons to many patients. But if we can administer subcutaneous buprenorphine, it gives us another option. It would be difficult to divert, and it isn’t as complicated to administer as the Probuphine implants.
I do have some concerns. First, how do the financial aspects work? Since it can only be dispensed to the healthcare provider for administration to the patient, I suspect the facility or physician owner of the practice will need to buy the medication and pay up front. What if a patient’s insurance company refuses to pay? What if a patient refuses to pay, or only pays part of the drug cost? Could the physician lose money treating patients if this happens?
Currently, with sublingual buprenorphine products, the physician isn’t in the middle. The patient pays the pharmacy directly.
I was thrilled to learn that North Carolina’s Medicaid program will pay for this medication, without even requiring a prior authorization. That’s wonderful, but many private buprenorphine practices don’t treat Medicaid patients, due to low reimbursement rates. But this will be good for facilities who do accept Medicaid as payment.
I’m amazed our state can afford this. Perhaps they got a much better deal from the drug company, Indivior, than the quoted priced of $1500 to $1800 per month. One month’s worth of generic monoproduct buprenorphine, dosed at 16mg per day, costs about $105 per month at the cheapest retail pharmacy, according to. That means this new subcutaneous injectable formulation costs fourteen times more than the cheapest form of buprenorphine on the market.
That’s quite a difference. I’m assuming the state’s willingness to pay this expense is based on expectation of a marked decrease in diversion of this medication. Apparently, the lump of buprenorphine can be cut out if it’s done within the first 14 days, but that seems an unlikely extreme for patients. In other words, with the monthly injection, the medication will reach the patient for whom it is prescribed.
At this point we could launch into a discussion about whether diversion of buprenorphine – possibly the safest opioid available – is a good or bad thing. Law enforcement types see diversion as bad, but arguing a pure harm reduction viewpoint, one could say that diverted, black market buprenorphine might be saving lives by giving people with untreated opioid use disorder a safer option. Note that I said safer, not safe. But that whole debate is an entire blog post so I’ll keep the focus on this new way of delivering buprenorphine.
About half of my office-based patients are self-pay, with no Medicaid or private insurance. They pay out of their own pocket for my office charges, and pay for their medication at their pharmacy. I think Sublocade’s price will make it an unworkable alternative for these people. About half my patient have private insurance, and most have Blue Cross/Blue Shield. I plan to make some phone calls, to get information about their payment policy for Sublocade.
I’m eager to try this new preparation at the opioid treatment program. It sounds like this will be workable for Medicaid patients.
But that brings up my second concern: how can I get patients to come for weekly counseling sessions if they only get medication once per month? I was pondering this idea in a group Email yesterday when I was informed (by someone who knows these things) that soon, a competitor of Indivior will be releasing a weekly injection form of buprenorphine. He envisioned weekly injections for new patients, with gradual decreasing of frequency of visits as the patient stabilizes, eventually moving to monthly treatment and counseling sessions, when clinically appropriate.
I like this idea. This sounds workable. And as I emailed him…let’s hope there’s a price war, with both companies lowering their prices to attract patients.
I’m happy about any new options for patients, and I’m eager to use this product. I just hope cost won’t be a deal-breaker for patients and their insurers.
FDA Approves Injectable Suboxone
If you are living with opioid use disorder, or have sought treatment for the condition, then you’ve probably heard of or used various drugs to treat the addiction. Buprenorphine is one such drug, regularly used in detox and treatment settings, typically in the form of Suboxone or Subutex. Regarding the former medication, the formula contains buprenorphine and naloxone (yes, the same drug used to reverse the deadly symptoms of an opioid overdose).
Drugs like Suboxone help people in the early weeks of recovery navigate both acute and post-acute withdrawal symptoms. The medication comes in the form of dissolvable film strips that patients take sublingually (under the tongue). Suboxone is not the only medication on the market that has shown promise in the treatment of opioid use disorder, in recent years addiction experts have turned to Vivitrol (naltrexone for extended-release injectable suspension), a drug that may help people with the physical and mental withdrawal symptoms occurring after stopping prescription opioid or heroin use.
Both buprenorphine and naltrexone have helped many an addict overcome the grip of addiction; however, there have long been concerns about the former for the fact that it causes euphoria and is often diverted for no medical use. Indivior, the maker of Suboxone, may have found a solution the above problem.
Sublocade: Injectable Suboxone?
The U.S. Food and Drug Administration has approved an injectable version of Suboxone, known as Sublocade, STATreports. The injection, containing long-acting buprenorphine, received 18 to 1 support from an FDA advisory panel. The drug is administered to patients abdominally by doctors or health professionals.
“It’s potentially a game changer,” said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University. “This could become first-line [medication] for opioid addiction. It could open up opportunities for getting more patients on buprenorphine.”
Unlike Vivitrol, full detoxification isn’t a prerequisite before patients can start Sublocade injections; however, they will need to take sublingual buprenorphine for at least seven days before their first infusion, according to the article. The FDA is expected to approve a second form of injectable buprenorphine that was submitted for approval and produced by Braeburn Pharmaceuticals.
One of the chief complaints about Suboxone and arguments against relying on buprenorphine is that it can be habit-forming. Some people argue that opioid addicts are just switching from one addictive substance to the next.
“There’s still a tremendous amount of stigma among patients and in communities about taking any opioid agonist in treatment,” said Dr. Chinazo Cunningham, associate chief of general internal medicine at Montefiore Medical Center. “I hope that a reduction in potential diversion [from long-acting buprenorphine] may get more providers to offer buprenorphine [of all kinds]. The more options the better, so we can match treatment to patients’ needs.