Providers in Frederick County are largely optimistic about the arrival of a new, injectable form of buprenorphine — a popular medication used to treat patients with opioid use disorder.
Last week, the federal Food and Drug Administration announced the approval of Sublocade, a once-a-month injectable buprenorphine treatment. The medication is intended for patients who have already been stabilized on daily buprenorphine for at least a week, according to Michael Felberbaum, a spokesman for the agency.
Buprenorphine — also known as Suboxone or Subutex — has been available for years in tablet form or as a strip that dissolves under the tongue. The FDA also approved an implantable, six-month buprenorphine pellet last year.
Sublocade, though, is a shorter-acting shot that provides a steady level of medication over the course of a month. The newest form of the drug could present a happy medium for patients who don’t want a daily medication but aren’t ready to commit to a long-lasting implant, said Dr. Erika Kane, the chief medical officer at Concerted Care Group.
Concerted Care Group is a Baltimore-based company that took over outpatient drug treatment services for the Frederick County Health Department in October.
“Even though a shot is invasive, it’s less invasive than a surgical implant,” Kane said. “We just want to use it as one more tool to fight addiction, this deadly disease we’re seeing.”
A monthly shot could also reduce the potential for medication abuse. Unlike Vivitrol, another monthly injection that totally blocks the effects of opioids, buprenorphine works by mimicking those effects.
Misuse of the medication is common among patients early in recovery, said Korey Shorb, the founder of Frederick County’s Up and Out Foundation for addiction recovery and awareness.
“People will take a higher dose than they’re supposed to, or inject it intravenously,” Shorb said. “Suboxone is very abused. I mean, people in early recovery have a hard time following directions, so to think we’re going to follow directions when it comes to a daily prescription is insane.”
The drug can also be purchased on the street or even smuggled into jail. Both Shorb and David Brooks — a former drug treatment supervisor at the Frederick County Adult Detention Center who now runs a private recovery practice — said that buprenorphine is one of the most commonly abused drugs in local prisons.
A monthly shot would drastically reduce the potential for abuse by taking most of the responsibility away from patients, Brooks said.
“Because they’re not the ones administering the drug,” he continued. “So, they can’t sell it. There’s not an instance where they can’t take it as prescribed.”
For many, though, price will continue to remain a barrier to treatment. The wholesale cost of Sublocade is $1,580 per monthly dose, according to Indivior, the company that manufactures the drug.
Private insurance plans vary in coverage levels for addiction treatment medication, and the Maryland Medicaid program is still reviewing information on the new injection, according to spokeswoman Brittany Fowler.
“Some of the uphill battles are going to be the costs and whether or not it’s paid for by insurance companies,” Kane said. “And that’s the same issue we’ve been seeing with many of these new treatments.”