Medication assisted treatment for opioid use disorder (Sublocade)

In this video, you're going to find out all about a brand new medication called Sublocade. Now Sublocade is the newest advancement in medication assisted treatment. And here to tell us all about it is Mark Burrows. Now not only is Mark an Met specialist, but he also does a lot of volunteer work on the side, running needle exchange programs and also is a licensed distributor of naloxone, the over the counter medication that can save lives in an overdose. If you haven't seen my video on that, make sure you check that out. But Mark's here to tell us all about Sublocade. It's a once a month injection that shows a lot of promise for helping people taper off of heroin and pain pills and any other kind of opiate. So traditionally with medication assisted treatment, we're talking about opioid use. Right. And so the medicines, first it was methadone, Right. And then Suboxone came along.

Yeah.

And now there's this new thing out there that you were telling me about the other day, brand new thing called supplicate.

Right.

So can you tell us what supplicate is, first of all?

Yeah. So Supplicade is a monthly buprenorphine injection.

Okay.

So buprenorphine is the same drug in Suboxone and buprenorphine.

Am I understanding it right, Mark? It's a long lasting opiate.

Yeah, it's a long acting opioid. It's a partial agonist.

So, so what does that mean in regular people? Yeah, that sounds fancy, Mark. Tell us what that means.

So a full agonist would be something like morphine or heroin and it produces euphoria with that, hence people taking it to get high. You know, you can overdose off something like that. Whereas buprenorphine, being a partial agonist, it produces a sealing effect. So after a certain amount of it, you don't really get an increased effect from it. It's very difficult to overdose off buprenorphine.

Okay, so it's like safer, I guess.

You would say it's a safer opioid. That's a way to put it.

Alternative. Okay.

It also blocks the effects of other opioids. So and the reason it does that is because it has such a strong affinity or a strong grip to the opioid receptors in the brain that it, when someone's on buprenorphine, it prevents other opioids from latching onto those receptors. Okay, and which is a good thing.

For treatment, obviously, Right, because it, it helps prevent overdose. It helps prevent people trying to use on top of their medicine.

Yeah. So it prevents opioid cravings. It kind of. You'll hear most people on mat say they just feel normal. They don't really feel high. They might just kind of feel good. And most of them will say they feel normal on their Suboxone.

Gotcha. And Suboxone, historically, so far up until this new medicine came along, you give it to people either in like a pill form or in these like dissolvable strips that are kind of like Listerine strips.

Right.

And they take it somewhere between one and three times a day or one and four times a day. Is that right?

Yeah, yeah. Usually once or twice a day, sometimes more. But yeah, it's called a sublingual tablet or a film. Suboxone comes in a film, other forms come in a tablet, and it just goes under the tongue and it dissolves.

And so now they have this new thing out. This is the sublocade that's just been out like a couple of months.

Okay. Yeah.

And so tell us how that differs from the normal way of taking Suboxone.

Yeah, so it's a subcutaneous injection, which means it just goes kind of under the skin around the abdomen, so around the belly button.

Okay. And so it's an injection that you get once a month?

Once. Yeah, about once every 30 days, yeah.

Okay. And so what would be the. What would be the benefits of. Of doing a once a month injection versus the, like the strips, the sublingual strips?

One of the big ones that I like is it's kind of. It's one and done. So the person comes in, they get their injection and they're good for the next month. So they don't have to think about that medication anymore. It kind of makes the medication part a non issue.

Right.

They don't have to wake up in the morning and take it. They don't have to remember to bring it to work with them. They don't have to worry about keeping it hidden from certain people or children. So it takes like all the problems that could arise from just possessing. It takes those problems away. It also gets them out of the. That routine of habitually taking something every day. And I think obviously with addiction that's a. That's a big problem.

So it's the whole, almost like the whole people, places and things. It's the change in the routines and the neural pathways. And I tell people to wear different clothes and take a different route home and like change everything possible. So getting out of that, like taking something, ingesting medication really is kind of helpful.

Yeah. And I think when we look into, like, the behavioral aspects of substance use and addiction and we talk about, you know, learning new coping skills, and we look into why did that person use those drugs in the first place? It takes the act of taking a drug or a substance, taking it just to change the way they feel. So if I had a bad day at work or an argument or whatever, and I just want to change the way I feel, taking something orally like Suboxone or anything else could kind of keep that cycle going in some ways. So supplicate. A monthly injection eliminates that.

It kind of reminds me of with alcoholics sometimes. I. We have a thing called a Sober Link, which basically, basically is this really, like, high tech alcohol monitoring device. And when I'm talking to patients about being on it, we love this thing. We found it's like really effective. But I tell them it's going to make it so much easier because once you decide to get on this thing, you're not really going to get around it. It's pretty high tech. And you don't have to redecide a thousand times a day to be sober. It makes it so much easier because you don't have to be obsessed with it. You don't have to think, okay, my wife's not gonna be home for four hours. Maybe if I just have a couple drinks, it'll be gone. You know, you don't have to do math. You don't have to fight sneaky thoughts. And so it literally makes it easier. And I think a little bit of that's what I'm hearing and what you're saying, Marc, like, even if they're on the Suboxone, they have the strips, they can still have, though. Well, I'm not gonna take these. Maybe I'm just gonna sell these and I'm gonna take something else. Or maybe I'm gonna save them up and take them all at once. You know, there's all those, like, sneaky addictive thoughts that there's still room for when you're taking it the other way.

Yeah. And I think if you take all that out of the equation, I would think that it allows for, like, a much better quality of recovery. And another thing is, a lot of times if someone's on Suboxone and they're trying to taper their dose, right. And then trying to get down to a lower dose to eventually come off of it, well, that's a really hard process. And that takes month after month of kind of whittling away at that dose. So there can be a lot of up and downs created in that. And if someone's trying to take less, but again, then they have those emotional triggers or stressors, it's real easy to say, well, I'll just try again tomorrow. I'm gonna take, I'm gonna take the bigger dose. You know, if I'm taking two strips a day and I'm trying to take one and a half a day, but I have an emotional stressor, it's easy to say, oh, I'll just take that extra half a strip like I normally would have. You.

You know, it's like, relies a little too heavily on the willpower thing. It's like, I was like, you can feel really solid right now, but eventually you're going to be worn out and tired and have a bad day and the gas and gas tank is going to be low. That willpower thing early on, I'm like, you can't rely on that. You got to have something else.

Right?

Kind of. Would you say it's a bigger commitment, recovery wise to get on supplicate versus Suboxone?

Yeah. So I would think it's a bigger commitment for someone to say that they want, that they're ready for supplicade.

So it's kind of like a more, a bigger step or a more serious step. Something that it just, it gives you less wiggle room when you make that decision. It's more of a commitment. Okay.

Yeah, yeah.

And you were telling me something interesting we talked about this other day. You were saying that there's been some evidence, early evidence, that it's easier for people to eventually come off of the sublocade versus coming off of the suboxone. Can you tell us about that?

Yeah. So we haven't, there aren't any studies on this yet, but there have been some reports of people saying that after about six or seven months of sublocade injections, they just didn't go back for that next injection. And that their, their body at that point is so saturated with the drug that it just slowly and naturally tapers out of, out of the system, out of the body.

Is it kind of like, like an antidepressant that builds up in your system? Is that what you're saying, Mark? Like, and then it takes a while, it kind of just slowly, even when you stop taking it, it's still slowly coming off.

That it just kind of slowly tapers out over the next couple weeks. And so the reports that have been made have said that up to 12 months later, they still never felt withdrawal symptoms. So that's big news. That's really exciting if that's true.

Yeah, if that's true, that's pretty huge. Because what my client told me about Suboxone is that they always say they. I've never really seen people have much trouble going down until they get that very. They'll just be on the tiniest, tiniest little piece. But going off those, like 2 milligrams or freaking 1 milligram is like, so hard. That's where they hit the wall. That's my experience with what clients tell me.

Yeah, yeah, yeah. It's. It's a difficult process and it takes a long time, and a lot of things need to be lined up for someone to be successful in that. And, God, if this just kind of tapered out on its own without the person even having to control any of that, that's a big deal.

That would be huge.

Like you said, like, it takes the will, I think you said it takes the willpower out of it. And it takes, like, the discipline and all of those things of controlling that substance perfectly every day to taper.

Yeah. Because you can have willpower 95% of the time and be doing awesome, but one little moment where you just hit the wall can mess it all up.

I'm really excited about that. I haven't had anyone get to that point yet. I have some people who are hoping.

To do that, but it's so new, though.

You.

You haven't even.

Right, right, right. It's been seven months or something.

Are there any cons to going this way? What would be a drawback of choosing supplicating?

Well, of course it can be. It can be expensive.

You gotta shoot it to a straight now. So you got possibly be more than Vivitrol. Like, how much are we.

I think it's about the same, actually. So I believe the cost is like $1,500 a month per injection. Now there's copay assistance, so that cost might get down to seven or eight hundred dollars a month with copay assistance. So right now, obviously, that's a lot of money. Right now, it's been mostly for people with commercial insurance or any insurance for that. All of our people that are on it are all insured, and none of them have paid a dime for the medication. So insurance is covering it.

Really?

Yeah.

So if you have private insurance and it will cover it, this might be a really good option.

Yeah. Okay. Yeah. So far, so good. No one's been denied. No one's had to pay Anything they have, the companies come out with this great copay assistance to help with that. So yeah, that's big because even for some oral medications, patients might pay out of pocket for it.

Oh yeah, just the regular can be really expensive. Okay. So if you don't have private insurance or insurance at all, you could end up paying as much as 1500amonth. If you do have insurance, you might not pay at all.

Yeah.

Okay. And then there's anywhere in between, I'm guessing.

Yeah. And like I said, I think even if you don't have insurance, I could be wrong about this, but I think even though the cost of the drug is $1500, the company offers some sort of co pay assistance even to people without insurance to get the cost down to around 7 or $800. I could be wrong about that, but I think that, I think that's how it works.

I do want to say this because a lot of families view our videos. So there's a lot of parents and spouses gonna be watching this video and they're thinking $800. Holy crap.

Yeah.

I just want to make a side note to the family members. If your loved one is addicted to pain pills, they are very likely spending more than $100 a day.

Oh yeah, easily.

Easily more than a hundred dollars a day.

Yeah.

Feeding their habit very easily.

Yeah. $100 a day is probably average, you.

Know, so $800 is like eight days worth per month. So when you think about it, it's hard sometimes for family. But you've got to put it in perspective sometimes. Alright, Is there anything I didn't ask you that I probably should ask you that people might want to know?

I think, I think one, one fact that maybe especially for family members is the elimination of people being able to divert. Supplicate.

Okay. So divert is fancy for what?

So diversion is like when we hear about people abusing it or selling it on the streets or you know, getting it for some improper reason, you know, so, you know, sometimes you'll hear about people getting Suboxone and then trading it or selling it for what they really want.

Right.

Their heroin or whatever. So, so the way supplicate works is it's very, it's highly controlled so it, it never gets the patient's hands. So it goes from the specialty pharmacies right to the doctor's office. The doctor's office takes it and they lock it inside a little box and that gets locked inside a refrigerator. So it's double locked. So it's never in the patient's hands, which I think is huge.

What are your people that you have so far? Are you getting any feedback about it? Just personal experience. What are people saying?

So so far we haven't had any complaints. Everybody seems to love it. I think the biggest pro that people like, the biggest benefit that people say is they wake up and they feel normal sometimes. If people especially are dosing only once a day, by the time they wake up the next morning, they feel kind of crummy. They're in withdrawal, fatigued. Right. They feel kind of withdrawal. Ish.

Just I could see that.

Not great.

You know, they feel level.

They just feel more level.

Okay, that's huge too.

People say they just wake up and they feel good and they don't. There's not that hour of waiting to take their medicine and letting it kick in and all that. The whole idea of the medication just a non issue, it just takes it out of their lives.

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