Medication can be an important part of opioid use disorder treatment. Some people prefer an option that does not require a daily dose.
Sublocade is a long-acting buprenorphine injection used to treat moderate-to-severe opioid use disorder. It releases medication gradually over about a month and is administered by a healthcare professional. Understanding how it works and how treatment begins can help you discuss your options with a provider.
What Is Sublocade?
Sublocade is the brand name for buprenorphine extended-release injection. Buprenorphine is one of the FDA-approved medications used to treat opioid use disorder.
Unlike daily buprenorphine products taken under the tongue or inside the cheek, Sublocade is injected under the skin by a healthcare professional. After injection, it forms a small depot under the skin that releases buprenorphine gradually.
Sublocade is a Schedule III controlled medication and should be used as part of a complete treatment plan that includes counseling and psychosocial support.
How Does Sublocade Work?
Buprenorphine is a partial agonist at the mu-opioid receptor. It attaches to the same type of receptors affected by opioids such as heroin, fentanyl, and prescription opioids, but activates them differently than full opioid agonists.
When used as prescribed, buprenorphine can reduce withdrawal symptoms and opioid cravings. Its strong receptor binding can also reduce the effects of other opioids, although Sublocade does not block every opioid effect or make overdose impossible.
The extended-release formulation keeps buprenorphine in the body longer without a daily dose.
Who Is Sublocade Used For?
Current FDA labeling indicates Sublocade for moderate-to-severe opioid use disorder in people who have initiated treatment with a single dose of a transmucosal buprenorphine product or who are already receiving buprenorphine.
This differs from older guidance that commonly required at least seven days of stabilization on transmucosal buprenorphine. Current labeling no longer requires that seven-day period for every patient. The FDA labeling change to this initiation pathway took effect in 2025.
A clinician still evaluates withdrawal status, medical history, medications, and treatment needs before starting therapy.
What Happens When Starting Sublocade?
Treatment generally begins with a clinical assessment and confirmation that buprenorphine is appropriate.
For someone who is not already taking buprenorphine, treatment begins when clear, objective signs of opioid withdrawal are present. Current labeling allows the first Sublocade injection after a supervised dose of transmucosal buprenorphine confirms tolerability. The provider then monitors the patient for worsening withdrawal or sedation.
People already receiving buprenorphine may transition differently based on clinical response.
Do You Have to Take Suboxone First?
Not necessarily. Current FDA labeling does not require every patient to take Suboxone for seven days first.
A person who is not already receiving buprenorphine can receive a supervised dose of a transmucosal buprenorphine product before the first Sublocade injection. The treating clinician determines the appropriate transition plan.
How Often Is Sublocade Given?
Sublocade is a long-acting medication that generally continues with monthly injections after the initial treatment phase. Current prescribing information allows some timing flexibility for the second injection, while later injections follow a monthly schedule with appropriate spacing.
The treating clinician determines the schedule based on response, side effects, and other medical considerations.
Potential Benefits of Sublocade
For an appropriate patient, a monthly buprenorphine injection may offer several advantages:
- Removes the need to remember a daily buprenorphine dose
- Maintains medication exposure over an extended period
- Can help reduce withdrawal symptoms and cravings
- Keeps medication administration within a healthcare setting
- May help people who find daily medication difficult to manage
Whether Sublocade fits a treatment plan depends on factors such as previous response to buprenorphine, treatment preferences, side effects, and the ability to attend scheduled injections.
Common Sublocade Side Effects
Current prescribing information lists common adverse reactions that include:
- Constipation
- Headache
- Nausea or vomiting
- Fatigue
- Injection-site itching or pain
- Increased liver enzymes
Buprenorphine may also cause sleepiness or sedation. New, persistent, or concerning symptoms should be discussed with the treating provider.
Important Sublocade Safety Considerations
Why Sublocade Must Be Given by a Healthcare Provider
Sublocade carries a boxed warning because intravenous administration can cause serious harm or death. It is available only through the Sublocade Risk Evaluation and Mitigation Strategy (REMS) Program.
The restricted distribution system prevents Sublocade from being dispensed directly to patients. Certified pharmacies and healthcare settings supply it to healthcare professionals.
Breathing and Sedation Risks
Buprenorphine can cause serious respiratory depression, especially when combined with substances that slow the central nervous system. Alcohol, benzodiazepines, other opioids, and other sedating medications can increase risk.
Patients should tell their clinician about medications, alcohol use, and other substances so the treatment plan can account for potential interactions. Because people receiving treatment for opioid use disorder can remain at risk of relapse and overdose, current labeling also recommends discussing access to naloxone when Sublocade treatment is started or renewed.
Liver Health and Physical Dependence
Buprenorphine has been associated with liver enzyme changes and, less commonly, serious liver problems. Current labeling recommends liver function testing before treatment and monitoring during therapy.
Buprenorphine can also cause physical dependence. Physical dependence means the body adapts to a medication and may develop withdrawal symptoms when it is stopped. Physical dependence alone is not the same as opioid use disorder.
Sublocade vs. Suboxone: What’s the Difference?
Sublocade and Suboxone both contain buprenorphine, but they differ in formulation and administration.
Sublocade is an extended-release injection given by a healthcare professional. Suboxone contains buprenorphine and naloxone and is generally taken as a sublingual or buccal film as prescribed.
A daily medication may offer more flexibility for some patients, while a long-acting injection removes the need for daily dosing.
Sublocade vs. Vivitrol
Sublocade and Vivitrol are both long-acting medications used in opioid use disorder treatment, but they work differently.
Sublocade contains buprenorphine, a partial opioid agonist. Vivitrol contains extended-release naltrexone, an opioid antagonist. Vivitrol requires an opioid-free period before treatment because starting it too soon can precipitate severe withdrawal.
Neither medication is universally better. The right option depends on current opioid use, previous treatment, medical history, preferences, and recovery goals.
How Long Do People Stay on Sublocade?
There is no universal endpoint for buprenorphine treatment. Some people benefit from medication for months, while others continue longer.
Treatment duration should reflect clinical benefit, side effects, recovery stability, and individual goals rather than an arbitrary timeline. SAMHSA notes that buprenorphine treatment length should be tailored to the individual and can continue indefinitely when clinically appropriate.
What Happens if Sublocade Is Stopped?
Sublocade remains in the body for an extended period after the last injection. After steady-state treatment, current prescribing information notes that buprenorphine may remain detectable in plasma and urine for 12 months or longer.
Withdrawal symptoms can be delayed because medication levels decline gradually. Discontinuation should be planned with a prescriber and followed with appropriate monitoring.
How Medication Supports Long-Term Recovery
Medication can address withdrawal and cravings, while counseling and psychosocial support can address behavioral, emotional, and social needs.
Some people with OUD also have depression, anxiety, trauma, chronic pain, or other conditions that require their own treatment plans. Follow-up visits help clinicians assess how treatment is working and identify medical or mental health needs that may require additional attention.
Making an Informed Treatment Decision
Medication treatment for opioid use disorder should reflect your medical history, current medications, recovery goals, and individual treatment needs. Sublocade may be one option within a broader treatment plan, but deciding whether it is appropriate requires a qualified healthcare provider.
A healthcare provider experienced in opioid use disorder treatment can explain the benefits and risks of different medications and help determine which approach fits your needs. If depression, anxiety, or another mental health condition is also part of the picture, contact Pulse TMS to learn more about available mental health treatment options.
Frequently Asked Questions
Is Sublocade the same as Suboxone?
No. Both contain buprenorphine, but Sublocade is a long-acting injection, while Suboxone contains buprenorphine and naloxone and is generally taken under the tongue or inside the cheek.
Is Sublocade an opioid?
Sublocade contains buprenorphine, a partial opioid agonist. It activates opioid receptors differently from full opioid agonists and is used as an evidence-based medication for OUD.
Does Sublocade stop cravings?
Buprenorphine can reduce opioid cravings and withdrawal symptoms, although individual response varies.
Can Sublocade be removed after injection?
Sublocade forms a depot under the skin that releases medication gradually and is not intended to be routinely removed. Patients should not try to remove or manipulate it. Any concern about the depot or injection site should be evaluated by a healthcare professio
How long does Sublocade stay in your system?
Sublocade releases buprenorphine over about one month, but after steady-state treatment, detectable levels may persist for 12 months or longer.
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