What Is the Sublocade Shot? And What to Expect from Treatment

Prescription medications treat many chronic conditions, improve lives, and even save them. Opioid use disorder (OUD) is no different.

“Opioid use disorder is not a failure of willpower,” says Shannon Boustead, MD, a family physician and MOUD specialist at Boulder Care. “It is a medical condition that changes how the brain works.”

When taking medications for any condition, choices matter. Sometimes, daily pills or tablets fit your lifestyle better. Other times, a once-a-month injectable makes more sense. If you have OUD, the Sublocade shot might be the right choice for you (or a loved one).

The Sublocade shot is an option for long-acting injectable buprenorphine (LAIB) that you take once a month. It must be administered by a health care professional. Buprenorphine is a medication used to treat opioid use disorder. It helps reduce cravings and withdrawal symptoms. It can also reduce the risk of death from opioid overdose. It can be a lifesaving medication while aiding recovery. 

“Medications like Sublocade are not shortcuts,” Dr. Boustead says. “They are evidence-based tools that give people the stability they need to heal. The goal isn’t perfection. It’s safety, dignity, and a real chance at recovery.”

In this article, we explore what the Sublocade shot is, Sublocade shot side effects, Sublocade withdrawal, Sublocade shot cost, and more.

The Food and Drug Administration (FDA) has approved Sublocade for treating moderate to severe OUD in adults.

“Sublocade is a once-monthly injectable form of buprenorphine, one of the most effective medications for opioid use disorder,” Dr. Boustead says.

Research shows that patients treated with a long-acting injectable buprenorphine had, on average, higher abstinence rates (about 40%) from illicit opioid use. Examples of illicit opioids include heroin or fentanyl.

In comparison, study participants who took a placebo had an average abstinence rate of 5%. A placebo is an inactive medication.

“Instead of taking a daily tablet or film under the tongue,” Dr. Boustead adds, “Sublocade is given as a monthly injection. The medication is slowly released over time, creating steady levels in the body.”

Sublocade must be administered by a doctor, nurse practitioner, pharmacist, or nurse. Injections used to only occur in clinics or hospitals, but now selected pharmacies can also do the injections.

In some cases, you may even be able to receive an injection at home. In this case, a traveling healthcare professional would perform the injection. 

• Route: Sublocade is a subcutaneous injection. It is given just under the skin and is not injected into a vein or muscle.
• Location: Sublocade is typically injected into the abdominal (belly) area.
• Administration: A healthcare professional must inject it.
• Frequency: The dosing schedule for Sublocade is every four weeks. But you may opt for a booster in the first month, if needed.
• Before taking Sublocade: You or a loved one must be stabilized on oral buprenorphine first for at least seven days. 

According to Dr. Boustead, Sublocade stabilizes opioid receptors in the brain, just like other forms of buprenorphine. It reduces cravings, prevents withdrawal, and lowers the risk of overdose and death.

Sublocade is different because of how the medication is taken—It's a shot and not a pill or film.‍

• The medication is injected under the skin in liquid form once a month.
• It turns into a gel.
• The gel breaks down over time. This steadily releases buprenorphine into the bloodstream.
• The result is a stable blood level of buprenorphine without having to take a daily medication.

What are the benefits of the Sublocade shot?

When considering which form of buprenorphine, or of another medication, is right for you, you and your provider can weigh the pros and cons. This discussion process with your clinician is called shared decision- making.  It’s an important part of treatment for OUD.

“There are many reasons patients might choose to initiate LAIB or not,” says Ilana Hull, MD, MSc, FASM, a collaborating physician with Boulder Care.

“When I am talking to a patient about what form of buprenorphine they would like to use, we review their values and goals, review risks and benefits.” Dr. Hull shares some of the benefits of Sublocade below.

Benefits of Sublocade:

• Sublocade is long-acting: It stays in your system for the full month. This eliminates the hassle of taking a daily medication.
• Sublocade provides a steady dose: A steady level in your bloodstream may feel more stabilizing, as compared to taking a daily medication.
• Sublocade helps protect against overdose: A return to use can sometimes occur during recovery. But Sublocade offers robust protection against overdose.
• Sublocade does not need to be stored at home: Not everyone, including those who are unhoused or staying with others, has a place to store medication.
• Taste is not a factor with Sublocade: Oral buprenorphine options may be unappealing.
• Sublocade does not contain naloxone: You might feel more comfortable taking a medication without this ingredient.

The only medication in the Sublocade shot is buprenorphine. Buprenorphine is a partial opioid agonist. An agonist is a substance that activates receptors in the body.

The receptors in the body and brain that buprenorphine activates are called mu-opioid receptors (MOR). These receptors affect pain, comfort, and mood. Buprenorphine partially activates these receptors—just enough to reduce withdrawal and cravings. Because buprenorphine only partially activates MOR, it does not cause a rush or sedate you like other opioids.

Buprenorphine benefits:

• Partial opioid agonist: Buprenorphine only partially activates MOR. This means that its feel-good and sedating effects are much milder than for stronger opioids. But the medication does help reduce cravings and withdrawal symptoms.
• Strong binding and long acting: Buprenorphine binds strongly to MOR. This means it blocks other opioid medications from attaching to these receptors. The medication also takes a while to detach from MOR. This means it has long-lasting benefits, including blocking other opioids, thereby reducing risk of death from opioid overdose.
• “Ceiling effect”: At a certain dosage, the effects of buprenorphine can no longer increase. This means that it can only cause respiratory depression (slow and shallow breathing) to a certain point. Because of this, buprenorphine is much safer to take when compared to other opioids that present a high risk of overdose.

“These medications save lives,” Dr. Boustead says. “Buprenorphine in all its forms—daily or monthly—dramatically reduces overdose risk. It helps people stay engaged in care. It helps families stay intact. It helps people survive long enough to rebuild.”

He adds, “Treatment doesn’t look the same for everyone. Some people do well on daily medication. Some prefer a monthly injection. Some may transition between options over time.”

Most medications have a list of potential side effects, and Sublocade is no different. However, just because you take Sublocade doesn’t mean you will experience these symptoms.

Common side effects of Sublocade:

• Injection site reactions: Medications that are injected can cause irritation at the place on the skin where the medication is injected. Redness, itching, swelling, or mild pain can occur.
• Gastrointestinal (GI) upset: GI side effects include constipation, nausea, and vomiting.
• Miscellaneous side effects: Headache, dizziness, and fatigue may also occur.
• Liver enzyme changes: Sometimes liver enzymes can increase.

If you experience any of the below side effects, talk to your prescribing clinician. They can help figure out ways to lessen side effects or even switch your medication if necessary.

Serious side effects of Sublocade:

• Allergic reactions: Rashes, hives, or swelling can indicate a serious allergic reaction called anaphylaxis.
• Respiratory depression: Slow or shallow breathing can occur when Sublocade is taken with other opioids, alcohol, benzodiazepines, or other substances that act as depressants on the central nervous system.
• Sedation: Extreme sleepiness or confusion can also occur.
• Blood pressure decrease: Drops in blood pressure may cause dizziness or fatigue.
• Liver concerns: Signs of liver issues include jaundice (yellow skin or eyes), abdominal pain, or tea-colored urine.
• Opioid withdrawal: Sublocade is designed to reduce withdrawal, but symptoms may still occur.

If you experience any of the above side effects, seek medical attention right away. If necessary, Sublocade can be surgically removed by a healthcare professional in an emergency.

Do you get Sublocade shot withdrawal?

Since the extended-release function of Sublocade helps maintain a steady level of buprenorphine in the bloodstream, you should not experience withdrawal from month to month while taking the medication.

However, if you or a loved one stops taking Sublocade altogether, withdrawal symptoms may occur. Typically, these withdrawal symptoms are less severe than what you’d experience stopping an opioid that is a full agonist, such as heroin or fentanyl.

Withdrawal symptoms will also likely have a more gradual onset, rather than all at once. This is because Sublocade takes a while to leave your system, about 10 to 12 months or longer. However, therapeutic levels drop about two to five months after you stop taking it. So you might notice some withdrawal symptoms around this point.

If you decide to discontinue Sublocade, be sure to talk through this milder withdrawal process with your clinician. They can provide strategies for helping to lessen potential symptoms.

The short answer is no. Buprenorphine, the active ingredient in Sublocade, is also an OUD medication sold under the brand name Suboxone.

However, Suboxone also contains naloxone. Naloxone is included to discourage injection misuse and ensure the medication is taken as intended.  

This precaution isn’t necessary with Sublocade. “Sublocade does not include naloxone because it’s already delivered as a controlled injection in a medical setting,” Dr. Boustead explains. “There’s no take-home product to misuse in that way, so naloxone isn’t needed in the formulation.”

You’re not alone if the names for medications for opioid use disorder and what they do get a bit confusing. They’re both injectable medications, but Sublocade contains buprenorphine, while Vivitrol contains naltrexone. 

Buprenorphine is a partial opioid agonist, but naltrexone is an opioid antagonist. This means the medication blocks opioid receptors, preventing you from feeling the effects of the opioids.

Brixadi is also a long-acting injectable buprenorphine. However, Brixadi differs slightly. It allows patients the option of either weekly or monthly injections. The dosage differs for each option. Sublocade is only injected once a month, however.

Pricing for Sublocade varies depending on health insurance status and plan type. According to the Sublocade website, here are the cost ranges:

• Without insurance: The cost of Sublocade is about $2,200 per month.
• With private insurance: The cost of Sublocade ranges from about $0 to $100 per month, depending on copays and any assistance programs. The Sublocade Copay Assistance Program may be able to help.
• With Medicaid: The cost of Sublocade is about $0 to $4 per month.
• With Medicare: Sublocade is usually covered under  Medicare Part B, with the cost ranging from about $0 to $1,600 per month.

The Sublocade shot is an extended-release injectable buprenorphine option used to treat opioid use disorder. It is injected once a month by a health care provider.

“For some people, that stability can feel freeing,” Dr. Boustead says. “There’s no daily reminder. No need to carry medication. No daily negotiation with cravings or routine. The brain stays supported in the background while life moves forward.”

If you’re wondering where you can get the Sublocade shot, Boulder Care offers MOUD and other elements of a customized and comprehensive recovery plan.

Elements include clinician support and peer support from providers who have lived experiences with OUD. To reduce barriers to care, Boulder operates virtually, via telehealth (866-901-4860).

However, you or a loved one would need to visit a clinician who partners with Boulder Care to receive your Sublocade shot.

Do you get withdrawal while on Sublocade?

In general, you shouldn’t experience withdrawal while on Sublocade. The Sublocade shot provides a steady release of the medication buprenorphine into your bloodstream.

How long do you have to take Sublocade?

How long you take Sublocade is an individual decision, one you should make under the guidance of your prescribing clinician. You may wish to stay on Sublocade long-term.

Can I switch from Suboxone to Sublocade?

Yes, you can switch from Suboxone to Sublocade with the help of your prescribing clinician.