LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 351.03 Buprenorphine Extended-Release (SUBLOCADE) Injection
 
  PROCEDURES
  1. Prescription Order:
    1. Initiate burprenorphine extended-release (SUBLOCADE) treatment only on clients maintained on buprenorphine or following induction and 7-day dose-adjustment with a sublingual buprenorphine-containing product.
    2. Prescription for SUBLOCADE shall be sent to a certified pharmacy.
    3. The prescriber shall indicate to the certified pharmacy that the SUBLOCADE be delivered directly to the clinic for client administration.
  2. Education:
    1. Prior to client receiving SUBLOCADE, authorized personnel shall provide counseling to the client on the following:
      1. Due to the risk of serious harm or death due to intravenous self-administration, SUBLOCADE is available only through the SUBLOCADE REMS Program and dispensed directly to a healthcare provider for administration.
      2. SUBLOCADE is a controlled substance; there is a risk for abuse or physical and psychological dependence.
      3. Client should inform the physician of any side effects or reactions from SUBLOCADE prior to the next visit.
      4. Seek emergency attention if client has signs or symptoms of respiratory or CNS depression or overdose.
    2. After administration, authorized personnel shall provide counseling to the client on the following:
      1. Advise the client that they may have a lump for several weeks that will decrease in size over time.
      2. Instruct the client not to rub or massage the injection site and to be aware of the placement of any belts or clothing waistbands.
    3. Educate client on risk of opioid overdose and offer naloxone for the emergency treatment of suspected opioid overdose, per DMH Policy 352.01 Administration of Intranasal Naloxone.
  3. Preparation:
    1. Remove SUBLOCADE from the refrigerator at least 15 minutes prior to administration to allow the product to reach room temperature.
    2. Inspect visually that there is no particulate matter or discoloration prior to administration. SUBLOCADE normally ranges from colorless to yellow to amber.
    3. When ready to administer, remove the foil pouch and safety needle from the carton and open the foil pouch to remove the needle.
    4. Remove the cap from the syringe.
    5. Gently twist the safety needle clockwise until it is tight and firmly attached to the syringe. DO NOT remove the plastic cover from the needle.
    6. Immediately before administering, remove needle cover and slowly and carefully depress the plunger to push out excess air from the syringe. Be careful not to expel any liquid to prevent loss of drug.
  4. Administration:
    1. Administer each injection only using the syringe and safety needle included with the product.
    2. SUBLOCADE shall be administered monthly with a minimum of 26 days between doses, unless an exception is clinically indicated and documented.
    3. To avoid irritation, rotate injection sites.
    4. SUBLOCADE shall be administered only by subcutaneous injection in the abdominal region. 
    5. Clean injection site well with an alcohol swab.
    6. Pinch skin around injection site and lift the adipose tissue from the underlying muscle to prevent accidental intramuscular injection.
    7. Use a slow, steady push to inject the medication. Continue pushing until all of the medication is given.
    8. Withdraw the needle at the same angle used for insertion and release the pinched skin.
    9. Do not rub the injection area after the injection.
    10. After administration, lock the needle guard and discard the syringe.
  5. Disposal:
    1. Discard of all syringe components in a secure sharps disposal container.
  6. Documentation:
    1. Document medication administration according to DMH Policy 352.10 Medication Administration.