• Sublocade (buprenorphine extended-release) injection, for subcutaneous use (CIII) is indicated for the treatment of moderate to severe opioid use disorder in patients who have initiated treatment with a buprenorphine-containing products. It is administered every 4 weeks by a medical professional.
• Sublocade should be used as part of a comprehensive treatment plan which includes counseling, behavioral therapy, and psychosocial support.
• I agree and understand, I will not take any illicit Benzodiazepines
or Other CNS depressants including alcohol with Buprenorphine. As the combination can cause life-threatening respiratory depression, overdose, coma, and death.
• I agree and understand the most common injection site reactions are pain, erythema and pruritus. In few cases abscess, ulceration, infections, and necrosis can occur. Such cases resulted in surgical depot removal, debridement, antibiotic administration, and discontinuation of Sublocade.
• I agree and understand there will be a depot (small bump) for
several weeks at the injection site and it will decrease in size over
time.
• I agree and understand not to message, rub or apply direct pressure/force at the injection site.
• I agree and understand that I will wear the belt and clothing waistbands below or above the injection site to avoid the friction.
• I agree and understand that Sublocade can cause low blood pressure and liver damage.
• I agree and understand to call 911 or get emergency medical help right away in
all cases of known or suspected opioid overdose, even if naloxone is administered.
• I agree to tell my family and the people closest to me of this increased sensitivity to opioids and the risk of overdose.
• I agree and understand, the risks associated with pregnancy. It is my responsibility to update about my pregnancy or breast-feeding status to my medical professional. I will also update my medical provider if I am planning to get pregnant.
• I agree and understand that I will continue behavioral therapy and counseling. I will update the clinic with medical updates and changes including any new onset or worsening of current mental health issues.
• I will carry the card of Sublocade and will update my other medical providers.
• I agree to inform my medical providers before starting any new medications including over the counter medications and supplements due to possible contraindications.
• I agree not to drive or operate machinery or do dangerous activities until it is known how this medication will affect me.
• I agree and understand that I will not drink alcohol or take any other illicit drugs while on Sublocade.
• I agree to return to clinic in one month for next injection.
• I agree to make aware of Sublocade to all of medical providers.
• I agree, it is my responsibility to update my phone number and address for communication purposes.
• I have read all the information about Sublocade. All my questions are answered. Side effects, dosage, risks, benefits, and adverse effects discussed in detail. I agree and understand that I am responsible to abide by these instructions. I have no further
questions currently. I acknowledged and repeated back the risks and benefits to medical provider. I would like to start my treatment of Sublocade with WellCare Medical Clinic.