The Pennsylvania Department of Corrections is moving to reduce Suboxone diversion in its prisons by giving inmates suffering from opioid withdrawal an injectable form of the treatment drug buprenorphine. The plan may even make a dent in the state’s annual toll of more than 5,000 overdose deaths.
A DOC spokesperson told Filter that the agency will begin piloting Sublocade—the first once-monthly, extended-release injectable buprenorphine formulation for the treatment of opioid use disorder—as early as this month.
The pilot will take place at two prisons: SCI Albion and SCI Cambridge Springs. The facilities are among six state institutions designated especially for people with substance use disorders. They were chosen because of their high rates of Suboxone diversion among prisoners. The DOC has previously struggled to contain this with a variety of new restrictions, including strict rules on how prisoners may receive mail.
“The number of individuals entering state prisons with substance use disorder has doubled in the last decade from 6 to 12 percent,” said PA Corrections Secretary John Wetzel. “The opioid crisis doesn’t stop at the gates.”
Sublocade was reviewed and approved by the US Food and Drug Administration (FDA) with Fast Track and Priority Review designation last November. According to the drug’s maker, Indivior, Sublocade is available in dosage strengths of 100 mg/0.5 mL and 300 mg/1.5 mL buprenorphine.
Although the formulation is designed to deliver a maintenance dose of buprenorphine and is not specifically approved for detoxification, the DOC will begin its pilot using the subcutaneous injectable buprenorphine as a detox medication only.
“The long-term goal is to be able to offer ongoing maintenance; however, the DOC is not yet there,” said Amy Worden, a DOC spokesperson. “The buprenorphine [detox] pilot program will hopefully get us closer to achieving that long-term goal.”
It will also serve as a unique trial for a new drug that many view as the future of addiction treatment. Because each injection is designed to last a month, proponents of Sublocade say it will increase patient compliance and reduce diversion.
Skeptics worry that even diverted Suboxone has important harm reduction potential. The prosecuting attorney for the Vermont county of Chittenden recently announced that her office would refuse to pursue charges for arrests made for Suboxone diversion, recognizing its potential to save lives even when illicitly obtained.
This will be the first known off-label use of Sublocade for detoxification. But some physicians have had success using Braeburn Pharmaceuticals’ Probuphine buprenorphine implants (which contain four 80 mg doses of buprenorphine) to slowly detox patients.
Dr. Raymond Bobb, a physician at Parkside Recovery in Philadelphia, says he successfully used a single set of four Probuphine implants, which are designed to last 24 weeks, to wean two patients off buprenorphine over the course of a year. In both cases the patients were still opioid-free at 56 weeks.
He speculates that while Sublocade has not been tested for detoxification, it could work in a controlled setting like a prison.
“Sublocade floods the opioid receptors at pretty high levels, but it won’t all shut off at once; I suspect it will be prolonged and slow at first,” he said. “Using it for detox is untested but it might work among inmates. And if it is ultimately employed as a maintenance drug it could radically diminish rates of overdose better than Vivitrol, which has levels dropping after a couple weeks.”
Vivitrol, a once-monthly injection of the opioid antagonist naltrexone, is currently favored in correctional settings, with some 200 agencies using the drug—despite little evidence of its effectiveness.
The PA DOC began offering a single shot of Vivitrol to a small number of prisoners in 2014, and has since expanded the program to encompass 25 of its prisons. Its move to the opioid agonist buprenorphine, even in a limited and untested fashion, puts it among only a tiny handful of correctional facilities in the US willing to invest in evidence-based treatment.
According to a recent study by Pew Research: only only about 200 of the nations 5,000 jails and prisons have embraced even Vivitrol, while “nearly all corrections officials reject the use of either methadone or buprenorphine behind prison walls.”
Main image shows SCI Albion in Erie County, PA.