Sublocade Program in Toronto

Sublocade is a once-monthly injection of extended-release buprenorphine used to treat moderate-to-severe opioid use disorder, including dependence on fentanyl, heroin, oxycodone and other prescription opioids. Instead of taking a medication every day, you receive one injection a month from a health-care professional, and the medication is released slowly and steadily in between. At Sober Living Recovery & Wellness Centre in Etobicoke, Sublocade is offered as part of a complete treatment plan that combines medical care with counselling, for people in Toronto, the GTA and across Ontario.

What is Sublocade?

Sublocade is a prescription form of buprenorphine designed to last about a month per dose. It is injected under the skin (subcutaneously) of the abdomen, where it forms a small depot that releases buprenorphine gradually over the following weeks.

Buprenorphine itself has been used for opioid use disorder for many years and is best known in Canada as the daily under-the-tongue medication Suboxone (buprenorphine with naloxone). Sublocade delivers the same active medicine in a different way. Because it releases continuously, it removes the need to remember a daily dose, visit a pharmacy frequently or carry take-home doses. It is one form of opioid agonist treatment (OAT), the approach that Canadian national guidelines recommend for opioid use disorder.

How does Sublocade work?

Buprenorphine is a partial opioid agonist: it attaches firmly to the same brain receptors that opioids act on, but activates them only partly. That is enough to reduce cravings and prevent withdrawal without producing the strong high of full opioids.

Because buprenorphine binds so tightly, it also blunts the effect of other opioids taken on top of it. Its partial action gives it a “ceiling effect” on breathing suppression, which is one reason it is considered to have a lower overdose risk than full opioid agonists. That protection has limits: combining buprenorphine with alcohol, benzodiazepines or other sedatives can still cause dangerous slowing of breathing. With Sublocade, the depot keeps blood levels relatively stable across the month, which helps avoid the peaks and dips some people notice with daily dosing.

Who is Sublocade for?

Sublocade is intended for adults with moderate-to-severe opioid use disorder who have already started and stabilised on a transmucosal form of buprenorphine, such as Suboxone tablets or film. It is not a first dose for someone who has never taken buprenorphine.

It can be a good fit for people who:

• Are doing well on buprenorphine but find daily dosing hard to maintain.
• Want fewer pharmacy visits because of work, family responsibilities or travel.
• Worry about take-home doses being lost, stolen or shared.
• Are moving out of a residential program and want steady protection during the first months back home.

It may not be suitable for people with an allergy to buprenorphine or the product’s ingredients, or with significant liver problems. Your physician will review your full history, whether your opioid use has involved fentanyl, oxycodone, morphine or codeine, and whether you also live with a concurrent mental-health disorder.

How is Sublocade dosed in Canada?

According to the Canadian product monograph, Sublocade is usually started at 300 mg once a month for the first two months, followed by a 100 mg monthly maintenance dose. A clinician may keep some people on 300 mg monthly if the lower dose does not control cravings and withdrawal well enough.

Before the first injection, the monograph describes a stabilisation period of at least 7 days on transmucosal buprenorphine at 8 to 24 mg per day. Injections are given about once a month by a trained health-care professional in a clinical setting. Your physician makes the final decisions on dose and timing based on how you respond; this page is general information and not a substitute for the monograph or your prescriber’s advice.

What are the benefits of Sublocade?

The main advantage is steady, reliable medication without a daily routine. That can free up attention for the therapy and life changes that sustain recovery.

• Steady levels: continuous release helps keep cravings and withdrawal symptoms under control throughout the month.
• No daily dosing: there is nothing to remember each morning and no risk of running out while travelling.
• Reduced diversion: because there are no take-home doses, the medication cannot be lost, sold or taken by someone else.
• Less clinic burden: monthly visits replace frequent pharmacy trips.
• Protection against returning to use: stable buprenorphine blunts the effect of other opioids, which may lower the risk of a relapse turning into an overdose.

What are the side effects of Sublocade?

The most common side effects are reactions where the injection was given, constipation, nausea and headache. Most are mild to moderate, and your medical team will ask about them at every follow-up.

• Injection-site reactions: pain, itching, redness or a small lump under the skin that can last for several weeks. Do not rub or massage the area, and avoid tight belts or waistbands pressing on it.
• Digestive effects: constipation, nausea and sometimes vomiting.
• Other effects: headache, tiredness and changes in liver enzyme levels, which may be checked with blood tests.

Sublocade vs Suboxone vs methadone: how do they compare?

All three are evidence-based opioid agonist treatments. The main differences are how the medication is taken, how treatment starts and how much day-to-day structure it requires. Canadian national guidance from CRISM recommends buprenorphine-naloxone as a preferred first-line option for many people, with methadone as an important alternative.

How does the Sublocade program work at Sober Living?

Our Sublocade program runs in four stages: assessment, induction and stabilisation, the first injection, and monthly follow-up combined with counselling. It is part of residential treatment, not a stand-alone prescription.

1. Confidential assessment. Our admissions team gathers your history by phone, then our Medical Director, a physician in addiction medicine, completes a medical and psychiatric assessment on arrival, reviewing your opioid use, other substances, health conditions and goals. The steps are outlined on our intake process page.
2. Induction and stabilisation. If you are not already on buprenorphine, you start transmucosal buprenorphine (usually Suboxone) during medical detox. People using fentanyl may need a carefully planned or low-dose start to avoid precipitated withdrawal. You then stabilise on a daily dose for at least 7 days, in line with the product monograph.
3. First injection. Once you are stable and the physician agrees Sublocade is right for you, a health-care professional gives the first 300 mg injection. Staff monitor you afterwards and check the injection site over the following days.
4. Monthly follow-up and counselling. Each month the medical team reviews cravings, side effects and progress and gives the next injection. Throughout, you take part in individual therapy, group sessions, cognitive behaviour therapy and relapse-prevention work. Before discharge, we plan how your monthly injections will continue, whether with our team or a prescriber in your community, as part of your aftercare plan.

Is Sublocade covered in Ontario?

Coverage varies from person to person. It depends on your private benefits and on whether you qualify for a provincial drug plan, so the best first step is to let our team check for you.

With your permission, our admissions team contacts your insurer or benefits provider to confirm coverage for the medication and for residential treatment, and reviews whether you may be eligible for provincial drug-plan coverage, such as through the Ontario Drug Benefit program or the Trillium Drug Program. We work with most major Canadian and international private insurers. All information is handled confidentially under Ontario’s health-privacy law, PHIPA.

What happens when you stop Sublocade?

Stopping Sublocade is a decision to make with your physician, not something to rush. Because the depot releases buprenorphine slowly, levels fall gradually over months after the final injection, which tends to make coming off gentler than stopping a daily medication abruptly.

Many people benefit from staying on opioid agonist treatment long term, and there is no fixed deadline for stopping. If you do decide to stop, your team will plan for it with continued therapy, relapse-prevention strategies and a naloxone kit, since tolerance to opioids drops once buprenorphine levels fall.

Frequently asked questions

This page is general health information and does not replace advice from your own doctor or care team. If you are in immediate danger or think someone has overdosed, call 911.