Using Sublocade May Be The Easiest Way To Quit Opioids
- Harold Pierre, MD
- Apr 10
- 9 min read
Updated: May 1
Sublocade Detox: Why This Injection May Be the Easiest Way to Finally Quit Opioids
Most people trying to quit opioids hit the same wall. They taper down their Suboxone dose slowly over weeks or months, feeling worse with every reduction. Then somewhere around 2 mg, the opioid withdrawal symptoms become unbearable. Anxiety, insomnia, restless legs, nausea, a deep dysphoria that makes it impossible to function at work or take care of your family. So they go back up. And the cycle repeats.
I've watched this play out in my practice more times than I can count. But over the past few years, something has changed. First, we witnessed a peculiar benefit of injecting Sublocade, the monthly buprenorphine extended-release injection. We stumbled on the fastest and least painful way to get off opioids for good. Now, researchers support my findings.
And the science behind it makes a lot of sense.
What Is Sublocade and How Does It Work?
Sublocade is a once-monthly injection that contains buprenorphine, a partial opioid agonist and the same active ingredient found in Suboxone (buprenorphine/naloxone). A healthcare provider injects it into the subcutaneous tissue of your abdomen, where it forms a small solid deposit under the skin. That deposit slowly releases buprenorphine into your bloodstream over the course of a month.
The standard treatment protocol starts with two monthly 300 mg injections followed by ongoing 100 mg maintenance doses. Sublocade is FDA-approved for the treatment of moderate to severe opioid use disorder in patients who have already stabilized on sublingual buprenorphine (the film or tablet you dissolve under your tongue). That's the maintenance protocol.
But what makes Sublocade interesting for detox isn't the maintenance protocol. It's what happens when you stop.
The Pharmacokinetics That Make Sublocade a Built-In Taper
This is what we weren't expecting. Sublingual buprenorphine (Suboxone) has a half-life of about 24 to 42 hours. That means when you stop taking it or drop your dose, blood levels fall fast. Your brain notices. Withdrawal symptoms kick in within a day or two.
Sublocade is completely different. Its half-life is 43 to 60 days and possibly longer. After your last injection, buprenorphine levels don't crash. They drift down slowly over months. The manufacturer's own data shows that buprenorphine can still be detected in your blood and urine up to 8 months after the last dose of Sublocade. In my practice, I have a patient who continues to test positive for buprenorphine 12 months after his last injection. We were only able to detect it using LCMS and the numbers were below the cutoff.
Think about what that means. Your body is essentially tapering itself. No daily dose adjustments. No counting milligrams. No waking up every morning wondering if today is the day you feel terrible. The drug just quietly leaves your system at a pace your brain can adjust to.
Compare that to the traditional Suboxone taper. You're making deliberate dose cuts every month, and each reduction can trigger a mini withdrawal. The lowest available sublingual buprenorphine tablet is 2 mg, which still occupies about 48% of your opioid receptors and equals roughly 80 morphine milligram equivalents. That's not a small amount of opioid activity. Jumping off from 2 mg is where most people fail, and research confirms that withdrawal severity peaks at that dose and below. Plus, you can't cut the tablet beyond 4 pieces (each 0.5mg) without it shattering.
Sublocade sidesteps that entire problem.
What the Research Actually Shows
Multiple published case series now document what happens when patients use Sublocade to discontinue opioids. The results are remarkably consistent.
The Ritvo Case Series (2021)
Researchers at the University of Colorado reported on three patients who had been stuck on sublingual buprenorphine and couldn't taper off despite repeated attempts. One man had tried everything. Tramadol, buprenorphine patches, clonidine, lorazepam, even attempting his taper while on vacation so he wouldn't have work stress. Nothing worked. He stayed stuck at 4 mg of Suboxone for a year because every time he went lower, the dysphoria was unbearable.
Each of these three patients received a single 100 mg Sublocade injection. The results? One patient reported "a slight, not intolerable, malaise" for about two weeks that fully resolved by week three. A second reported "zero withdrawal symptoms" and "only a little pain at the injection site." The third said, "Once I had the shot, I had no withdrawal symptoms."
All three successfully discontinued opioids.
The Rodriguez and Suzuki Case Series (2023)
A team at Harvard's Brigham and Women's Hospital followed four patients with opioid use disorder who transitioned from sublingual buprenorphine to Sublocade and then stopped. These patients received between 4 and 11 Sublocade injections before discontinuing.
Three of the four reported no withdrawal symptoms, no cravings and no return to opioid use for periods ranging from 10 months to over a year. One patient did have a brief 3-day relapse to fentanyl after being opioid-free for a year and a half. He restarted buprenorphine quickly because he was still connected to his treatment program, stabilized again and has stayed clean since.
The researchers noted that none of these patients needed the slow, painful sublingual taper that typically causes so much suffering.
The Hayes Study: The Largest to Date (2025)
This is the most detailed study we have so far. Australian researchers tracked 15 participants discontinuing long-acting injectable buprenorphine (Buvidal, a similar depot formulation) in a residential treatment setting for up to 16 weeks after their last injection.
The numbers tell the story. Average peak withdrawal scores on the Clinical Opioid Withdrawal Scale (COWS) were just 4.8 out of a possible 48. That's barely above "no withdrawal" territory. Peak symptoms showed up around 5 to 8 weeks after the last injection and then faded. Most participants described the withdrawal as mild and manageable.
Ten of the participants completed exit interviews. Every single one said this attempt to quit was better than their previous tries. Six said "very much better." Three said "much better." One said "a little better." Nobody said it was worse.
The Kruk Study: Even Works for Heroin and Methadone (2026)
The most recent data comes from an Australian hospital where five patients received a single dose of depot buprenorphine as part of opioid withdrawal management. These weren't patients on Suboxone looking to step down. These were people withdrawing from heroin and methadone who had failed conventional detox protocols.
After stabilizing on short-term sublingual buprenorphine for a few days, each patient received one injection. They were discharged with minimal withdrawal symptoms. At follow-up visits over three months, most reported manageable low-grade symptoms that resolved. Patient satisfaction scores were high, with several rating their experience a 10 out of 10.
Who Is a Good Candidate for Sublocade Detox?
Not everyone should jump straight to this approach. The patients who did well in these studies shared a few things in common.
They were motivated. They had made a personal decision to stop opioids and had thought carefully about what that meant. They were psychologically stable, meaning their mental health was in a decent place and their life circumstances weren't in crisis. And they stayed connected to their treatment provider after stopping, with regular follow-up visits for months afterward.
In my clinical experience, the patients who do best with this approach have usually been stable on buprenorphine for a while, and I mean years with no relapses. They've rebuilt their lives, they've got support systems in place and they're not running from something. They're making a deliberate choice.
That last part matters. Staying connected to your addiction treatment provider after your last Sublocade injection isn't optional. It's a safety net. Cravings can show up weeks or months later, even when withdrawal symptoms are minimal. Having a plan and a provider who knows your history makes the difference between a brief lapse and a full relapse.
The Honest Caveats
I'd be doing you a disservice if I made this sound risk-free. It's not.
First, the evidence is still early. We're talking about case series with small numbers of patients, not large randomized controlled trials. The science is encouraging, but we need bigger studies to confirm these findings and figure out the best protocols. How many Sublocade injections should someone get before stopping? Does the 300 mg dose work differently than the 100 mg dose for this purpose? We don't have firm answers yet.
Second, the risk of relapse and overdose is real. After months of buprenorphine blocking your opioid receptors, your tolerance drops. If someone returns to using opioids at their old dose, the overdose risk is serious. One patient in the Rodriguez study relapsed briefly at 18 months. He was fine because he had a treatment team watching out for him. Not everyone has that.
Third, this is technically off-label use. The FDA approved Sublocade for maintenance treatment of opioid use disorder, not as a detox tool. Using it to discontinue opioids isn't what the label says. That doesn't mean it's wrong, and doctors prescribe medications off-label all the time when the clinical rationale is sound. But you should know that going in.
Fourth, my greatest successes have come with 3 consecutive 300mg Sublocade injections before stopping. So, keep that in mind since your body composition may be different.
Lastly, I am not compensated by Sublocade to write this article or for any other reasons.
What This Means for You
If you've been stuck on Suboxone (buprenorphine) and want off, or if you're looking for an addiction treatment approach that doesn't require years of daily medication, Sublocade detox is worth a conversation with your healthcare provider. The research so far suggests that the extended-release injection can do what months of painful sublingual tapering often can't: get you to zero with minimal withdrawal symptoms.
It won't work for everyone. But for the right person at the right time, Sublocade may be the smoothest exit ramp from opioids that currently exists. For those pursuing sustained recovery, this form of medication-assisted treatment offers something no other approach can: a taper your body runs on its own. The most commonly reported side effects of Sublocade (injection site reactions like a small bump or mild pain) are minor compared to the weeks of suffering that come with a traditional opioid taper.
Frequently Asked Questions
How long does Sublocade stay in your system after the last injection?
Sublocade has a half-life of 43 to 60 days, which means it can be detected in your blood and urine for up to 8 months after the last dose. In my practice, I've detected buprenorphine 12 months after the last dose. This slow clearance is actually what makes it effective for detox, because your body experiences a gradual natural taper rather than abrupt withdrawal.
Can you use Sublocade to detox from heroin or methadone, not just Suboxone?
Early research says yes. The Kruk 2026 study showed that patients withdrawing from heroin and methadone who had failed traditional detox were able to stabilize on short-term sublingual buprenorphine and then receive a single depot buprenorphine injection with good results. This approach is still considered off-label and should only be done under medical supervision.
What are the withdrawal symptoms after stopping Sublocade?
Most patients in published studies reported minimal withdrawal symptoms after their last Sublocade injection. The most common complaints were mild insomnia, restless legs and low-grade discomfort peaking around 5 to 8 weeks after the last injection. Average withdrawal scores in the largest study were just 4.8 out of 48 on the Clinical Opioid Withdrawal Scale, which falls in the mild range. Some patients reported no withdrawal symptoms at all.
Is Sublocade detox covered by insurance?
Sublocade is covered by many insurance plans, including Medicaid in most states, for the treatment of opioid use disorder. Coverage for using Sublocade specifically as a detox or discontinuation strategy may vary since this is off-label use. Contact your insurance provider and your healthcare professional to discuss your treatment plan and coverage options.
References
Ritvo AD, Calcaterra SL, Ritvo JI. Using Extended Release Buprenorphine Injection to Discontinue Sublingual Buprenorphine: A Case Series. J Addict Med. 2021;15(3):252-254.
Rodriguez CP, Suzuki J. Case Series: Voluntary Discontinuation of Sublingual Buprenorphine Treatment for Opioid Use Disorder using Extended-Release Buprenorphine. Am J Addict. 2023;32(3):314-317.
Hayes V, Mills L, Byron G, et al. Characterizing withdrawal from long-acting injectable buprenorphine: An observational case series. Drug Alcohol Depend Rep. 2025;15:100329.
Kruk JS, Fraser JL, Datta P, Fisher KA. Single-Dose, Long-Acting Injectable Buprenorphine for Opioid Withdrawal Treatment. Drug Alcohol Rev. 2026;45:e70070.
Greenwald MK, Johanson CE, Moody DE, et al. Effects of buprenorphine maintenance dose on mu-opioid receptor availability, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. Neuropsychopharmacology. 2003;28:2000-2009.
Haight BR, Learned SM, Laffont CM, et al. Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2019;393:778-790.
About the Author
Harold Pierre, MD, is a board-certified anesthesiologist, board-certified addiction medicine specialist, and a concierge addiction doctor based out of Tulsa, Oklahoma with over 27 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine. He is licensed in Florida, Texas, Oklahoma, Louisiana, and Arizona. If you are seeking care, you may schedule an appointment with him by calling or texting 918-518-1636. LinkedIn
Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before making changes to your medication or treatment plan. If you or someone you know is struggling with opioid addiction, please reach out to a healthcare professional. You can also schedule a consultation with Dr. Pierre to discuss your treatment options.
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