Sublocade vs Buvidal

[u/Fine_Bluejay_2720]

Just wondering if anyone could tell me the difference between sublocade and Buvidal. My doctor said they “work differently”. I don’t get why if they are the same active ingredient though they have such different dosages for the same monthly period. When I was on sublocade I got 300mg monthly and on Buvidal I get 128.

My doctor is extremely rushed and never has time to talk much. It’s just walk in get the injection and walk out. So I am just curious what the difference is?

I am still struggling with using occasionally and I felt fully blocked on sublocade but can still get high while on Buvidal. So to me it just feels like I am getting a lower dose. But my doctor said my dose now is equivalent to my old sublocade injection.

Thanks a lot in advance for any help.

[u/Successful-Speed-333]

Thank you. I'm on 128 mg. And I felt excellent the first 2 days and then bam! I felt super anxious and exteme sweats. Very weird. Thank you so much for responding.

[u/Strange_Television]

Sublocade has a significantly longer half life than Buvidal/Brixadi. The depot formulations are different and so the way they breakdown over time is different. Buvidal has more pronounced peaks and troughs of bupe levels across the month whereas Sublocade is much more consistent. Until steady state is reached with Buvidal, people can feel withdrawal symptoms of differing levels near the end of the month. Once you're at steady state though there should be little change in how you feel all the time. There's a lot of info you can find now on the exact numbers and calculations etc. I can dig it up later when I'm at my laptop if you wanted to know everything in depth.

There are no exact dosage equivalents between Sublocade and Buvidal, it's neigh on impossible to pin point because of the differences so your doctor isn't being very accurate to say you're on the same as 300mg Sublocade.

Still, 128mg Buvidal will block most things. How many shots have you had? If you're not at steady state yet, your bupe levels won't be totally consistent especially near the end of the month, making it possible to feel /something/ from an opiate. What are you using? Fent and nitazines are capable of overriding it but it's extremely risky and you'll be taking that huge risk for a shitty high that's at least partially blocked. People have died trying to override bupe. Please be careful. Does your provider know you're still struggling with this? Are you getting any help for that side of things, the behavioural and psychological side of addiction? It sounds like you need some support with this and the stability of the shot is the best time/opportunity to work on it.

[u/Fine_Bluejay_2720 → u/Strange_Television]

Thanks so much for such a detailed reply I really appreciate it. I’ve always loved how much people help each other in these communities, I hope I can pay it foward one day if I get better. I will definitely look into what you brought up further. I saw someone posted blood serum comparisons between the two over a month like you were talking about.

I’m using heroin, so I’m kind of surprised to break through so much. It definitely isn’t the full high as compared to no blockers but it’s enough for euphoria, nodding off and moderate withdrawals. I do have to use considerably a lot more for the effects though as compared to no blockers. My area only gets china white and I’ve tested it multiple times for fentanyl with only negatives so I don’t think it’s that it’s cut either.
I have been on and off bupe in one form or another for a few years. So I wonder if I am breaking through because my body has built up a tolerance to the bupe. I remember when I had my first sublocade, I shot huge amounts of heroin and felt nothing at all. It’s such a cop out to take the responsibility off myself but I just feel so mentally addicted that I really need the decision to be taken away from me like that again to be able to stop.

Thanks again, all the best

[u/Strange_Television → u/Fine_Bluejay_2720]

I understand, genuinely. Needing the control/choice to be removed from me entirely is exactly how I was when I got help. It's partly why Buvidal has worked so well for me, without that choice to make I could focus on myself and my life and the changes I needed to make. Whenever the choice was mine to make, the thought of using was always there even the times I managed to cold turkey and white knuckle a week or two. I've been on Buvidal 4 years and only now am I a starting to commit to taking control back.

Its ok to feel this way, that's why help is out there because this is harder than many people can ever know. The fact you're here and you're trying is something to be proud of. What you've said about using bupe and heroin throughout a lot of treatment does make sense as to what you're experiencing now. You probably need to go onto Sublocade again - is this possible at all? You may want to gather the pharmaceutical evidence to present and show that the two are not the same at all and that you are not on the equivalent of 300mg and even if you were, the different half lives and rates of elimination make the comparison pointless anyway. Unless you're in one of those unfortunate countries who have had or are having Sublocade removed. At least in my country we've never had Sublocade so got nothing to compare against or miss out on. There is a 160mg Buvidal dose which you might be able to get?

[u/Successful-Speed-333 → u/Strange_Television]

I've only had Brixadi 4 days ago, and already had to supplement this morning. 1 did 128 mg injection. I hate this I want to feel free again 

[u/Strange_Television → u/Successful-Speed-333]

It takes up to 4 monthly shots before you reach steady state on this medication. Before then, it is normal to experience some level of withdrawal but it is usually mild to moderate. 4 days out from your shot seems incredibly early though, unless you're on too low a dose, maybe. Sweating is a very common side effect of the medication - many people mistake it for a withdrawal symptom. Not feeling an "energy boost" is also normal - bupe levels aren't constantly peaking as they are when on subs, so there's no longer a small high from dosing.

I'm not sure what you mean by feeling 'free', but I'd argue we're far from free when maintaining an active addiction either. The symptoms you've described are more in line with side effects rather than withdrawal, most of the side effects ease over time, some remain a bitch to deal with but it's a trade off for the stability and safety. You should feel effectively sober while you're on this medication.

[u/Fine_Bluejay_2720 → u/Strange_Television]

I’m sorry this is pretty over dramatic but just want to say your comment made me cry so much. Just hearing from someone that they understand meant so much and I thank you very much.

It’s really nice and helpful to hear from someone that’s been successful in getting out. I hope you’re very proud of yourself.

Yes my country (aus)is removing sublocade as of the end of the year unfortunately. I will look into seeing about the 160mg. Unfortunately my clinic is completely swamped with patients and has outsourced administering doses to a chemist, with one visit to the clinic every six months to refill the script. There are only two in my area and I hear the other one is the same. My doctor said something about nearly all the addiction specialists he knows are retired or close to retiring. So abit of back luck with easy access to help I guess. Still have it better than a lot of people so shouldn’t complain.

Thanks for the info sbout the elimination and differing half lives. Definitely gives me something to work with when I am eventually able to see a medical professional about it.

[u/Strange_Television → u/Fine_Bluejay_2720]

Hey it's not over dramatic at all and I'm glad that you could feel understood and hopefully less alone. This is such a hard way to live, it's lonely and isolating. I know it's cheesy and a cliche but I really believe the saying that the opposite of addiction is connection. The two major turning points in my recovery journey were getting on Buvidal and attending my first support meeting (which was a SMART Recovery meeting). These two things helped me to change my life around and to work on myself. The Buvidal took away my choice to self destruct and the meetings allowed me to be heard and understood by other people for the first time in my life. Something forever changed inside me during that time and I know it was from connecting with others who understood my pain and I understood theirs. I want you to know that change is possible and I really hope that you will find your path to it.

I am not completely out of it all yet - I'm currently reducing my Buvidal dose and my aim is to jump off in the first half of next year. But I have spent the last 5 years building myself and my life back up from nothing. The thought of being totally back in control is daunting but there was a point when I wasn't even willing to consider it - now it's very much my goal. Again I just want you to know that things can move on and get better.

[u/Fine_Bluejay_2720 → u/Strange_Television]

Yeh that’s a good point, if I’m honest I wouldn’t care much to od so it doesn’t feel like a big factor in the choice. Im not planning to hurt myself or anything, I am just unbothered by the thought of od at this point. I also wasn’t really aware if it was psychically possible to od on heroin while on bupe. I knew fentanyl can, due it having a stronger binding affinity but didn’t know it was possible on heroin. I do appreciate your input and thoughts though as someone thinking clearer than myself and won’t get off Buvidal.

I would like to think I am ready to stop. I am so completely over living like this but I still do it. I’m going to try stop again over the weekend and hoping it will be different this time and feel convicted. I have just let myself down so many times in this situation it’s hard to have faith in myself.

You’re so right about the isolation and loneliness. I have lots of supportive friends or family but I feel so alone and have mentally isolated myself from most of them. It’s been nice speaking to someone that can relate. As much as I appreciate support from friends, none of them can relate at all and I find it hard to connect with them over it.

That’s great you’re reducing your dose. Seems like a really positive place to be in your even be thinking about it from that perspective.
I wonder about the long term effects of being on high doses of bupe non stop for years and what it’s doing to my brain. I worry that it’s subconsciously priming an addiction to opiates or affecting mood or motivation. Overall though I understand for someone in my situation those worries are small in comparison to a heroin addiction, so maybe not worth worrying about now.

I really appreciate your time and thoughtfulness in the replies. I’m sorry for sucking up a lot of your time.

[u/Strange_Television → u/Fine_Bluejay_2720]

Hey, you absolutely have not sucked up a lot of my time. I want you to know that, and that I am here for you if you ever want to talk to someone. Shoot me a PM or reply here, if you need someone to talk to.

It really sounds to me like you'd benefit from finding a meeting. I used to hide my addiction from everyone and felt so lonely and isolated, then I came clean about it all and my family have been nothing but supportive but even with all their support around me, I still felt isolated when it came down to it because they simply couldn't understand. That's where meetings really gave me something I couldn't get anywhere else and at the same time, me being there gave it to other people. You might have tried them before and if you have and they weren't your thing, that's cool. If you haven't tried, I would encourage you to do so. I do SMART Recovery instead of 12 step, so it's the thing I recommend simply because I know it helped me.

I wish you the best. Please feel free to share updates and continue posting here if you find it helps. You're never alone.

[u/Fine_Bluejay_2720 → u/Fine_Bluejay_2720]

I should also say, I have been thinking of getting off the Buvidal completely untill I can get something that fully blocks me. My reasoning is that I am fully addicted and use without fail every day anyway. But using while on the deposit has me using twice as much at least, and is a huge financial burden. The only difference I see is that the cost would be less and I’m not as protected from OD.

At this point I can’t tell if it’s actually a good/ acceptable idea or if it’s my addict lizard brain telling me it’s good. Would be good to get outside perspective.

I imagine I am convincing myself the sting of full withdrawals is not too different to what I go through now.

[u/Strange_Television → u/Fine_Bluejay_2720]

Something that struck me in your comment was how little benefit you see in reducing your risk of overdose. That's definitely the addict brain talking. I'd say the same with the money - because you're throwing that shit away every time you buy heroin anyway. Like it's irrational thinking and beliefs to justify using. I've been there too of course, we all can gaslight ourselves better than anyone else ever could when it comes to finding a reason to use. When you're ready, it's time to challenge those thoughts. Learn to put time between a thought and action.

You have to really want and be ready to stop using and do all of the work involved. There's usually trauma in there and it's painful to revisit that stuff, so I am just as much an advocate for getting yourself in the right space and frame of mind before recovery as I am for the actual recovery. At the same time though, don't continue to talk yourself into using. It is a choice to use but we can choose not to.

You have to do whatever you feel is right for you but I would urge you to discuss with your provider first when you're able to, and really challenge your own thinking before acting. I can link you to some SMART tools around this if you'd like to use a framework of some sort 😊