Eli operates the Dopeless Nation Alliance with a resolute goal: advocate for extended-release buprenorphine injections. This bustling Tampa nonprofit is his battleground, where he champions a transformative approach—shifting from daily oral medication to a single shot in the belly. For patients at risk of overdose, these injections offer a lifeline of protection, and Eli sees it as his paramount chance to make a lasting impact.
In a state where overdose fatalities have surged, this innovative treatment holds exceptional promise, particularly for those grappling with instability, such as homelessness. However, the utilization of injectable buprenorphine remains relatively underexplored and underutilized compared to other forms of addiction medication. Shockingly, there's a paucity of research pitting the various buprenorphine administration methods against one another.
Buprenorphine, among the trio of U.S.-approved opioid use disorder medications, binds to brain opioid receptors, curbing cravings and withdrawal. Its presence precludes other opioids from binding, reducing the risk of overdose. Many patients rely on buprenorphine for years, yet prescribing oral tablets or sublingual films demands daily adherence—a challenge for patients with tumultuous lives, especially those experiencing homelessness and using methamphetamine.
Eli articulates, "It’s like a religious thing — you have to wake up every morning and repeat your vows." For many, this becomes untenable. Injectable buprenorphine, specifically Sublocade, approved in 2017, offers a monthly solution. But, it comes at a cost—$1,829.05 per injection. Indivior, the drug manufacturer, reaped $244 million from Sublocade last year, striving for annual sales of $1 billion. Despite insurance coverage mitigating the high price, it can still pose a hurdle, particularly for private health plans.
However, access to Sublocade is not merely financial—it's riddled with regulatory hurdles. Providers must secure Drug Enforcement Administration registration and a prescribing waiver due to its controlled substance status. Clinics must undergo FDA safety certification, while specialty pharmacies, the sole distributors, must also meet stringent standards.
Eli highlights the challenge. "At many hospitals, that will mean either a delay in getting this medication on their shelves or just opting out." The hoops to access are incomparable to any other medical treatment. Yet, the urgency looms—access to effective opioid addiction treatment is critical, more so as fentanyl infiltrates the Tampa Bay area, causing a surge in overdose fatalities.
For patients, Sublocade proves transformative. Former heroin users switch from daily buprenorphine films to monthly injections offering newfound freedom and stability. However, the struggle persists. Access barriers, long waits for Sublocade, and regulatory complexities hinder comprehensive treatment.
Eli's mission remains steadfast. As fentanyl-related deaths escalate in Florida, he's driven to expand the use of injectable buprenorphine. He perceives the urgency of this moment—a time where decisive actions hold the key to avert potential tragedies.