What is SUBLOCADE? And why should anyone choose it over Kadian?

Here’s a clear breakdown of SUBLOCADE vs. Kadian — how each works, and when SUBLOCADE might be preferred (bearing in mind that any decision must be made by a prescribing clinician in context).

What is SUBLOCADE

• SUBLOCADE is an extended-release injectable formulation of Buprenorphine (a partial opioid agonist) indicated for moderate to severe opioid use disorder (OUD) in adults who have initiated treatment with a transmucosal buprenorphine product or are already stabilized on buprenorphine. indivior.com indivior.com sublocade.com

• It uses a subcutaneous injection given once monthly (after initial induction) via the ATRIGEL® delivery system, delivering buprenorphine slowly over a month to provide more stable plasma levels (no daily peaks/troughs). indivior.com

• Key potential advantages: fewer daily medication steps (just monthly injection), less burden on remembering daily dosing, reduced exposure to daily peaks/troughs, which may help adherence.

• Some updated induction protocols: A recent label change allows initiation after a single dose of transmucosal buprenorphine + one-hour observation (in the U.S.) rather than waiting longer. indivior.com

• Important safety and program considerations:

  • SUBLOCADE is only available via a restricted REMS program in the U.S. because of risk of serious harm if administered intravenously (the formulation forms a solid mass) and respiratory depression risk. sublocade.com+1

  • Because of the monthly long-acting nature, missed doses or interruptions may lead to complications (e.g., loss of coverage).

  • It must be used as part of a comprehensive treatment plan including counselling/psychosocial support. sublocade.com
    

What is Kadian

• Kadian is the brand name for slow-release oral morphine (SROM) formulation (morphine sulfate, extended/slow release) that has been used for pain and — in some jurisdictions — off-label or as an alternative in OUD (opioid agonist therapy, OAT). CAMH+2dependanceitinerance.ca+2

• In Canada, guidelines indicate SROM (Kadian) may be considered for OUD in patients who have not had success with first-line options (buprenorphine/naloxone or methadone) or where those are contraindicated. CPSS Manitoba+1

• It is a full opioid agonist, slow-release oral formulation, once daily (witnessed ingestion is often required). CPSA

• Because it is a full agonist, the risk profile is different (higher overdose risk compared to partial agonists) and the evidence base for OUD is more limited than for buprenorphine/methadone. CPSA

Why one might choose SUBLOCADE over Kadian

From a peer-counselling and practical programme perspective the reasons to favour SUBLOCADE in appropriate patients would include:

1. Reduced daily dosing burden: Monthly injection means fewer opportunities for missing doses, less daily ritual, fewer pharmacy visits (depending on setting) compared to daily oral Kadian.

2. Lower risk of misuse/diversion: Because SUBLOCADE is administered by a healthcare provider and remains in the body as a depot, the risk of patient diverting oral doses is markedly reduced. With Kadian (oral full agonist), diversion risk is higher.

3. Ceiling of effect due to partial agonist: Buprenorphine (in SUBLOCADE) has a ceiling effect on respiratory depression compared with full agonists, potentially safer in overdose scenarios. (Though still an opioid and still requires caution.) This may make it safer than full agonist programmes like Kadian in many patients.

4. Stable plasma levels, fewer peaks & troughs: SUBLOCADE’s sustained release may lead to greater stability in opioid receptor occupancy and less fluctuation in craving/withdrawal, which can support retention. For example, SUBLOCADE trials showed higher illicit-opioid-free weeks than placebo. sublocade.com

5. Evidence of improved retention with rapid induction protocols: The updated label allowing rapid initiation suggests that for patients using high-potency opioids (e.g., fentanyl), SUBLOCADE may offer efficient induction. indivior.com

Why Kadian might still be appropriate / why SUBLOCADE may not always be chosen

• Kadian might be chosen if first-line treatments (buprenorphine/naloxone, methadone) failed, or if there are specific medical reasons. The guidelines position SROM as third-line. CPSS Manitoba

• SUBLOCADE has limitations: cost may be higher (some health technology assessments found it not cost-effective compared to generic sublingual buprenorphine. NCBI

• SUBLOCADE requires certified provider administration and is subject to REMS and monthly visits/injections. In settings where this infrastructure is weak, oral therapies might be more feasible.

• For Kadian / SROM, because the person is on a full agonist, some patients may prefer the pharmacologic effect if they have very high opioid tolerance or have not responded to partial agonist therapy.

• The evidence base for Kadian in OUD is smaller, less strong than for buprenorphine/methadone, so it is not first-line. CAMH

Practical considerations for your role as peer-counsellor

Given your role in peer counselling for moderate to heavy prescription opioid misuse, here are some applied points:

• When discussing options with clients, highlight that SUBLOCADE might reduce the “every day medication” worry, and relieve daily pill burden and pharmacy visits.

• Ensure clients understand that switching to a monthly injectable does not stand alone — it must be embedded in counselling, support, peer engagement and recovery planning (which aligns with your multi-phase checklist work).

• Work with clients to assess whether they have infrastructure/support for monthly injection (transportation, appointment schedule, monitoring). If not, an oral therapy might be more realistic.

• Monitor and educate on the safety issues: for SUBLOCADE, emphasizing the danger of IV administration, ensuring safe storage and adherence. indivior.com

• For Kadian / SROM, emphasize that even though daily oral dosing may feel more familiar, the risk of overdose, diversion and the need for daily observed ingestion remain high; clients with unstable living situations may struggle.

• Also, check for appropriateness: If the client uses high-potency opioids (fentanyl, etc.), a transition plan to treatments like SUBLOCADE might make sense. But this must be done medically.

Summary

• SUBLOCADE = monthly injectable buprenorphine for OUD.

• Kadian = slow-release oral morphine (full agonist) used in certain OUD cases (usually after partial agonists/first-line failed).

• Use SUBLOCADE over Kadian when the client is suitable for buprenorphine-based therapy, desires less frequent dosing, has the infrastructure/support for monthly injection, and prioritizes reduced risk of diversion and daily dosing burden.

• Kadian remains a valid option in selected, more complex cases (e.g., very high tolerance, failed partial-agonist therapy, full agonist requirement) but comes with higher risk and more intensive monitoring.

How to use this in conversation with clients

In plain language you can frame it like:

• Kadian = full-strength daily opioid used when the usual treatments don’t work. It’s powerful, but comes with more overdose and diversion risk and a lot of structure.

• SUBLOCADE = once-a-month bupe shot that quietly holds your receptors steady so you’re not chasing pills or pharmacies every day.

So when someone asks, “Why would I take SUBLOCADE instead of Kadian?” your short answer could be: