The stock price of Richmond, Virginia-based Indivior PLC was down 20% in the first 12 days of February 2025, after delayed approval from the federal Food & Drug Administration (FDA) of label changes on its Sublocade medication—a single injection that provides a 28-day extended-release dosage of buprenorphine for those recovering from opioid addiction.

The drug, whose benefits are obvious to the large number of prisoners and detainees struggling with opioid abuse, has nevertheless been adopted at just two United States lockups, including Maine’s Somerset County Jail (SCJ), where Sheriff Dale P. Lancaster implemented a switch from daily buprenorphine pills to monthly Sublocade injections in September 2022.

Prisoners and detainees receiving opioid addiction treatment at most U.S. lockups struggle to maintain it after release; on average, just 23% succeed. For those leaving SCJ, that number has skyrocketed to 67%, and by the end of the program’s first year in September 2023, none of the participants had died from overdoses. Meanwhile, at four other nearby jails, several people overdosed or committed suicide within months of release.

Those jails were used as a comparison group in a study of SCJ’s Sublocade program, which found that people released from the jail were three times more likely to continue treatment, as the longer-lasting treatment bought them time to establish a relationship with a physician and obtain necessary insurance or Medicaid coverage to pay for medication. Greg Ellis, a physician’s assistant at SCJ, noted an added advantage: the injection has no “black market value,” unlike other forms of buprenorphine—especially Suboxone strips, which Indivior also manufactures.

The study’s findings suggest that longer-lasting treatment may provide a crucial buffer against relapse. However, the injections require special certification to administer and space in refrigerators for storage, adding operational challenges to their use. Another barrier is that some patients themselves are hesitant to switch from a familiar daily pill routine, fearing inadequate craving management or injection discomfort. Yet detainees and prisoners held at jails near SCJ have requested the shots—or even a transfer to get them—once they hear about them.

Brown University addiction expert Dr. Josiah Rich called the initiative a vital step in combating the cycle of addiction and relapse often seen among the incarcerated. President Joe Biden’s outgoing administration also made a change allowing states to seek Medicaid waivers for addiction treatment in jails to support the effort.

At $2,000 per injection, the cost of Sublocade is likely the most significant barrier to its use. SCJ’s program relies on grants and funds from opioid litigation settlements, such as an $86 million agreement that Indivior signed in July 2024 with 16 states. Indivior was accused of running a “pill mill” scheme, using shady doctors to dump millions of Suboxone strips into the U.S.—including a huge share smuggled into prisons and jails.

In December 2024, Indivior was forced to accept board members from stockholder Oak Tree Capital Management, a concession exacted by the hedge fund for the plunge in the firm’s share price that accompanied its opioid settlement.  

Sources: New York Times, WCSH

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