 No commercial support was provided for the creation of this video project. Funding was made possible through grants from the Bureau of Addiction Services at the Massachusetts Department of Public Health. Additional funding for this initiative was made possible in part by a grant from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services. Nor a dispension of trade names, commercial practices, or organizations imply endorsement by the U.S. government. Hi, my name is Justin Alves and I'm a nurse with the Boston Medical Center OBAT TTA Training Program. I'm here today to talk about Injectable Buprenorphine. Currently, the only commercially available form of Injectable Buprenorphine is sublocate. It's a once-monthly abdominal subcutaneous injection of buprenorphine that comes in two doses, 300 milligrams and 100 milligrams. It's FDA approved for use in patients with moderate to severe opioid use disorder who have already initiated treatment with at least seven days of a transmucosal buprenorphine product. Injectable buprenorphine formulations should only ever be prepared and administered by a healthcare provider. Patients should never handle this medication because there's a risk of serious harm or death with intravenous administration of the medication. This is because the medication forms a semi-solid mass on contact with body fluids and could cause occlusion or serious thromboembolitic event like pulmonary emboli if administered incorrectly or into a site besides the subcutaneous tissue. So now we'll do a quick demonstration of how to actually administer and manage the medication in your clinic. With another healthcare provider, document the need to administer the medication in the locked medication room. Prior to the removal of the medication from the locked refrigerator, a daily inventory should be taken by two healthcare providers and documented on their narcotics log. It is best to keep track of the medication expiration dates if possible to avoid storing expired medication. Once the medication has been removed from refrigeration, it should stay out for at least 15 minutes prior to administration to allow it to come to room temperature. Do not remove the medication from the foil pouch or assemble the medication until it is ready for administration. Good morning, Mr. Smith. My name is Melanie. How are you today? Good. How are you doing? Good. Hello. My name is Jeanette. I'm one of the nurses here in the clinic and I'll be administering your injection today, okay? Okay. All right. First, can you verify your first and last name in your date of birth for these? John Smith, 11, 12, 1970. Thank you. Okay. Mr. Smith, Jeanette will be handling and administering your injection today, okay? Any questions? Feel free to ask her, okay? Have a good day. Patients have reported that the injection burns and should be warned about this patient's condition. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. I'm sorry. Have reported that the injection burns and should be warned about this potential pain with the injection. When administering injectable buprenorphine, it is important to remember the five rights of medication administration. Always confirm with another nurse that this is the right patient, the right drug, the right dose, the right route, and the right day and time. Wash your hands prior to administration. Check for any contaminants or particulate matter in the syringe. The medication can range from yellow to clear to dark amber. Attach the safety needle provided in the package to the end of the syringe. Do not substitute any other needles in lieu of the one provided. Gather your supplies and have the patient supine on the exam table. Prepare the injection site with an alcohol swab. Remove the needle cover and advance the plunger to push out any excess air from the syringe. Pinch the injection site. Lift an adipose tissue from the underlying muscle to prevent accidental intramuscular injection. With the bevel facing upwards at a 45-degree angle, insert the needle fully into the abdominal subcutaneous tissue. Use a slow, steady push until all the medication has been injected into the tissue and the syringe is empty. Do not rub the injection area. If there is bleeding after the injection, use minimal pressure with gauze to stop the bleeding. Lock the needle guard by pushing the safety on a flat surface and disposing it into a sharps container. Educate the patient that there will be a lump at the injection site that will decrease over time. Advise the patient not to rub or massage the injection site. Document the injection site along with the lot number and expiration date of the medication. Remember to rotate injection sites to avoid irritating just one quadrant. Pro tip. For the two loading doses of 300 mg injecting into the lower quadrants of the abdomen has been reported to decrease pain during the injection. Some healthcare professionals have applied ice to the injection area beforehand or topical lidocaine. But there is not yet significant evidence to prove the effectiveness of these practices in decreasing pain during the injection. If the medication is removed from the refrigerator and not administered and the box is unopened, there are two options. Leave the medication in a twice locked area at room temperature and administer to the appropriate patient within seven days of removing it from the refrigerator. Or return the medication to the refrigerator but mark the medication box to indicate that it has already had an excursion or a removal from refrigeration until the medication can be used or until their expiration date on the box. Important note. The medication can only have one excursion before it should be discarded and returned to the REMS pharmacy per your facility policy and procedures. Pro tip. Have a follow-up appointment scheduled for the patient's next injection before they leave the office and provide this information to the patient during the visit. Ensure the patient with emergency contact information on who to call should they have a problem with the injection site or depot. Ensuring the patient has the right phone number of who to call can alleviate any concerns about reaching the team should they need them. Special thanks to our OBAC clinic nurses, Jeanette McKinnon and Melanie Daley for their time and effort in creating this project. ORN, or the Opioid Response Network, is a funded initiative by SAMHSA to facilitate free access to training and practical support to states and territories focusing on evidence-based practices, prevention, and recovery. Additional training opportunities can be found through the Opioid Response Network website or by emailing orn at aap.org or by calling 401-270-5900. Other additional educational opportunities related to addiction nursing and the nurse care manager model can be found at our website, bmcobat.org.