Important notice: This clinical guide is an educational resource originally developed as a reference for our patients. It does not replace professional medical advice, diagnosis, or treatment. You must strictly adhere to the treatment plans and instructions provided by your own healthcare provider. Please consult your personal clinical team for any individual treatment decisions or guidance.

Long-Acting Buprenorphine Injections: Sublocade® and Brixadi® Guide

Medically Reviewed by: Dr. Olusola Olowe, MD, Board-Certified - Addiction Medicine

Last Updated: March 3, 2026

For many in recovery, the daily ritual of taking a Suboxone film or tablet is a constant reminder of their struggle with opioids. Long-acting buprenorphine injections—often referred to as "The Shot"—offer a revolutionary alternative: a once-monthly or once-weekly dose that provides a steady, level amount of medication in your system 24/7.

At Better Life MD, we specialize in transitioning patients from daily films to these advanced injectable options, including Sublocade® and Brixadi®.

What is the Buprenorphine Injection?

Unlike daily Suboxone, which is absorbed through the lining of the mouth, these injections are administered subcutaneously (just under the skin of your abdomen, arm, or thigh) by a healthcare professional. Once injected, the medication slowly and continuously releases into your bloodstream over several days or weeks [1, 2].

Sublocade® (Monthly)

Sublocade is a monthly injection that forms a solid "depot" under the skin. Over the course of the month, the depot gradually dissolves, releasing a consistent dose of buprenorphine.

• Best For: Patients stable on a daily dose of 8mg to 24mg of transmucosal buprenorphine (Suboxone) for at least seven days.

• Dosing: Treatment usually starts with two monthly 300mg "loading doses," followed by a 100mg maintenance dose [1].

Brixadi® (Weekly or Monthly)

Brixadi is a newer FDA-approved injectable that utilizes a different delivery system (FluidCrystal technology). It offers more flexible dosing and does not always require the 7-day lead-in on oral films.

• Best For: Patients who need weekly adjustments, patients transitioning directly from other opioids, or those stabilized on lower doses of buprenorphine.

• Comfort & Storage: Brixadi uses a significantly smaller needle and lower injection volume than Sublocade, which many patients find much more comfortable. It also does not require refrigeration [2].

Key Advantages of "The Shot"

1. Superior Dental Safety

In 2022, the FDA issued a warning that daily buprenorphine films and tablets can cause severe dental decay and tooth loss due to their acidity [3]. Because the injection bypasses the mouth entirely and is absorbed through the skin, it eliminates the direct contact between the medication and your teeth, drastically reducing your risk of chemical dental damage.

2. Eliminating the "Peaks and Valleys"

Daily films cause "peaks and valleys" in your blood levels—you feel the dose "kick in" and then slowly wear off by the evening. Injections provide a flat, steady state. Many patients report that this makes them feel completely "normal" and finally breaks the psychological habit of taking a daily substance to feel better [4].

3. Freedom from Daily Dosing

• No "Forgetfulness": No more worrying about missing a dose, losing a prescription, or having your medication stolen.

• Travel-Friendly: You are free to travel without the hassle of carrying controlled substances or navigating pharmacy shortages.

• Smoother Taper: Because the injectable medication leaves the body so incredibly slowly (often over the course of 6 to 12 months after your last shot), it provides a "natural taper." Patients who eventually choose to stop treatment often report experiencing little to no withdrawal symptoms [4, 5].

Important Clinical Realities

Supplemental Films (Suboxone) It is important to know that during the first month or two of the transition, some patients may still need to take supplemental Suboxone films. As your body adjusts to the "steady state" of the injection, you may experience minor "breakthrough" cravings or mild discomfort. This is normal. At Better Life MD, we can provide a small bridge prescription of films to ensure you remain totally stable while the injection reaches its full therapeutic level in your system [4, 5].

Potential Side Effects While generally well-tolerated, buprenorphine injections can cause side effects similar to other buprenorphine products:

• Injection Site Reactions: Redness, itching, or a small, temporary lump under the skin (the "depot," which is common and expected with Sublocade).

• Pain: The injection itself can be uncomfortable. Many patients report that Sublocade stings or burns during administration. Brixadi is often reported as less painful due to the smaller volume [1, 2].

• Systemic Effects: Constipation, headache, nausea, or tiredness.

• Serious Risks: As with all opioids, there is a risk of respiratory depression if improperly combined with alcohol or benzodiazepines.

What to Expect During Your Appointment

1. Consultation: We review your current dose and check your insurance. (All Indiana Medicaid plans cover the shot).

2. Pharmacy Coordination: We handle the "Prior Authorization" paperwork so the medication is shipped directly from a specialty pharmacy to our clinical site. You never have to pick it up yourself.

3. The Injection: You visit our Portage, IN location for the administration of the injection by our medical staff.

4. Support: We monitor your progress closely and manage any supplemental film needs during your first month.

Frequently Asked Questions

Q: If the shot bypasses my mouth, is my dental health safer? Yes, regarding direct chemical exposure. Unlike films that stay in contact with your teeth, the injection has zero direct contact with your enamel. This eliminates the chemical tooth decay associated with sublingual buprenorphine. However, all opioids can cause dry mouth, so you should still maintain standard daily brushing and routine dental check-ups [3].

Q: Will I feel "sick" or go into withdrawal when the shot starts to wear off at the end of the month? This is not expected. Because the medication depot dissolves so slowly and stays in your system for so long, you will not feel a "crash" at the end of the month. Most patients feel exactly the same on Day 28 as they did on Day 5 [1, 4].

Q: Can I get the shot if I'm on a very low dose of Suboxone? Yes. While Sublocade requires a higher daily dose to start, Brixadi offers specific low-dose weekly and monthly options designed exactly for patients who are tapering down or do not require high-potency loading doses [2].

Q: Can I still get the shot if I have an active fentanyl or Tranq addiction? If you are actively using, you must first transition onto daily Suboxone films to stabilize your brain receptors before receiving a monthly injection. We will assess your specific situation during your consultation and build a safe induction plan [4, 5].

Q: Does the injection leave a permanent lump? No. Sublocade forms a small lump (depot) under the skin, which is how the medication is slowly released. This lump will gradually shrink and disappear completely as your body absorbs the medication [1].

Medical References & Citations

1. FDA (2025).SUBLOCADE® (buprenorphine extended-release) injection prescribing information. U.S. Food and Drug Administration. Link

2. FDA (2023).BRIXADI™ (buprenorphine extended-release) injection prescribing information. U.S. Food and Drug Administration. Link

3. FDA (2022).Drug Safety Communication: FDA warns about dental problems with buprenorphine medicines dissolved in the mouth. U.S. Food and Drug Administration. Link

4. ASAM (2020).National Practice Guideline for the Treatment of Opioid Use Disorder. American Society of Addiction Medicine. Link

5. SAMHSA (2021).Treatment Improvement Protocol (TIP) 63: Medications for Opioid Use Disorder. Substance Abuse and Mental Health Services Administration. Link