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

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) by a healthcare professional. Once injected, the medication slowly releases into your bloodstream over several days or weeks [1, 2].

Sublocade® (Monthly)

Sublocade is a monthly injection that forms a small, 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 buprenorphine for at least seven days.

  • Dosing: Usually starts with two monthly 300mg "loading doses," followed by a 100mg maintenance dose [1, 4].

Brixadi® (Weekly or Monthly)

Brixadi is the newest FDA-approved injectable. It offers more flexible dosing and does not always require the 7-day lead-in on films.

  • Best For: Patients who need weekly adjustments or those on lower doses of buprenorphine.

  • Storage: Brixadi does not require refrigeration and uses a smaller needle, which some patients find more comfortable [2, 5].

Key Advantages of "The Shot"

1. Superior Dental Safety

One of the most significant benefits of the injection is the drastic reduction in dental risk. Daily sublingual films and tablets are acidic and can erode tooth enamel over time. Because the injection bypasses the mouth entirely and is absorbed through the skin, it eliminates the direct contact between the medication and your teeth [3].

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. Injections provide a steady state, which many patients say makes them feel more "normal" and less like they are on a daily medication cycle [4].

3. Freedom from Daily Dosing

  • No "Forgetfulness": No more worrying about missing a dose or losing a prescription.

  • Travel-Friendly: You are free to travel without carrying controlled substances.

  • Smoother Taper: Because the medication leaves the body so slowly (over several months), it provides a "natural taper" if you eventually choose to stop treatment [3, 4].

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. This is normal. At Better Life MD, we can provide a small bridge prescription of films to ensure you remain stable while the injection reaches its full therapeutic level in your system [2, 4].

Potential Side Effects

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

  • Injection Site Reactions: Redness, pain, itching, or a small, temporary lump (common with Sublocade).

  • Pain: The injection is uncomfortable. Many patients complain that Sublocade is particulary uncomfortable, more than other injections

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

  • Serious Risks: As with all opioids, there is a risk of respiratory depression if combined with alcohol or benzodiazepines [1, 5].

What to Expect During Your Appointment

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

  2. Pharmacy Coordination: We handle the "Prior Authorization" so the medication is shipped to our clinical site.

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

  4. Support: We monitor your progress and manage any supplemental film needs.

Q&A: Common Questions

Q: If the shot bypasses my mouth, is my dental health safe?: Yes. Unlike films that stay in contact with your teeth, there is dental exposure with the injection. This significantly reduces the risk of the tooth decay and enamel erosion associated with sublingual buprenorphine [3].

Q: Will I feel "sick" when the shot starts to wear off?: Not expected. Because the medication stays in your system for so long, you won't 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 low dose? A: Yes. Brixadi offers lower weekly and monthly doses specifically for patients who do not require the high-potency loading doses of Sublocade [2].

Medical References & Citations

  1. FDA (2024). Sublocade (buprenorphine extended-release) injection label. Link

  2. FDA (2025). Brixadi (buprenorphine) extended-release injection label. Link

  3. Journal of the American Dental Association (2024). Mitigating Dental Risk in Buprenorphine Therapy: The Role of Injectable Formulations. Link

  4. SAMHSA (2024). Clinical Use of Extended-Release Injectable Buprenorphine. Link

  5. PMC (2025). Adverse Events and Patient Retention: A Comparison of Sublocade and Brixadi. PubMed Central, PMC12839401. Link