Brixadi vs Sublocade: Which Buprenorphine Injection, and What Changed
Last updated
Both are extended-release buprenorphine injected under the skin by a clinician, both treat opioid use disorder, and neither contains naloxone. Brixadi comes in a weekly form and a monthly form, is stored at room temperature and can be injected in the buttock, thigh, abdomen or upper arm. Sublocade is monthly only, has to be kept refrigerated until shortly before the appointment, and since February 2025 can also be injected in four sites rather than the abdomen alone. That same 2025 revision removed the rule most comparisons still quote, that you must be stabilised on Suboxone for at least seven days first; the current label asks only for a single transmucosal dose before the first injection. No trial has compared the two products against each other, so the honest difference is practical: how often you want to come in, what your clinic can store, and how long a decision you are comfortable making.
The short version
- Injection interval: 7 or 28 days vs 28 days — Brixadi is the only one with a weekly option
- Apparent half-life: 3–5 d / 19–26 d vs 43–60 d — from each FDA label: the depot, not the liver, sets this
- Injection sites: 4 vs 4 — Sublocade went from 1 to 4 in February 2025
- Storage: Shelf vs Fridge — decides which clinics and mobile units can carry it
Side by side
Dosing interval
- Brixadi
- Weekly or monthly: two separate formulations
- Sublocade
- Monthly only, at least 26 days apart
Before the first injection
- Brixadi
- A 4 mg transmucosal test dose when mild withdrawal appears
- Sublocade
- A single transmucosal dose (was 7 days of stabilisation until Feb 2025)
Injection sites
- Brixadi
- Buttock, thigh, abdomen, upper arm
- Sublocade
- Abdomen, thigh, buttock, back of upper arm (abdomen only until Feb 2025)
Storage
- Brixadi
- Room temperature, 20–25 °C
- Sublocade
- Refrigerated 2–8 °C; up to 12 weeks at room temperature, then discard
Doses available
- Brixadi
- Weekly 8, 16, 24, 32 mg · monthly 64, 96, 128, 160 mg
- Sublocade
- 300 mg and 100 mg
Standard schedule
- Brixadi
- Titrated to the individual, weekly or monthly
- Sublocade
- Two 300 mg doses, then 100 mg monthly (300 mg if needed)
Missed dose allowance
- Brixadi
- Weekly ±2 days; monthly ±1 week
- Sublocade
- Delays up to 2 weeks not expected to matter clinically
Apparent half-life
- Brixadi
- Weekly 3–5 days · monthly 19–26 days
- Sublocade
- 43–60 days
Who can give it
- Brixadi
- Certified healthcare setting, REMS programme
- Sublocade
- Certified healthcare setting, REMS programme
Contains naloxone
- Brixadi
- No
- Sublocade
- No
Approved in the US
- Brixadi
- 2023
- Sublocade
- 2017
Generic available
- Brixadi
- No
- Sublocade
- No
In numbers
Injection interval
7 or 28 daysvs28 days
Brixadi is the only one with a weekly option
Apparent half-life
3–5 d / 19–26 dvs43–60 d
from each FDA label: the depot, not the liver, sets this
Injection sites
4vs4
Sublocade went from 1 to 4 in February 2025
Storage
ShelfvsFridge
decides which clinics and mobile units can carry it
Brixadi makes sense when
- You want to try a long-acting injection without committing to a month at a time: the weekly form is the only way to do that
- You are starting from active opioid use and the clinic wants the shortest possible bridge from a test dose to the injection
- The service is a mobile unit, an emergency department or a rural clinic with no reliable refrigeration
- You need dose changes at short intervals while things are still settling
- You would rather not have a depot in your abdomen, and want the buttock or arm instead
Sublocade makes sense when
- Monthly suits you and you would rather come in twelve times a year than fifty-two
- You are already stable on the film or tablet and want to stop thinking about a daily dose
- Your clinic stocks it, bills it under the medical benefit and has been doing so since 2017: the longer track record is on this side
- You want the longest gap between appointments that any buprenorphine product offers
- A missed appointment by a week or so should not derail treatment
How far the injection is from the average clinic, from the federal directory
Our analysisPeople ask which injection is better long before they find out whether either is available near them. Nobody publishes that as a proportion, so we counted what the SAMHSA treatment locator reports: 10,233 facilities after deduplication by name, street and ZIP.
- 59.2%
- offer buprenorphine in some form
- the film or tablet: a depot injection needs certification, stock and storage on top of this
- 12.8%
- are certified opioid treatment programmes
- the regulated clinics, and the setting where an injection is most often available
- 13.7%
- offer methadone
- for scale: the medication people assume is everywhere is the scarcest of the three
How we got this: we pulled the full public listing from SAMHSA’s FindTreatment.gov on , removed duplicate entries by name, street and ZIP, and counted how many of the 10,233 remaining facilities report each service. SAMHSA publishes the directory; it does not publish these proportions — see how the count is made. Repeat the pull and you will get the same numbers, give or take facilities that opened or closed since.
What these numbers cannot tell you: they are self-reported by facilities, they describe availability rather than quality, and a national proportion says nothing about what is open near you this week. Use them to know what to ask for, not to decide where to go.
What changed in February 2025, and why most comparisons are out of date
Almost every page comparing these two injections repeats a rule that no longer exists. It is worth starting here, because it was the single biggest practical difference between them and it is now gone.
The old rule: seven days on the film first
Until early 2025, Sublocade was indicated for people "who have initiated treatment with a buprenorphine-containing product, followed by dose adjustment for a minimum of 7 days". In practice that meant a week of daily Suboxone or a generic film before the first injection, which is a week in which a lot of people disappear. Brixadi, approved in 2023, never had that requirement: its label describes a 4 mg transmucosal test dose given when objective signs of mild to moderate withdrawal appear, followed by the first injection the same day.
The current rule: one dose
The label in force now indicates Sublocade for patients "who have initiated treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine", and the dosing section says people not currently taking buprenorphine "should receive an initial dose (e.g. 4 mg) of transmucosal buprenorphine before administering the first injection". The recent-major-changes note on the label dates that revision to 02/2025. The seven-day wait is not in the document any more.
Two other things the same revision changed
The instruction "FOR ABDOMINAL SUBCUTANEOUS INJECTION ONLY" became "the abdomen, thigh, buttock, or back of the upper arm", so Sublocade now has the same four sites Brixadi has. And the second injection may now be given as early as one week after the first, rather than a month. Both changes narrow the gap that made Brixadi distinctive on paper.
How to check this yourself in two minutes
Open the current prescribing information for each product on DailyMed, which publishes the FDA label as the manufacturer files it, and read section 1 and section 2.3. Then open the archived version of the same page from 2024 in the Internet Archive. The wording above is quoted from exactly those two documents. We mention the method rather than asking you to take our word for it, because this is a page saying that better-known pages are wrong.
What each product actually is
Both are buprenorphine: the same partial opioid agonist that is in Suboxone — formulated so that one injection releases it slowly for a week or a month. Neither contains naloxone, because the naloxone in a film is there to discourage injecting a tablet, and a depot given by a clinician has no such problem.
Brixadi
Made by Braeburn, approved in the US in May 2023, known in trials as CAM2038 and sold in Europe and Australia as Buvidal. It comes as a prefilled syringe in a weekly form (8, 16, 24 and 32 mg) and a separate monthly form (64, 96, 128 and 160 mg). The two are not interchangeable: the label states plainly that weekly doses cannot be combined to make a monthly dose. On injection it turns from a liquid into a gel that encapsulates the drug and releases it as the gel biodegrades.
Sublocade
Made by Indivior, approved in November 2017 as the first extended-release buprenorphine injection, known in trials as RBP-6000 or BUP-XR. It comes in 300 mg and 100 mg prefilled syringes. On injection the polymer precipitates into a solid depot that can be felt as a bump under the skin for several weeks, and the drug is released as the depot breaks down. Six years of use in the US means most clinics with experience of a buprenorphine injection have that experience with this one.
What neither of them is
Neither is Vivitrol. Vivitrol is naltrexone, an opioid antagonist: the opposite pharmacology, requiring 7 to 10 opioid-free days before the first dose. Our comparison of Vivitrol and Suboxone covers that distinction. Neither is Subutex, which is buprenorphine alone as a daily tablet. And neither is approved for pain: Butrans and Belbuca are the buprenorphine products for pain, while these two are indicated for moderate to severe opioid use disorder.
Starting: what each label asks for now
This is the part that decides whether you can begin today or have to come back, and it is where the two products are now closer than their reputations suggest.
Starting Brixadi from active opioid use
The label describes giving a 4 mg transmucosal buprenorphine test dose when objective signs of mild to moderate withdrawal appear. If that dose is tolerated without precipitated withdrawal, the first injection of 16 mg weekly follows, with a further 8 mg within three days to reach the recommended 24 mg weekly dose. A further 8 mg may be given in that first week, at least 24 hours after the previous injection, to a maximum of 32 mg weekly.
Starting Sublocade from active opioid use
A single transmucosal dose, for example 4 mg, then the first 300 mg injection, with monitoring in the healthcare setting afterwards for worsening withdrawal or sedation; the label says symptoms should be stable or improving before you leave. Up to 8 mg more of transmucosal buprenorphine may be given on induction day to manage symptoms. The second 300 mg injection can come as early as one week later.
Switching from the daily film or tablet
People already taking 8 to 24 mg a day of transmucosal buprenorphine can move directly to 300 mg of Sublocade. For Brixadi, the label sets out a conversion from the established daily dose to the corresponding weekly or monthly dose. Either way the daily medication stops when the injection starts — you do not take both on an ongoing basis, though a prescriber may use a short overlap or supplemental doses while things settle.
Switching from methadone
Harder, and not a home project. Methadone is a full agonist with a long half-life, so moving to any buprenorphine product risks precipitated withdrawal, and the taper and timing are set by the clinic. Our comparison of Suboxone and methadone covers why that transition is the difficult direction and the reverse is not.
Precipitated withdrawal, and why the test dose exists
Buprenorphine binds tightly and only partially activates the receptor, so given while a full agonist is still attached it displaces that drug and can bring on sudden, severe withdrawal. The transmucosal test dose is a small, reversible probe for exactly that: if it is tolerated, the long-acting injection, which cannot be taken back — is safe to give. In an emergency-department study of the weekly formulation in 100 patients with minimal to mild withdrawal, 7% met the definition of precipitated withdrawal within four hours, and the risk was concentrated in those with the lowest withdrawal scores at the time of injection: 13.5% of those scoring 0 to 3 on the Clinical Opiate Withdrawal Scale against 3.2% of those scoring 4 to 7.
The injection itself
People ask what it feels like more often than they ask about pharmacology, and the labels answer more of it than you would expect.
Where it goes
Both are subcutaneous — into the fat layer, not the muscle and never the vein. Brixadi: buttock, thigh, abdomen or upper arm, with sites rotated for the weekly form. Sublocade: abdomen, thigh, buttock or back of the upper arm, rotated between doses. One detail worth knowing is in the Brixadi label: injection in the arm produced roughly 10% lower plasma levels than other sites, which is a reason to keep to the same kind of site rather than alternating between arm and abdomen at random.
Does it hurt, and what is the bump
In the emergency-department study of the weekly injection, the median pain score immediately after injection was 2 out of 10, and 0 after four hours. What lasts longer is the depot: with Sublocade in particular it can be seen or felt as a lump at the site for several weeks, shrinking over time. The label is explicit that you should not rub or massage it and should not try to remove it. A lump that is getting larger, hot, red or painful rather than smaller is a reason to call the clinic, that is infection, not the normal depot.
What the appointment looks like
A clinician prepares and gives the injection; neither product is dispensed to you to take home, and that restriction is the point of the REMS programme rather than an inconvenience. Sublocade has to come out of the fridge at least 15 minutes beforehand. Expect a short observation period, particularly on the first injection. Bring your medication list and, if you are switching, the dose you are currently taking.
A safety point that is not a formality
Both carry a boxed warning that intravenous administration can cause occlusion, tissue damage and pulmonary embolism, including fatal ones. This is why both are restricted programmes and why neither is handed over as a prescription. The Brixadi needle cap also contains natural rubber latex, which matters if you have a latex allergy.
Doses, strengths and how flexible each one is
This is the difference that survives the 2025 label change, and for some people it is the deciding one.
Brixadi: eight strengths across two schedules
Weekly 8, 16, 24 and 32 mg; monthly 64, 96, 128 and 160 mg. Dose adjustments can be made at weekly appointments while on the weekly form, with 32 mg the weekly maximum. The practical meaning is that the dose can be tuned in smaller steps and more often — useful early on, when nobody yet knows what will hold.
Sublocade: two strengths, one schedule
Two initial doses of 300 mg, then 100 mg monthly maintenance, with 300 mg monthly considered where the benefits outweigh the risks. That is the whole ladder. It is simple, and it is less adjustable; if 100 mg does not hold and 300 mg is more than needed, there is nothing in between.
Equivalence to the daily film
The conversions in each label are from a stable daily transmucosal dose to a starting injection dose, and they are not a milligram-for-milligram exchange rate — blood levels from a depot behave differently from a daily peak and trough. Asking "how many milligrams of Suboxone is 100 mg of Sublocade" does not have a clean answer, which is why the labels give conversion tables rather than a formula.
Missing or delaying a dose
Life interferes with appointments, and the two products tolerate that differently: this is a genuine, checkable difference rather than a marketing one.
Brixadi
To avoid missed doses, the weekly dose may be given up to two days before or after the weekly point, and the monthly dose up to a week either side. If a dose is missed, the next one should be given as soon as practically possible.
Sublocade
A missed maintenance dose should be given as soon as possible, with the following dose at least 26 days later. The label adds that occasional delays of up to two weeks are not expected to have a clinically significant effect, which follows from a half-life measured in weeks rather than days.
What a gap actually feels like
Because both release slowly, a late appointment does not produce the abrupt withdrawal that missing a daily dose can. That is the advantage of a depot and also its trap: it is easy to let a gap grow because nothing bad happens immediately, and the protection fades at the far end of it.
How long each stays in your system
This matters for drug tests, for stopping, and for the overdose-risk window afterwards, and the two products are far apart here.
The published half-lives
Brixadi: an apparent terminal half-life of 3 to 5 days for the weekly formulation and 19 to 26 days for the monthly, both because of slow release from the depot rather than slow metabolism. Sublocade: 43 to 60 days. For context, the daily film is 24 to 42 hours.
Detection on a drug test
Buprenorphine does not show on a standard opiate screen; it needs a specific buprenorphine assay, which the federal and DOT panels do not include. After Sublocade, the label states that patients who stop after reaching steady state: four to six months — may have detectable plasma and urine levels for twelve months or longer. Our guide to how long Suboxone stays in your system covers the testing side in full, including what a positive result with a prescription means.
What happens after the last injection
Model simulations in the Sublocade label show plasma concentrations remaining at therapeutic levels for two to five months after the last injection, depending on dose. Withdrawal after stopping a depot therefore starts late and builds slowly rather than arriving the next morning, and the label asks prescribers to monitor for several months. The same long tail means the protection against other opioids fades gradually, which is exactly the period in which tolerance falls and overdose risk rises.
Can the depot be removed?
The Sublocade label has a section on removal of the depot, which is done surgically under local anaesthetic within a limited window after injection; it is a real option and not a routine one. It exists for situations like a serious adverse reaction, and a case report in the addiction-medicine literature describes surgical excision after an unintentional injection into the skin rather than the fat layer. Asking to reverse a depot is not a simple request, and that is a fair thing to weigh before choosing a monthly product over a weekly one.
Storage and logistics: the difference nobody markets
On paper this is a footnote. In practice it decides which service can offer you which product, and therefore what you are actually choosing between.
Sublocade needs a fridge
Store refrigerated at 2 to 8 °C. It may be kept in its original packaging at room temperature for up to 12 weeks before administration and must be discarded after that, and it needs at least 15 minutes out of the fridge before the injection.
Brixadi does not
Store at 20 to 25 °C, ordinary controlled room temperature. For a street-medicine team, a mobile unit, a rural clinic or an emergency department that gives a handful of injections a month, that is the difference between stocking it and not stocking it.
Why this shapes the real choice
Both products are restricted to certified settings under their own REMS programmes, and a clinic typically stocks one rather than both. So the question "which is better for me" is usually preceded by "which one does this service have". It is a fair question to ask on the phone before the first appointment, and it saves a wasted visit.
Getting it: who provides it and how to find them
Neither product is something you collect from a pharmacy counter. Both are given in a certified healthcare setting, which changes how you go about finding one.
Where to start
The federal treatment locator at FindTreatment.gov lists licensed programmes and what each one offers, and SAMHSA's opioid treatment programme directory lists the regulated clinics specifically. The national helpline will route you to services in your area at any hour, free and confidentially. Ask three things when you call a clinic: whether they are certified to give the injection, which of the two they stock, and what happens at the first appointment if you are still using.
Telehealth and the first injection
An assessment and the prescription may happen remotely in many places, but the injection itself cannot — someone has to give it in person in a certified setting. That is a fixed constraint of both products rather than a local policy.
Why it is offered in fewer places than the film
Buprenorphine in some form is reported by 59.2% of the US treatment facilities in our count of the federal directory, and regulated opioid treatment programmes by 12.8%. A depot injection needs certification, stock, storage and a billing route on top of that, so the subset of places offering it is smaller again. If the injection is what you want and the nearest clinic does not have it, the next question is whether starting on the film locally beats travelling for an injection — usually it does, because the medication matters more than the format.
Side effects and what to watch
The side-effect profile is buprenorphine's, with the injection adding its own local effects. Nothing here is a substitute for the medication guide you will be handed.
The common ones
Constipation, nausea and vomiting, headache, sweating, sleep problems, fatigue and injection-site reactions such as pain, itching or redness. Constipation is the one people most often underestimate and the one most easily managed if raised early. Diarrhoea is more often a sign of under-dosing or withdrawal than of the medication itself.
The ones worth reporting quickly
An injection site that becomes hot, swollen or increasingly painful rather than settling; yellowing of the skin or eyes, dark urine or right-sided abdominal pain, which can signal liver problems the labels ask prescribers to monitor; and any severe sedation, particularly if you are also taking benzodiazepines, alcohol or other sedatives. That combination is the main way buprenorphine contributes to respiratory depression.
Weight, mood and sexual side effects
Weight change, low mood and reduced libido are reported with buprenorphine generally and come up often in searches about the injections. Long-term opioid treatment of any kind can lower testosterone, and this is a reasonable thing to raise with a prescriber rather than to endure silently; it is not a reason on its own to stop a medication that is working.
Does it get you high, and does it block other opioids
Buprenorphine has a ceiling on its opioid effect, so at treatment doses in someone with tolerance it relieves withdrawal and craving without producing a high. Both depots maintain concentrations intended to blunt the effect of other opioids across the dosing interval, that is the blockade people ask about. It is not absolute: enough of a potent opioid, particularly illicitly manufactured fentanyl, can overcome it, and the risk of doing so is greatest as the depot wanes. Naloxone at home is a reasonable precaution for anyone on either product, and both labels tell prescribers to consider providing it.
What the trials actually show
Here is the part that most comparison pages state as though it were settled. It is not, and knowing exactly what was tested is more useful than a verdict.
There is no head-to-head trial
Brixadi and Sublocade have never been compared against each other in a randomised trial. Every claim that one is more effective than the other is an inference across separate studies with different designs, comparators and populations, which is precisely the kind of comparison that does not survive scrutiny.
What Brixadi was tested against
A double-blind, double-dummy randomised trial at 35 US sites, published in JAMA Internal Medicine in 2018, compared weekly then monthly depot buprenorphine with daily sublingual buprenorphine-naloxone in 428 adults. The response rate was 17.4% on the depot against 14.4% on the daily film, a 3.0% difference, and the proportion of opioid-negative urine samples was 35.1% against 28.4%. Both met the pre-set non-inferiority margins, and the depot was statistically superior on the cumulative distribution of no illicit opioid use. A separate 48-week open-label safety study in 227 people reported treatment-emergent adverse events in 63.0%, most of them mild, with 73.6% completing the treatment period.
What Sublocade was tested against
A randomised, double-blind, placebo-controlled phase 3 trial at 36 US centres, published in the Lancet in 2019, compared two monthly dosing regimens with placebo injections after a run-in of up to two weeks on the sublingual film. Being placebo-controlled makes it a strong test of the product against nothing, and no test at all of the product against the daily film.
What that leaves you with
Good evidence that extended-release buprenorphine works, no evidence that either brand beats the other, and a cost-effectiveness analysis in JAMA Network Open in 2023 that put the practical tension plainly: at the time of that model, the extended-release form cost more and showed lower retention than transmucosal buprenorphine, while being valuable as an additional option. The decision is therefore about fit and access, not about a winner.
Cost, coverage and what "cheaper" means here
Both are expensive at list price, and almost nobody pays list price. The number that matters is what reaches you after the billing route is settled.
Why the pharmacy cannot just hand it over
Both are usually billed under the medical benefit: the clinic buys the product and bills for administering it — rather than the pharmacy benefit you use for a film. That is why a price comparison between the two brands is rarely something you can look up: what you owe depends on your plan's rules for an administered drug, not on a shelf price.
If you have insurance
Ask the plan two separate questions: whether the product is covered, and whether the administration is covered. Ask the clinic whether prior authorisation is needed and who submits it. Medicaid covers medication for opioid use disorder in every state, though which products are on the preferred list varies, and that list is often what decides which injection a clinic stocks.
If you do not
Both manufacturers run patient-assistance and bridge programmes, and clinics that offer the injections usually know how to navigate them. State-funded programmes and opioid treatment programmes are the other route, and the national helpline can point you at them. It is worth asking directly rather than assuming: "I cannot afford this" is a sentence that produces options in this particular corner of healthcare more often than people expect.
Injection versus the daily film
For many people the real question is not Brixadi or Sublocade but whether to move off a daily medication at all. The honest answer is that the format matters less than staying on treatment, and the format that helps you stay on treatment is the right one.
What the injection removes
A daily decision, a daily reminder of being a patient, the need to keep medication safe from children or from someone else in the house, the risk of losing it, and the practical difficulty of travelling with a controlled substance. In the emergency-department study, 67% of participants rated not requiring daily medication as extremely important and 62% said the same about privacy.
What the injection costs you
Flexibility. A dose that is too low cannot be topped up as easily, a dose that is too high cannot be reduced until it wears off, and side effects cannot be stopped by not taking tomorrow's dose. You also have to attend the appointment; the film can be picked up monthly, the injection has to be given.
Where each tends to fit
People who describe the daily dose as the thing keeping them tied to their addiction often do better once it is gone. People who are still finding their dose, or who value being able to adjust, usually do better on the film first and can switch later. The one bad answer is stopping medication altogether because neither format is ideal.
Pregnancy, breastfeeding and other situations
Buprenorphine is used in pregnancy and is one of the recommended treatments for opioid use disorder during it. The depots are a narrower question.
Pregnancy
Treatment for opioid use disorder should continue in pregnancy — untreated opioid use disorder carries clear risks to both. Data specifically on extended-release injections in pregnancy are limited compared with the transmucosal forms, which is why many prescribers use the film during pregnancy. Neonatal opioid withdrawal syndrome is an expected and treatable outcome of prolonged opioid use in pregnancy, including treatment, and both labels say so.
Liver and other medicines
Buprenorphine is cleared by the liver through CYP3A4, so medicines that inhibit or induce that enzyme change its levels, and impaired liver function raises exposure. Both labels ask for liver monitoring. Tell whoever gives the injection about every medicine you take, including gabapentin and anything sedating.
Driving and work
The labels caution against driving or operating machinery until you are reasonably certain the medication does not affect you, which mainly means the start of treatment and dose changes. Once stable, people drive and work. A depot injection is not detectable on a standard workplace panel, and if you are tested on a panel that includes buprenorphine, a prescription is a legitimate medical explanation.
What this page cannot tell you
No clinician has reviewed this page. Everything above is drawn from the two current FDA labels, their archived earlier versions, the published trials and our own count of the federal treatment directory, and every claim is traceable to one of the sources listed below. What it cannot do is choose for you: which product suits a particular person depends on their history, their other medicines, what their clinic stocks and what their coverage allows, and those are questions for the prescriber who would be giving the injection. If a page about these two medicines gives you a verdict without knowing any of that, it is selling something.
Where this sits in the system of care
Addiction treatment is organised into levels of care, and clinicians choose between them using the ASAM criteria (six dimensions covering withdrawal risk, medical and psychiatric conditions, readiness, relapse risk and, decisively, the environment you return to. Facilities are licensed by the state and many hold additional accreditation from bodies such as the Joint Commission or CARF; that status is worth confirming for any specific programme. Percentages below are our count of how many facilities in the federal directory report offering each level of care.
- Detox19.5% of facilitiesmedical withdrawal management, 3–7 daysDetox vs rehab
- Residential21.4% of facilitieslive on site, 24-hour staffingInpatient vs outpatient
- PHP20–30 structured hours a week, sleep at homePHP vs IOP
- IOP9–19 hours a week, usually compatible with workPHP vs IOP
- Standard outpatient85.4% of facilities1–8 hours a week, the maintenance levelMutual aid options
“Remaining in treatment for an adequate period of time is critical.”
Programmes for specific groups
Facilities also report dedicated programming, and the coverage is wider than most people expect, worth asking about before assuming a programme will not fit. From our count: 42.7% run programmes for adolescents, 39.2% for veterans, 38% for pregnant and postpartum women, and 25% provide services in Spanish. Medication for opioid use disorder is available at 59.2% (buprenorphine) and 13.7% (methadone).
Cost and coverage vary by level: residential care is the tier insurers scrutinise most and almost always requires prior authorisation before admission. See what your plan covers and how to pay without insurance. Family involvement is a standard part of most programmes, and aftercare planning ( step-down to a lower level, sober living, relapse prevention) should be discussed before admission, not at discharge. If a mental health condition is also present, ask specifically whether the programme is staffed for co-occurring disorders: 69.5% of facilities in the directory report treating them, but that is a self-reported field worth confirming.
Common questions
Are Brixadi and Sublocade the same thing?
They are the same active drug — buprenorphine — in two different extended-release injections made by different companies. Brixadi comes in a weekly and a monthly form with eight strengths, is stored at room temperature and was approved in the US in 2023. Sublocade is monthly only with two strengths, must be refrigerated, and was approved in 2017. Neither contains naloxone, and both are given by a clinician in a certified setting.
Which one is better?
No trial has compared them against each other, so there is no evidence-based answer, and anyone giving you one is giving you a preference. What differs in checkable ways: dosing interval, number of available strengths, storage, and how long the drug lingers after the last injection. The practical decider is usually which of the two your clinic stocks, so ask before the first appointment.
Do you still need to be on Suboxone for a week before Sublocade?
No. That requirement was in the label until the revision dated February 2025. The current label indicates Sublocade for people who have initiated treatment with a single dose of a transmucosal buprenorphine product or who are already on buprenorphine, and the dosing section describes an initial dose of about 4 mg before the first injection. Many pages online still describe the old seven-day rule.
How long does the Sublocade shot last?
It is given every 28 days at minimum, and the drug leaves far more slowly than that: the label reports an apparent half-life of 43 to 60 days, therapeutic plasma levels for two to five months after the last injection depending on dose, and detectable plasma and urine levels for twelve months or longer in people who stop after reaching steady state. Brixadi's monthly form has a 19 to 26 day half-life and the weekly form 3 to 5 days.
Can you switch between them?
Yes, and people do, usually because a clinic changes what it stocks or because a weekly rhythm turns out to suit someone better than a monthly one. The timing depends on how much drug is still in the depot, so it is planned by the prescriber rather than simply booked. Switching from Sublocade in particular has to account for a half-life measured in weeks.
Does the injection contain naloxone?
No, neither of them does. Naloxone is added to films and tablets to discourage crushing and injecting them; a depot given by a clinician in a certified setting cannot be misused that way, so there is nothing for it to do. Urine testing in treatment programmes sometimes measures naloxone precisely because its presence indicates a combination product rather than an injection.
What happens if I miss my injection?
Less than you might fear, and that is both the advantage and the trap. Brixadi allows two days either side of a weekly dose and a week either side of a monthly one. For Sublocade, a missed dose should be given as soon as possible with the next at least 26 days later, and the label says delays of up to two weeks are not expected to matter clinically. Because the drug fades slowly, a gap does not produce next-day withdrawal, which makes it easy to let the gap grow.
Can the depot be taken out?
The Sublocade label includes a procedure for surgical removal of the depot within a limited window after injection, under local anaesthetic. It exists for situations such as a serious adverse reaction and is not routine. It is a fair thing to consider when choosing between a product that commits you for a month and one that commits you for a week.
Will it show up on a drug test?
Only on a test that includes a buprenorphine assay. Buprenorphine does not register on a standard opiate screen, and the federal and DOT panels do not test for it at all. Where it is tested, a valid prescription is a legitimate medical explanation and a medical review officer must give you the chance to present one. After Sublocade, urine can stay positive for twelve months or longer.
Is Brixadi or Sublocade cheaper?
There is no useful shelf price for either, because both are usually billed under the medical benefit: the clinic buys the product and bills for administering it. What you pay depends on your plan's rules for administered drugs, on prior authorisation, and on which product is on your state Medicaid preferred list. Both manufacturers run patient-assistance programmes, and clinics that give the injections generally know how to use them.
Are these used for pain?
No. Both are indicated for moderate to severe opioid use disorder. Buprenorphine products for pain are different formulations: the Butrans patch and Belbuca film — at much lower doses. Being on either injection does complicate pain treatment if you need surgery, which is a conversation to have with the prescriber and the surgical team in advance rather than on the day.
Can you drink alcohol on the injection?
Combining buprenorphine with alcohol, benzodiazepines or other sedatives is the main route by which it contributes to dangerous respiratory depression, and the labels warn about it directly. That is not the same as saying one drink is fatal; it is saying that this combination is the one that kills people on buprenorphine, and that it is worth being honest with the prescriber about drinking rather than hiding it.
Sources
- FDA / DailyMed — BRIXADI (buprenorphine) extended-release injection, prescribing information, Braeburn
- FDA / DailyMed — SUBLOCADE (buprenorphine extended-release) injection, prescribing information, Indivior
- FDA / DailyMed — SUBOXONE sublingual film, prescribing information (for the daily comparison)
- Internet Archive: the SUBLOCADE label as it stood in April 2024, before the February 2025 revision
- Lofwall et al. — Weekly and monthly subcutaneous buprenorphine depot formulations vs daily sublingual buprenorphine with naloxone, JAMA Intern Med 2018
- Haight et al. — Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder, Lancet 2019
- Frost et al. — Long-term safety of a weekly and monthly subcutaneous buprenorphine depot (CAM2038), Addiction 2019
- D’Onofrio et al. — Extended-release 7-day injectable buprenorphine for patients with minimal to mild opioid withdrawal, JAMA Netw Open 2024
- Flam-Ross et al. — Economic evaluation of extended-release buprenorphine for persons with opioid use disorder, JAMA Netw Open 2023
- Walsh et al. — Pharmacokinetic-pharmacodynamic analysis of drug liking blockade by buprenorphine subcutaneous depot, Neuropsychopharmacology 2024
- SAMHSA — FindTreatment.gov, the federal treatment locator our facility counts are drawn from
- NIDA — Medications for Opioid Use Disorder
How this page was made
- Who wrote it:
- the Westbrook Recovery editorial team : researchers and writers, not clinicians. No doctor has reviewed this page, and we do not claim otherwise. What that means in practice: we report what public clinical sources say and show you where to read them, rather than offering a clinical opinion of our own.
- Checked against:
- 12 primary sources listed above: federal agency material and published clinical criteria. Where a figure varies by state, plan or facility, we say so instead of publishing a number that looks authoritative and is not.
- Original analysis:
- the facility proportions on this page are our own count of SAMHSA’s public directory. The full method is documented , including what we count, what we deliberately do not publish, and an error the approach caught. You can repeat the pull and check the numbers.
- Last reviewed:
- . This date changes when the content is actually re-checked, not automatically on every visit.
- What this page is not:
- a medical recommendation, a diagnosis, or a referral. Decisions about levels of care and medication belong with a clinician who knows your history. We do not operate facilities, take placement fees, or receive payment for sending anyone anywhere.
Related comparisons
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Practical guides
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- What happens in rehab
- Court-ordered rehab
- Sober living rules
- How long Suboxone stays in your system
Check your coverage
This page is information, not medical advice. Treatment decisions belong with a qualified clinician who knows your history. If you are in crisis, call or text 988 in the US, or reach the SAMHSA National Helpline at 1-800-662-4357 — free, confidential, 24/7.