Long-Acting Buprenorphine: Weekly and Monthly Options

Taking daily medication works well for many people in opioid use disorder treatment. But for others, the routine becomes a daily reminder of their diagnosis, or the logistics make adherence difficult. What if you could receive your buprenorphine once a week, once a month, or even every six months?

Long-acting buprenorphine formulations—Sublocade, Brixadi, and Probuphine—offer exactly that freedom. These options deliver steady medication levels without the need to remember daily doses, making treatment fit more seamlessly into your life.

This guide breaks down how each long-acting option works, who's a good candidate, and how to discuss them with your provider. Whether you're just starting treatment or have been stable on daily Suboxone for months, understanding these alternatives helps you make informed decisions about your care.

What Is Long-Acting Buprenorphine?

Long-acting buprenorphine delivers the same medication found in daily Suboxone or generic buprenorphine tablets, but through a different system. Instead of dissolving a film or tablet under your tongue each day, you receive buprenorphine via injection or implant that releases medication slowly over weeks or months.

The active ingredient—buprenorphine—works identically to daily formulations. It's a partial opioid agonist that:

• Reduces cravings and withdrawal symptoms
• Blocks the effects of other opioids
• Provides stable medication levels without the "peaks and valleys" of daily dosing

The difference lies in delivery. Long-acting formulations use specialized technology to create a depot (reservoir) of medication in your body that releases gradually. This means consistent blood levels without thinking about dosing every morning.

Why Consider Long-Acting Options?

Patients choose long-acting buprenorphine for several reasons:

• Eliminate daily dosing stress: No more setting alarms, packing medication for trips, or worrying about running out
• Increased privacy: No visible medication to take at home or work
• Better adherence: Can't forget a dose when it's already in your system
• Fewer diversion concerns: Nothing to store, secure, or potentially misuse
• Steady medication levels: Avoid fluctuations that can occur with daily dosing

Research shows that long-acting formulations have comparable effectiveness to daily buprenorphine for preventing relapse and supporting recovery. For some patients, they work even better because they remove adherence barriers.

The Three Long-Acting Options

Three FDA-approved long-acting buprenorphine products are currently available in the United States. Each uses a different technology and dosing schedule.

Sublocade (Monthly Injection)

Sublocade is an extended-release subcutaneous injection (under the skin) given once monthly. Approved in 2017, it's the most widely available long-acting option.

How it works: Your provider injects Sublocade into the fatty tissue of your abdomen using a pre-filled syringe. The medication forms a solid depot that gradually dissolves, releasing buprenorphine steadily over the month. You'll feel a small, firm lump under your skin for a few weeks—this is normal and expected.

Dosing schedule:

• First two months: 300 mg injection monthly
• Maintenance (month 3+): 100 mg or 300 mg monthly, depending on your response

What to expect: The injection takes less than a minute. You might experience mild injection site reactions—redness, itching, or small bumps—that typically resolve within a few days. The depot lump gradually shrinks as medication releases.

Unique advantage: Sublocade can provide therapeutic buprenorphine levels for 6 months or more after your last injection, making it ideal for patients who want to eventually discontinue medication without traditional tapering.

Learn more in our complete Sublocade guide.

Brixadi (Weekly or Monthly Injection)

Brixadi, approved in 2023, offers the most flexible long-acting schedule with both weekly and monthly options. Like Sublocade, it's a subcutaneous injection, but it uses different depot technology.

How it works: Brixadi uses a liquid formulation that solidifies under the skin, creating a depot that releases buprenorphine over either a week or a month. Your provider injects it into your buttock, thigh, abdomen, or upper arm.

Dosing schedules:

• Weekly: 8 mg, 16 mg, 24 mg, or 32 mg injections
• Monthly: 64 mg, 96 mg, 128 mg, or 160 mg injections

What to expect: The injection is quick, and the depot is less noticeable than Sublocade. Injection site reactions are generally mild. You can switch between weekly and monthly schedules if your treatment needs change.

Unique advantage: The weekly option is perfect if you're transitioning from daily medication and want a middle ground before committing to monthly dosing. It also allows more frequent dose adjustments during early treatment.

Probuphine (Six-Month Implant)

Probuphine is a set of four small rods implanted under the skin of your upper arm. Approved in 2016, it provides six months of continuous medication from a single minor procedure.

How it works: A trained provider makes a small incision in your upper arm and inserts four matchstick-sized implants just under the skin. The rods contain buprenorphine that releases slowly over six months. At the end of six months, your provider removes the old implants and can insert new ones if you wish to continue.

Dosing: Each set delivers approximately 8 mg of buprenorphine daily—equivalent to one Suboxone film.

What to expect: Implant insertion takes 15-20 minutes under local anesthesia. You'll have a small bandage for a few days and might feel the implants under your skin. Removal is similar to insertion. Serious complications are rare but can include nerve damage or difficulty removing implants.

Unique advantage: True "set it and forget it" treatment. No monthly appointments needed, making it ideal for patients with transportation barriers or unpredictable schedules.

Important limitation: Probuphine delivers a relatively low dose, making it suitable only for patients stable on 8 mg/day or less of sublingual buprenorphine. It's not appropriate for patients who need higher doses.

Who Is a Good Candidate?

Long-acting buprenorphine isn't for everyone, and that's okay. The best formulation is the one you'll stick with. But certain situations make extended-release options especially appealing.

Ideal Candidates Include Patients Who:

• Have been stable on daily buprenorphine for at least 7 days (Sublocade/Brixadi) or months (Probuphine)
• Struggle with adherence to daily medication
• Want more privacy around treatment
• Have unpredictable schedules that make daily dosing difficult
• Are concerned about medication storage or diversion
• Experience stigma from visible daily medication use
• Are planning to discontinue treatment eventually and want a gradual offramp

You don't need to be on a high dose of daily buprenorphine to transition. Many patients successfully switch from 8-16 mg daily sublingual doses to monthly injections.

You Might Not Be Ready If:

• You're still in early treatment and need frequent dose adjustments
• You have active injection site infections or conditions affecting absorption
• You're not yet stable on any form of buprenorphine
• You prefer the control of daily dosing
• Cost or insurance coverage makes long-acting options inaccessible

Your provider at Grata Health can help assess whether a long-acting option fits your treatment goals. There's no pressure—some patients thrive on daily medication and never switch, and that's perfectly appropriate.

Transitioning From Daily Medication

Switching from daily Suboxone or generic buprenorphine to a long-acting formulation is straightforward, but timing matters.

Before Your First Injection or Implant

Sublocade/Brixadi: You need to be taking daily buprenorphine for at least 7 days before your first injection. This ensures you're not in withdrawal and helps determine the right starting dose.

Probuphine: You should be stable on 8 mg/day or less for several weeks or months. Probuphine isn't designed for dose induction—it's for maintaining an already-effective dose.

What Happens at Your Appointment

Your provider will:

1. Confirm your current buprenorphine dose and review your treatment progress
2. Explain what to expect during and after injection/insertion
3. Answer questions about side effects, activity restrictions, and follow-up care
4. Administer the injection or insert the implant
5. Observe you briefly to ensure no immediate reactions
6. Schedule your next appointment (one month for Sublocade/monthly Brixadi, one week for weekly Brixadi, six months for Probuphine)

The Day of Transition

For injections (Sublocade/Brixadi): Take your usual daily dose that morning. Your provider will give the first injection the same day. You won't need to take daily medication again after that.

For Probuphine: Take your daily dose the morning of implant insertion, then stop daily medication. The implants start working immediately.

What to Expect in the First Few Weeks

Most patients feel no different—that's the goal. Long-acting formulations maintain the same steady state you experienced on daily medication. Some patients report feeling "clearer" without the minor fluctuations of daily dosing.

Possible temporary effects:

• Mild injection site tenderness or visible lump (normal and expected)
• Slight nausea or headache (usually resolves within days)
• Feeling the implants under your skin (Probuphine)

If you experience withdrawal symptoms after switching, contact your provider immediately. This is rare but can happen if medication absorption is slower than expected. Your provider can supplement with daily medication temporarily if needed.

Insurance Coverage and Cost

Long-acting buprenorphine is more expensive upfront than daily medication, but many insurance plans cover at least one option after prior authorization.

Coverage Landscape

Medicaid: Most state Medicaid programs cover Sublocade and increasingly cover Brixadi. Probuphine coverage varies more widely. Ohio Medicaid, Pennsylvania Medicaid, and Virginia Medicaid typically require prior authorization but approve coverage for appropriate candidates.

Commercial insurance: Major insurers including Aetna, Cigna, Blue Cross Blue Shield, Anthem, and Humana generally cover at least one long-acting option. Prior authorization almost always required.

Medicare: Covers long-acting buprenorphine under Part B (medical benefit, not Part D pharmacy benefit) when medically necessary and properly documented.

Prior Authorization Requirements

Insurers typically require:

• Documentation of opioid use disorder diagnosis
• Evidence of stability on daily buprenorphine (duration varies)
• Explanation of why daily medication is insufficient (adherence issues, patient preference)
• Prescriber credentials verification

Your Grata Health provider handles prior authorization submissions and can appeal denials. The process usually takes 3-7 business days.

Out-of-Pocket Costs

With insurance: After approval, copays typically range from $0 (Medicaid) to $50-200 (commercial plans) per injection/implant set.

Without insurance: List prices are high:

• Sublocade: ~$1,700-2,000 per injection
• Brixadi: ~$1,200-1,800 per injection
• Probuphine: ~$5,000 for six-month implant set

Manufacturer assistance programs can significantly reduce costs. See our guide to copay assistance programs for current options.

Cost comparison over six months:

• Daily generic buprenorphine: ~$60-300 (with insurance) or ~$100-400 (self-pay)
• Sublocade: ~$0-1,200 (with insurance) or ~$10,000+ (self-pay)

The math makes long-acting options most accessible with insurance coverage. If your plan denies coverage, ask your provider about appealing denied claims.

Start treatment with Grata Health in Virginia, Ohio, or Pennsylvania, and we'll help navigate your insurance coverage for any buprenorphine formulation.

Comparing Your Options Side-by-Side

Choosing between Sublocade, Brixadi, and Probuphine comes down to your priorities around dosing frequency, flexibility, and treatment goals.

| Feature | Sublocade | Brixadi | Probuphine | |---------|-----------|---------|------------| | Administration | Subcutaneous injection (abdomen) | Subcutaneous injection (multiple sites) | Implant (upper arm) | | Frequency | Monthly | Weekly or monthly | Every 6 months | | Stability requirement | 7+ days on daily bupe | 7+ days on daily bupe | Stable on ≤8 mg/day for weeks/months | | Dose flexibility | Two monthly doses (100mg or 300mg) | Four weekly doses, four monthly doses | One dose (~8 mg/day equivalent) | | Visible depot | Noticeable lump for 2-4 weeks | Smaller, less visible | Slight ridge under skin | | Discontinuation | Provides coverage for months after last injection | Shorter tail than Sublocade | Requires removal procedure | | Best for | Patients wanting monthly dosing and eventual medication-free discontinuation | Patients wanting scheduling flexibility or weekly option | Patients wanting maximum dosing freedom and on lower doses |

None of these options is objectively "better"—they serve different needs. A patient who travels frequently for work might love Probuphine's six-month freedom, while someone who wants gradual dose adjustments might prefer Brixadi's weekly option.

Common Questions About Long-Acting Buprenorphine

Can I switch between long-acting formulations?

Yes. If Sublocade's monthly lump bothers you, you can switch to Brixadi at your next appointment. If you want less frequent dosing than Brixadi weekly, you can move to monthly Brixadi or Sublocade. Your provider will adjust timing and doses to maintain steady medication levels during the transition.

What if I want to stop treatment?

This depends on the formulation:

Sublocade: Provides a natural taper. Buprenorphine levels gradually decline over 6+ months after your last injection, reducing withdrawal risk. Many patients use Sublocade as a planned off-ramp from medication.

Brixadi: Shorter duration than Sublocade. You can transition back to daily medication for traditional tapering, or work with your provider to space out injections.

Probuphine: Requires removal. Your provider can remove implants anytime, and medication clears your system within weeks. You can transition to daily medication or another formulation before or after removal.

Never attempt to remove Probuphine implants yourself or have them removed by an untrained provider—this can cause serious complications.

Can I travel with long-acting buprenorphine?

Yes, and this is a major advantage. You don't need to carry medication, worry about TSA, or find prescribers when traveling. Just keep your provider's contact information and documentation of your treatment in case of medical emergencies.

What happens if I miss an injection appointment?

Contact your provider immediately