In addition to medication, behavioral therapy (such as cognitive behavioral therapy or dialectical behavior therapy) will usually be part of your MAT plan.
Understanding Brixadi & Sublocade
Brixadi and Sublocade are both injectable formulations of buprenorphine that have been approved by the U.S. Food & Drug Administration (FDA) for the treatment of OUD. Both drugs are used as part of MAT, in conjunction with psychotherapy services, to effectively treat people addicted to opioids. Both these medications promote long-term recovery.[1]
How Does Brixadi Work?
Brixadi works by curbing cravings for opioids. Whether injected weekly or monthly, the medicine is continuously released into a person’s system.
A consistent amount of buprenorphine is released so the person does not experience the highs and lows associated with opioid abuse. Buprenorphine helps by blocking the euphoric effects of opioids that drive misuse.[5]
How Does Sublocade Work?
Similar to Brixadi, Sublocade reduces cravings for opioids to encourage long-term sobriety. It is prescribed for the management of moderate to severe OUD in adults who have already been stabilized following detox on a product that contains buprenorphine.[3]
A healthcare provider injects the Sublocade under the skin where it turns into a solid gel. Sublocade then works by releasing a consistent level of buprenorphine into the bloodstream over the course of one month. Buprenorphine attaches to opioid receptors in the brain, which in turn reduces cravings for opioids.[7]
Comparing Brixadi & Sublocade
Brixadi and Sublocade are two very similar medications with some distinct differences. They provide alternate treatment options for people with OUD, and both serve valuable purposes. Explore the chart below to see how the two drugs compare and differ:[1,2,4-6]
| Brixadi | Sublocade | |
| Uses | Long-term treatment of OUD | Long-term treatment of OUD |
| Drug Schedule | Schedule III | Schedule III |
| Forms | Subcutaneous injectable solution | Subcutaneous injectable solution |
| How They Are Used | Injected underneath the skin by a professional once a week or once a month | Injected underneath the skin by a professional once a month |
| Common Side Effects | Pain and itchy skin at the injection site, headache, constipation, nausea, difficulty sleeping, and urinary tract infection | Constipation, nausea and vomiting, headache, drowsiness, pain and itching at the injection site, and abnormal liver function tests |
| Addiction Potential | Low but possible | Potential dependence and withdrawal symptoms |
| Insurance Coverage | Available through private insurance | Available through private and state or federal healthcare programs |
| Efficacy and Safety | Considered safe and effective for the treatment of OUD | Considered safe and effective for the treatment of OUD |
According to the FDA, less than 5% of people taking Brixadi experience negative side effects from the drug. Additionally, studies evaluating the efficacy and safety of the drug found a better response to treatment when taking Brixadi than when taking non-injectable forms of buprenorphine.[1]
All drugs containing buprenorphine, including Brixadi and Sublocade, are Schedule III drugs according to the Controlled Substances Act.[4] This means they have a low to moderate risk of physical and psychological dependence. They are controlled substances that are only available via prescription.
Due to the risk of self-harm, Brixadi and Sublocade may only be injected by a trained healthcare provider. Significant health complications can occur if buprenorphine is accidentally injected into a vein (intravenously) rather than just under the skin (subcutaneously).[7]
Key Differences Between Brixadi & Sublocade
One of the key differences between Brixadi and Sublocade is how often they are meant to be taken. Brixadi can be administered both weekly and monthly, whereas Sublocade is only meant to be injected once per month in an extended-release version.
Dosing Ranges
Brixadi offers more flexible treatment options than Sublocade. It has wider dosing ranges that can be administered both weekly and monthly.
Weekly doses of Brixadi are 8 mg, 16 mg, 24 mg, or 32 mg, while monthly doses are 64 mg, 96 mg, or 128 mg. By offering varying doses, individuals who may not tolerate higher doses well can still safely take the medication.[1]
Sublocade, unlike Brixadi, is only offered as a monthly injection. Doses are available in 100 mg or 300 mg injections. It is recommended to begin with 300 mg injections for the first two months, followed by 100 mg injections for as many months as needed.[3]
Immediate-Release vs. Extended-Release Forms
Both Sublocade and Brixadi are injected under the skin. A solid deposit, or depot, containing the buprenorphine then forms. Over time, the buprenorphine is released, reducing opioid cravings and withdrawal symptoms.[2]
Sublocade is only offered in higher doses with extended-release administration. The medication is slowly released over a month until the next injection occurs.
Short-term release options of Sublocade are not available like they are for Brixadi. Weekly injections of Brixadi allow for a more immediate release of the drug.
Choosing the Right Buprenorphine Injection
Choosing the right buprenorphine injection is a decision to make in consultation with your healthcare provider. Your doctor will review your health and substance use history to determine if a weekly or monthly injection is most appropriate. They’ll also use that information to determine the best dose.
If you begin on one buprenorphine injection and experience negative side effects that do not go away, share that information with your doctor. They can adjust your dosage or switch medications to reduce unpleasant side effects. If injectable buprenorphine doesn’t work well for you, they may switch you to a transmucosal form like Suboxone.
There isn’t a one-size-fits-all approach to MAT. Instead, you and your doctor will work together to find the treatment path that works best for you. In many instances, this treatment plan will need to change over time as you navigate your way to a lasting recovery.
- FDA approves new buprenorphine treatment option for opioid use disorder. U.S. Food and Drug Administration. Published May 23, 2023. Accessed February 20, 2024.
- FDA approves first once-monthly buprenorphine injection, a medication-assisted treatment option for opioid use disorder. U.S. Food and Drug Administration. Published November 30, 2017. Accessed February 20, 2024.
- Clinical review report: Buprenorphine extended-release injection (Sublocade). Canadian Agency for Drugs and Technologies in Health. Published July 2019. Accessed February 20, 2024.
- Buprenorphine. U.S. Drug Enforcement Administration. Published May 2022. Accessed February 20, 2024.
- Brixadi (buprenorphine) extended-release injection for subcutaneous use. Brixadi.com. 2023. Accessed February 20, 2024.
- Opioid use disorder treatment services. Medicare.gov. Accessed February 20, 2024.
- About Sublocade: How Sublocade works. Sublocade.com. Accessed February 20, 2024.
