If you or someone you love is navigating opioid use disorder (OUD), you’ve likely heard about medication-assisted treatment (MAT) options like Suboxone. But there’s a newer option that’s changing the landscape of OUD treatment: Brixadi (buprenorphine extended-release injection). This innovative medication offers a long-acting alternative that eliminates the need for daily dosing, providing greater flexibility and potentially better outcomes for people in recovery.
In this comprehensive guide, we’ll explore what Brixadi is, how it works, who it’s for, and how it compares to other buprenorphine formulations. Whether you’re considering treatment options or supporting someone in their recovery journey, understanding Brixadi can help you make informed decisions about care.
What Is Brixadi?
Brixadi is an FDA-approved, extended-release injectable formulation of buprenorphine used to treat moderate to severe opioid use disorder in adults. Approved by the FDA in May 2023, Brixadi represents a significant advancement in medication-assisted treatment.
Unlike daily sublingual (under-the-tongue) buprenorphine medications like Suboxone, Brixadi is administered as a subcutaneous injection—meaning it’s injected just under the skin—either once weekly or once monthly, depending on the dosage prescribed.
How Brixadi Works
Brixadi contains buprenorphine, a partial opioid agonist that works by:
- Binding to opioid receptors in the brain without producing the intense euphoria or “high” associated with full opioid agonists like heroin or fentanyl
- Reducing cravings and withdrawal symptoms, allowing individuals to focus on recovery
- Blocking the effects of other opioids, which helps prevent misuse and reduces overdose risk
According to the National Institute on Drug Abuse (NIDA), medications like buprenorphine normalize brain chemistry, block the euphoric effects of opioids, relieve physiological cravings, and normalize body functions without the negative effects of the opioid used.
The extended-release formulation of Brixadi uses a lipid-based delivery system that releases buprenorphine slowly and steadily over a week or month, maintaining therapeutic levels in the body without the peaks and valleys associated with daily dosing.
Brixadi Dosing: Weekly vs. Monthly Options
One of Brixadi’s key advantages is its flexible dosing schedule. It comes in two formulations:
Weekly Brixadi
- Administered once every seven days
- Available in doses ranging from 8 mg to 32 mg
- Ideal for patients who prefer more frequent monitoring or are early in treatment
Monthly Brixadi
- Administered once every 28 days (approximately monthly)
- Available in doses ranging from 64 mg to 128 mg
- Suitable for patients who are stable in their recovery and prefer less frequent visits
Your healthcare provider will work with you to determine the appropriate dose and schedule based on your individual needs, treatment history, and recovery goals. At Cedar Recovery, we offer monthly Brixadi injections as part of our comprehensive outpatient treatment program, providing patients with convenient, consistent medication support while minimizing the frequency of clinic visits.
Who Is Brixadi For?
Brixadi is approved for adults (18 years and older) with moderate to severe opioid use disorder. It may be particularly beneficial for individuals who:
- Struggle with daily medication adherence: For some people, remembering to take daily medication or the ritual of daily dosing can be challenging or triggering
- Want more privacy in their treatment: Injectable formulations eliminate the need to carry or store medication at home
- Have difficulty with sublingual medications: Some people experience side effects or absorption issues with sublingual buprenorphine
- Are stable in recovery and want more flexibility: Monthly dosing can reduce treatment burden and allow greater focus on other aspects of recovery
- Face barriers to daily medication access: Weekly or monthly dosing can be especially helpful for people with unstable housing or transportation challenges
Research on long-acting injectable buprenorphine formulations has shown promising results. A study published in JAMA found that extended-release buprenorphine was non-inferior to daily sublingual buprenorphine in terms of treatment retention and abstinence from opioids (Lofwall et al., 2018).
How Brixadi Compares to Other Buprenorphine Medications
Understanding the differences between buprenorphine formulations can help you and your healthcare provider choose the best option for your needs.
Brixadi vs. Suboxone
Suboxone (buprenorphine/naloxone) is the most commonly prescribed medication for OUD. Key differences include:
| Feature | Brixadi | Suboxone |
|---|---|---|
| Administration | Injectable (weekly or monthly) | Sublingual film or tablet (daily) |
| Dosing frequency | Once weekly or monthly | Once or twice daily |
| Naloxone included | No | Yes (to deter misuse) |
| Diversion risk | Lower (administered by healthcare provider) | Higher (take-home medication) |
| Patient preference | May prefer if adherence is challenging | May prefer if wanting control over dosing |
Both medications are highly effective when used as part of a comprehensive treatment program that includes counseling and behavioral support.
Brixadi vs. Sublocade
Sublocade is another extended-release injectable buprenorphine formulation that was approved by the FDA in 2017. Key differences include:
| Feature | Brixadi | Sublocade |
|---|---|---|
| Dosing options | Weekly or monthly | Monthly only |
| Injection site | Subcutaneous (various sites) | Subcutaneous (abdomen only) |
| Flexibility | More flexible dosing intervals | Fixed monthly schedule |
| Availability | Newer to market | Established since 2017 |
Both medications offer the benefits of long-acting buprenorphine, and the choice between them often comes down to patient and provider preference, insurance coverage, and individual treatment needs.
Benefits of Brixadi Treatment
Long-acting injectable buprenorphine like Brixadi offers several advantages:
- Improved Adherence
Weekly or monthly dosing eliminates the challenge of remembering daily medication, which can significantly improve treatment adherence and outcomes.
- Reduced Diversion Risk
Because Brixadi is administered by a healthcare provider, there’s virtually no risk of the medication being diverted (sold or given to others), which is a concern with take-home medications.
- Consistent Medication Levels
The extended-release formulation provides steady buprenorphine levels without the fluctuations that can occur with daily dosing, potentially reducing cravings and withdrawal symptoms.
- Greater Privacy and Convenience
Patients don’t need to carry medication or take it in front of others, which can reduce stigma and improve quality of life.
- Support for Long-Term Recovery
Research from American College of Physicians consistently shows that longer retention in medication-assisted treatment is associated with better outcomes, including reduced overdose risk and mortality (Wakeman et al., 2020). By making treatment more convenient and sustainable, Brixadi may help people stay in treatment longer.
What to Expect: Starting Brixadi Treatment
Induction Phase
Before starting Brixadi, patients typically need to be in mild to moderate opioid withdrawal. Your healthcare provider will assess your withdrawal symptoms using standardized scales to ensure safe initiation.
For patients new to buprenorphine treatment, induction may begin with sublingual buprenorphine before transitioning to Brixadi, though some patients may start directly with Brixadi weekly injections.
Maintenance Phase
Once stabilized, patients transition to a regular weekly or monthly injection schedule. At Cedar Recovery, we provide monthly Brixadi injections as part of our maintenance treatment program. At each monthly appointment, your healthcare provider will:
- Administer the injection
- Monitor your progress and any side effects
- Provide or coordinate counseling and support services
- Adjust your dose if needed
We integrate Brixadi treatment with comprehensive outpatient services, including individual therapy, group counseling, and care coordination to address all aspects of recovery.
Injection Administration
Brixadi is administered as a subcutaneous injection, typically in the:
- Back of the upper arm
- Abdomen
- Thigh
- Buttocks
The injection site is rotated with each dose to minimize irritation. The injection itself takes just a few minutes and is generally well-tolerated.
Potential Side Effects of Brixadi
Like all medications, Brixadi can cause side effects. The most common include:
- Injection site reactions (redness, pain, itching)
- Headache
- Constipation
- Nausea
- Fatigue
- Insomnia
Most side effects are mild to moderate and tend to improve over time. Serious side effects are rare but can include:
- Respiratory depression: Though much less likely than with full opioid agonists, buprenorphine can slow breathing, especially when combined with sedatives or alcohol
- Liver problems: Regular monitoring of liver function may be recommended
- Allergic reactions: Seek immediate medical attention if you experience severe reactions
Your healthcare provider will discuss potential side effects and monitor you throughout treatment. It’s important to report any concerning symptoms promptly.
Insurance Coverage and Cost
Brixadi is covered by many insurance plans, including Medicaid and Medicare, though coverage varies by state and plan. The manufacturer offers patient assistance programs for eligible individuals.
At Cedar Recovery, our team works with patients to verify insurance coverage and explore financial assistance options to ensure treatment is accessible.
Is Brixadi Right for You?
Choosing the right medication for opioid use disorder is a personal decision that should be made in consultation with a qualified healthcare provider. Brixadi may be an excellent option if you:
- Are committed to recovery but struggle with daily medication adherence
- Want a treatment option that offers more privacy and flexibility
- Have been stable on sublingual buprenorphine and want to transition to less frequent dosing
- Are looking for a medication with lower diversion risk
- Prefer the convenience of monthly clinic visits
However, Brixadi may not be ideal if you:
- Prefer to have control over your daily medication schedule
- Are uncomfortable with injections
- Have certain medical conditions that make injectable medications inadvisable
The best treatment is the one that works for you and supports your long-term recovery goals. Whether that’s Brixadi, Suboxone, or another evidence-based approach, what matters most is finding a treatment plan you can stick with.
The Role of Comprehensive Treatment
While Brixadi is a powerful tool in treating opioid use disorder, medication alone is rarely sufficient for lasting recovery. The most effective treatment combines medication with:
- Individual counseling: To address underlying issues, develop coping skills, and work through trauma
- Group therapy: To build connection, reduce isolation, and learn from others in recovery
- Case management: To address social determinants of health like housing, employment, and legal issues
- Peer support: To provide encouragement and accountability from people with lived experience
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the combination of medication and behavioral therapies provides the best chance of success for most people with OUD.
At Cedar Recovery, we use a “whole-person” approach to care that addresses not just the physical aspects of addiction but also the psychological and social dimensions of recovery.
Cedar Recovery: Your Partner in Recovery
At Cedar Recovery, we specialize in evidence-based outpatient treatment for opioid use disorder and other substance use disorders. Our compassionate, experienced team understands that recovery is a journey, not a destination—and we’re here to support you every step of the way.
Our Services Include:
- Medication-Assisted Treatment: Including monthly Brixadi injections, Suboxone, and other FDA-approved medications
- Individual Therapy: Personalized counseling to address your unique needs and goals
- Group Counseling: Peer support and skill-building in a safe, supportive environment
- Case Management: Connecting you with resources for housing, employment, legal assistance, and more
- Flexible Scheduling: We offer convenient appointment times to fit your life
Our monthly Brixadi injection program provides patients with the convenience and stability of long-acting medication while ensuring regular touchpoints with our clinical team for comprehensive support. This approach allows you to focus less on daily medication management and more on building the life you want in recovery.
We believe that everyone deserves access to quality, compassionate care—regardless of where they are in their recovery journey. If you’re considering Brixadi or other treatment options for opioid use disorder, we invite you to call us 1-(800) 799-1450 or fill out this form to learn more about how we can help.
Recovery is possible. Let us walk alongside you.
References
Center for Substance Abuse Treatment. (2004). Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Treatment Improvement Protocol (TIP) Series 40. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64245/
Lofwall, M. R., Walsh, S. L., Nunes, E. V., Bailey, G. L., Sigmon, S. C., Kampman, K. M., Frost, M., Tiberg, F., Linden, M., Sheldon, B., Oosman, S., Peterson, S., Chen, M., & Kim, S. (2018). Weekly and monthly subcutaneous buprenorphine depot formulations vs daily sublingual buprenorphine with naloxone for treatment of opioid use disorder: A randomized clinical trial. JAMA Internal Medicine, 178(6), 764-773. https://doi.org/10.1001/jamainternmed.2018.1052
National Institute on Drug Abuse. (2021). Medications to treat opioid use disorder. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction
U.S. Food and Drug Administration. (2023, May 26). FDA approves new injectable buprenorphine treatment option for opioid use disorder. https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-injectable-buprenorphine-treatment-option-opioid-use-disorder
Substance Abuse and Mental Health Services Administration. (n.d.). Medication-assisted treatment (MAT). https://www.samhsa.gov/medication-assisted-treatment
Wakeman, S. E., Larochelle, M. R., Ameli, O., Chaisson, C. E., McPheeters, J. T., Crown, W. H., Azocar, F., & Sanghavi, D. M. (2020). Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Network Open, 3(2), e1920622. https://doi.org/10.1001/jamanetworkopen.2019.20622
