Sublocade for Opioid Addiction: How the Monthly Buprenorphine Injection Works

Sublocade is a once-monthly buprenorphine injection prescribed for moderate to severe opioid use disorder. Unlike daily medications, Sublocade delivers a steady level of buprenorphine over four weeks, helping reduce cravings and withdrawal symptoms without the ups and downs of oral dosing. This guide covers how Sublocade works, who it may help, side effects, dosing, and how it compares to other MAT medications.

In This Article:

• What is Sublocade?
• How the Sublocade shot works
• Sublocade dosing
• Side effects and safety warnings
• Benefits of using buprenorphine in addiction treatment
• Drug interactions and contraindications
• Frequently asked questions
• Comparing Sublocade with other MAT options
• Combining buprenorphine with comprehensive treatment
• Insurance and cost

What Is Sublocade?

Sublocade is a prescription buprenorphine injection given once a month to treat moderate to severe opioid use disorder. It is only prescribed after a person has first been stabilized on an oral form of buprenorphine, and it must be administered by a certified healthcare provider.

Sublocade is used by healthcare providers after a client has completed an oral dose of buprenorphine to reduce withdrawal symptoms and provide stabilization. Medical personnel must observe patients for one hour after the initial dose of buprenorphine before Sublocade can be administered to decrease the risk of adverse events.

Once patients are stabilized, a health care provider may recommend an ongoing maintenance program that includes using Sublocade in conjunction with psychotherapy.

How the Sublocade Shot Works

Sublocade is a partial opioid agonist that activates opioid receptors at a lower intensity than drugs like heroin or fentanyl. Once injected, it forms a solid gel under the skin that releases buprenorphine at a steady rate throughout the month.

Sublocade contains buprenorphine, a partial opioid agonist. It activates opioid receptors in the brain, but to a lesser degree than full agonists like heroin, fentanyl, or oxycodone. Because buprenorphine binds tightly to these receptors, it also blocks other opioids from attaching and producing a high.

This creates what researchers call a ceiling effect: after a certain dose, the opioid effects level off. A person taking Sublocade will not experience the full euphoria that heroin or morphine produces, and their tolerance does not continue to escalate. This lowers the risk of overdose.

Sublocade is an extended-release formulation. The injection starts as a liquid but forms a solid gel (called a depot) under the skin. The depot gradually releases buprenorphine at a controlled rate over approximately one month. According to the FDA prescribing information, this sustained delivery avoids the peaks and troughs associated with daily oral dosing, keeping blood levels more consistent.[1]

The injection can be administered subcutaneously in the abdomen, buttock, thigh, or upper arm. A healthcare provider must give the injection; Sublocade is not available at retail pharmacies and cannot be self-administered.

Sublocade Dosing

Sublocade follows a specific dosing protocol: two 300 mg injections given one month apart, followed by a maintenance dose of either 100 mg or 300 mg each month based on clinical response.

Before starting Sublocade, a person must first be stabilized on a transmucosal (oral) buprenorphine product at a dose equivalent to 8 to 24 mg per day for at least seven days. This stabilization period confirms that the person tolerates buprenorphine without adverse effects.[1]

The standard Sublocade dosing protocol is:

• Month 1: 300 mg subcutaneous injection
• Month 2: 300 mg subcutaneous injection
• Month 3 and ongoing: 100 mg monthly, with the option to increase to 300 mg based on the individual’s clinical response and treatment goals

Injections must be given at least 26 days apart. A healthcare provider administers each injection in a clinical setting. The injection site should be rotated between the abdomen, buttock, thigh, or upper arm to reduce injection-site reactions.

A same-day start option is available for people who have not yet taken oral buprenorphine. Under this pathway, a healthcare provider gives a test dose of transmucosal buprenorphine (typically 4 mg) to confirm tolerability, then administers the first Sublocade injection the same day. This expanded access option was noted in updated labeling.[1]

Side Effects and Safety Warnings

Sublocade carries a Black Box Warning about the risk of serious harm from intravenous self-injection. Common side effects include headache, constipation, nausea, and injection-site reactions. Serious risks include respiratory depression and liver problems.

Sublocade carries an FDA Black Box Warning: the medication must never be injected into a vein (intravenously). Doing so can cause serious harm, including death. For this reason, Sublocade is only available through a restricted distribution program (see the REMS section below).[1]

Common side effects reported in clinical trials include:

• Headache
• Constipation
• Nausea and vomiting
• Injection-site reactions (pain, itching, redness, or swelling at the injection site)
• Fatigue

Serious side effects may include:

• Respiratory depression – Slow or shallow breathing, which can be life-threatening. Risk increases when Sublocade is combined with benzodiazepines, alcohol, or other CNS depressants. Healthcare providers may prescribe naloxone (Narcan) to carry in case of emergency.[1]
• Liver problems – Buprenorphine has been associated with liver injury in some cases. People with a history of hepatitis B or C or existing liver disease should discuss this risk with their provider. Blood tests may be recommended before and during treatment.
• Low blood pressure (hypotension) – Including sudden drops when standing, which can cause dizziness or fainting.
• Adrenal insufficiency – Rare, but possible with long-term opioid use. Symptoms include persistent nausea, fatigue, and weakness.

People should contact their healthcare provider immediately if they experience difficulty breathing, signs of an allergic reaction, dark urine, or yellowing of the skin or eyes.

Benefits of Using Buprenorphine in Addiction Treatment

Sublocade offers several advantages for people managing opioid use disorder, including reduced overdose risk, a monthly dosing schedule that eliminates missed daily doses, and evidence from clinical trials showing higher rates of sustained opioid abstinence.

Sublocade provides a long-term management option for opioid use disorder and is one of several evidence-based tools used in MAT programs. In the Phase III clinical trial (a 24-week, multicenter, randomized, double-blind, placebo-controlled study), 28% of people receiving Sublocade plus counseling achieved treatment success compared to 2% on placebo plus counseling. Treatment success was defined as opioid-free for at least 80% of weeks during the study period.[2]

Several specific benefits contribute to Sublocade’s role in treatment:

• Reduced overdose risk. Buprenorphine binds to opioid receptors without causing the respiratory depression that full agonist opioids produce. Because it also partially blocks other opioids from binding, a person is less likely to experience a fatal overdose if they use opioids while on Sublocade.[1]
• Monthly dosing eliminates missed-dose risk. Because Sublocade is administered once a month in a clinical setting, it removes the daily responsibility of remembering to take medication. This can be particularly helpful for people who have had difficulty maintaining consistent oral dosing.
• Reduced cravings and blocked euphoria. Buprenorphine helps the brain adjust to functioning without the reward of opioid-induced euphoria. Over time, this can reduce the motivation to seek opioids and support engagement with counseling and other recovery supports.

According to the National Institute on Drug Abuse (NIDA), opioids were involved in approximately 81,083 overdose deaths in the United States in 2023.[3] Pharmacological options like Sublocade, combined with therapeutic interventions, are an important part of expanding access to effective treatment.

Drug Interactions and Contraindications

Sublocade can interact dangerously with benzodiazepines, alcohol, and other CNS depressants. It is not recommended for people with severe liver disease, and pregnancy requires careful medical consideration due to the risk of neonatal opioid withdrawal syndrome.

Several substances and conditions can interact with Sublocade. A healthcare provider should have a complete picture of a person’s medications and health history before starting treatment.

• Benzodiazepines and CNS depressants. Combining Sublocade with benzodiazepines, sedatives, tranquilizers, or alcohol can cause severe respiratory depression, sedation, coma, or death. If a person is currently taking benzodiazepines, their provider will weigh the risks and benefits carefully. Abruptly stopping benzodiazepines is not recommended either, as it carries its own risks.[1]
• CYP3A4 inhibitors and inducers. Buprenorphine is metabolized by the CYP3A4 enzyme in the liver. Medications that inhibit this enzyme (such as certain antifungals and HIV medications) can increase buprenorphine levels, while inducers (such as certain anti-seizure medications) can decrease its effectiveness.[1]
• Liver disease. Sublocade is not recommended for people with severe hepatic impairment. People with moderate liver disease or a history of hepatitis should be monitored with regular liver function tests during treatment.
• Pregnancy. Long-term use of opioids, including buprenorphine, during pregnancy can cause neonatal opioid withdrawal syndrome (NOWS) in the newborn. Symptoms in the newborn may include high-pitched crying, poor feeding, tremors, and seizures. However, untreated opioid use disorder during pregnancy carries its own serious risks, and treatment decisions should be made with a healthcare provider who specializes in perinatal addiction medicine.[1]

Frequently Asked Questions

Comparing Sublocade with other MAT Options

Sublocade is one of several medications used in MAT for opioid use disorder. Each option differs in mechanism, dosing, administration route, and how it fits into a person’s treatment plan.

Sublocade is one of several medications that can be used in medication-assisted treatment. The table below summarizes key differences, followed by detailed comparisons.

Vivitrol vs Sublocade. Sublocade is a partial opioid agonist, meaning it activates opioid receptors at a reduced level. Vivitrol (naltrexone) is an antagonist that blocks opioid receptors entirely. A person on Vivitrol would not feel the effects of opioids if they used them. Both are given as monthly injections. A key difference: Vivitrol requires a person to be fully detoxed from opioids before starting, while Sublocade does not.

Brixadi vs Sublocade. Both are injectable buprenorphine formulations for opioid use disorder. Brixadi offers more flexibility: it comes in weekly and monthly options with four dosage levels and can be injected in the arm, thigh, or abdomen. Sublocade has two fixed monthly doses and is also available for injection in the abdomen, buttock, thigh, or upper arm.

Sublocade vs Suboxone. Suboxone contains both buprenorphine and naloxone, an added ingredient that discourages misuse. Suboxone is a daily oral film placed under the tongue and can be self-administered at home. It can also be gradually tapered. Sublocade is a monthly injection given in a clinical setting, which may be preferable for people who benefit from less frequent dosing and provider-supervised administration.

Methadone vs Sublocade. Methadone is a full opioid agonist, meaning it fully activates opioid receptors. It is taken orally every day, initially at a methadone clinic with observed dosing. Sublocade is a partial agonist given monthly. Methadone carries a higher overdose risk due to its full agonist mechanism, but it may be appropriate for people who have not responded to partial-agonist treatment.

Combining Buprenorphine with Comprehensive Treatment

Sublocade works best as part of a broader treatment plan that includes psychotherapy, peer support groups, case management, and long-term aftercare. Medication alone is one component of recovery from opioid use disorder.

Psychotherapy assists in identifying motivating factors behind addiction through exploring the emotional stressors and ingrained destructive behaviors used in coping with life.

Through identifying trauma, abandonment, neglect, and abuse experienced in life, therapy provides a safe environment for healing from those experiences and can help clients learn new ways to live. Therapy can last for as long as necessary and will need to be sustained throughout the MAT treatment.

Peer support systems such as Alcoholics Anonymous, Narcotics Anonymous and SMART Recovery are often part of a treatment program. They assist clients in developing support systems apart from connections they had while in their addiction.

Mentoring, education and resources provided through these peer programs support long term sobriety. Peer supports are now incorporated into most inpatient rehabilitation programs and continued through outpatient aftercare treatment.

Additionally, sober housing and case management along with other types of expressive therapies are integrated into a comprehensive treatment plan that supports MAT. Pain management courses offered through local hospitals or clinics can also be helpful for those experiencing an injury that causes chronic pain.

Many inpatient and outpatient treatment programs exist throughout the country and can be located through various websites such as Rehab.com. There are also free services operated by the government to help you find treatment, like findtreatment.gov.

Because the opioid crisis accounts for almost 80 percent of all deaths by drug overdose according to the National Institute on Drug Abuse, the necessity of providing services to save lives is a crucial focus of the treatment industry. Pharmacological options along with therapeutic interventions increase access and options for people to choose a new lifestyle apart from addiction.

If you’re ready to compare treatment programs or explore different MAT options, you can also learn more about rehab options to find supportive facilities near you.

Insurance and Cost

Sublocade can be expensive without insurance, but most major commercial plans and Medicaid programs cover MAT medications. Manufacturer copay assistance is also available for eligible individuals.

Sublocade is a brand-name medication without a generic equivalent, and the out-of-pocket cost can be significant. However, most major insurance plans are required under the Affordable Care Act and the Mental Health Parity and Addiction Equity Act to cover substance use disorder treatment, including MAT medications.

Coverage and copay amounts vary by plan. A person’s treatment provider or insurance company can verify benefits before starting. Indivior, the manufacturer of Sublocade, also offers a copay assistance program for commercially insured individuals and a patient assistance program for those who are uninsured.

Medicaid coverage for Sublocade varies by state but is available in many states as part of opioid use disorder treatment. Medicare Part B may also cover injectable medications administered in a clinical setting.

If cost is a barrier, exploring different levels of care and contacting facilities directly about financial assistance can help identify affordable options.

References

1. Sublocade (buprenorphine extended-release) injection, for subcutaneous use. Prescribing Information. Indivior Inc. Available at: https://www.sublocade.com. Accessed May 2026.
2. Haight BR, Learned SM, Laffont CM, et al. Efficacy and safety of a monthly buprenorphine depot injection for opioid use disorder: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2019;393(10173):778-790.
3. National Institute on Drug Abuse (NIDA). Drug Overdose Death Rates. National Institutes of Health. Updated 2025. Available at: https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates.
4. Substance Abuse and Mental Health Services Administration (SAMHSA). TIP 63: Medications for Opioid Use Disorder. 2021.