Brixadi vs. Sublocade (and Suboxone): How the Buprenorphine Options Compare

Medically reviewed by Dr. Jerrel Boyer, D.O. — Medical Director, Fresh Start Health Centers · Last reviewed: August 6, 2026

The short answer: Brixadi and Sublocade are both long-acting buprenorphine injections for opioid use disorder, given by a provider. Sublocade is a once-monthly shot in two strengths (100 mg or 300 mg). Brixadi comes in weekly and monthly versions with seven strengths, so the dose and schedule can be adjusted more finely. Suboxone is the daily film or tablet most people start with. Below is the full side-by-side comparison of dosing, cost, side effects, and who each option tends to fit.

Getting Sublocade or Brixadi in Kentucky or Ohio

Fresh Start Health offers Sublocade, Brixadi and Suboxone at four eastern Kentucky clinics, two of them minutes from the Ohio line. Injections are given in the clinic, and many follow-up visits can be done by telehealth for Kentucky and Ohio residents. We accept Medicaid and many commercial insurance plans.

Schedule online Call (606) 225-8200 Our Sublocade & Brixadi care

Quick comparison: Suboxone vs. Sublocade vs. Brixadi

Feature	Suboxone	Sublocade	Brixadi
Active ingredient	Buprenorphine + naloxone	Buprenorphine	Buprenorphine
How it’s taken	Daily film or tablet, dissolves under the tongue	Once-monthly injection under the skin	Weekly OR monthly injection under the skin
Where you take it	At home	Fresh Start Health clinic	Fresh Start Health clinic
Dose flexibility	Highly adjustable, day to day	Fixed: 300 mg × 2 months, then 100 mg	Wide range: weekly 8–32 mg or monthly 64–128 mg
Time from decision to start	Same day	Often same day, after a test dose	Often same day
Best suited for	People who want flexibility and control	People who are stable and want maximum convenience	People who want an injectable but also flexibility
Requires clinic visit?	No (after initial appointments)	Yes, monthly	Yes, weekly or monthly

Use this table as a starting point — then read on to understand why each option fits different patients.

What Suboxone, Sublocade, and Brixadi have in common

All three medications are built around buprenorphine, a partial opioid agonist that reduces cravings and prevents withdrawal without producing the same high as full opioids like heroin, fentanyl, or oxycodone. Buprenorphine has a built-in “ceiling effect” that makes it far safer in overdose than methadone or full opioid agonists. It’s the medication that SAMHSA recognizes as one of the most effective treatments for opioid use disorder, cutting overdose death risk by more than half compared to no medication.

All three are also part of medication-assisted treatment (MAT) — which means the medication works alongside counseling, medical follow-up, and community support. At Fresh Start Health, we prescribe all three across our Ashland, Grayson, Morehead, and Vanceburg clinics, and via telehealth for eligible Kentucky patients.

The difference between the three comes down to how the medication enters your body and how often you take it.

Suboxone: the daily film or tablet

Suboxone is buprenorphine combined with naloxone in a small film or tablet that dissolves under your tongue once a day. It’s the most widely prescribed form of buprenorphine in the country and the option most patients start with.

How often: Once daily, at home
Best for: People starting treatment, people who want flexibility to adjust their dose with their provider, people who prefer daily involvement in their recovery
What to consider: Requires daily consistency. You’ll need to keep the medication on hand, take it at roughly the same time each day, and store it safely (especially if you have children in the home)

Suboxone is FDA-approved for treatment of opioid use disorder. If you want the full picture on daily buprenorphine, see our Suboxone treatment page or read about how long people typically stay on Suboxone — a common question and one that deserves its own conversation.

Sublocade: the once-monthly injection

Sublocade® is a long-acting buprenorphine injection administered by a healthcare provider once a month. After injection under the skin of the abdomen, thigh, buttock, or back of the upper arm, the medication forms a small deposit under the skin that releases buprenorphine steadily over the following weeks.

How often: Once monthly, in the clinic
Best for: People who are already stable on treatment and want to stop thinking about a daily dose; people who travel or have unpredictable schedules; people who find daily medication hard to maintain
What to consider: Since a 2025 FDA label update, Sublocade can be started after a single dose of oral buprenorphine and a one-hour observation period, so people new to buprenorphine no longer need a week of daily doses first. The standard dosing is 300 mg for the first two months, then 100 mg maintenance monthly

Sublocade is FDA-approved for treatment of moderate to severe opioid use disorder in patients who have initiated treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine.

Brixadi: weekly or monthly injection with flexible dosing

Brixadi® is also a long-acting buprenorphine injection, but it comes in both weekly and monthly formulations and a wider range of dose strengths (weekly: 8, 16, 24, or 32 mg; monthly: 64, 96, or 128 mg). This built-in flexibility means treatment can be tailored more precisely to each patient.

How often: Weekly or monthly, depending on your treatment plan
Best for: People who want the convenience of an injection but need more dosing flexibility; people who don’t yet feel stable enough to commit to a fixed monthly dose
What to consider: Like Sublocade, Brixadi can be started after a single dose of oral buprenorphine. Injections can be given in the buttock, thigh, abdomen, or back of the upper arm

Brixadi is FDA-approved for the treatment of moderate to severe opioid use disorder in patients who have initiated treatment with a single dose of a transmucosal buprenorphine-containing product or who are already being treated with buprenorphine.

Brixadi vs. Sublocade: head-to-head

This is the comparison most patients researching injectables want a clear answer on. Both are buprenorphine injections. Both are given by a provider. Both work extremely well for opioid use disorder. But they differ in ways that matter for real-world life.

Dosing schedule. Sublocade is monthly only. Brixadi comes in both weekly and monthly versions — so if you want to build up to a monthly injection gradually, Brixadi lets you start weekly and step up.

Time to first injection. Under current FDA labeling, both can be started after a single test dose of oral buprenorphine, so neither has a real speed advantage anymore. Your provider can tell you how soon your first injection can happen.

Dose range. Sublocade uses a fixed protocol: 300 mg × 2 months, then 100 mg monthly. Brixadi offers seven different dose options across weekly and monthly formulations, so your provider can fine-tune to what your body actually needs.

Injection site. Both can now be injected into the abdomen, thigh, buttock, or upper arm, which helps if you have skin sensitivity or scar tissue in one area. Injection sites are rotated between doses.

Cost and coverage. In Kentucky, both are covered by Medicaid and most commercial plans when prescribed for opioid use disorder. As a 340B covered entity, Fresh Start Health can often help make either affordable regardless of your coverage.

Which one wins? Neither. They win for different patients. If you’re already stable on Suboxone and want “set-and-forget” convenience, Sublocade is often the cleaner choice. If you want an injectable with more dose flexibility, or aren’t yet sure you want to commit to monthly, Brixadi is usually the better fit.

Which one is right for you?

There’s no universally “best” medication. There’s only the best fit for your situation. A rough framework:

Choose Suboxone if: You value flexibility, you’re new to treatment, you want to fine-tune your dose regularly, or you prefer taking your medication at home
Choose Sublocade if: You’re already stable, daily dosing has been a struggle, you travel often, or you simply want the convenience of one shot a month
Choose Brixadi if: You want an injectable with dose flexibility your provider can adjust, or you’d rather build up from weekly to monthly injections

The most important thing is this: any buprenorphine-based treatment dramatically reduces your risk of overdose and supports long-term recovery. Waiting for the “perfect” choice is riskier than starting with a good one. You and your Fresh Start Health provider will decide together based on your medical history, your daily life, and your goals — and you can switch between them later if your needs change.

Side effects and what to expect

Buprenorphine medications are generally well-tolerated, but every medication has side effects worth knowing about.

Common with all three:

Constipation (often manageable with hydration and fiber)
Headache, especially in the first few weeks
Nausea (usually improves within the first month)
Sweating
Difficulty sleeping in the first days

Specific to the injectables (Sublocade and Brixadi):

Injection site reactions — redness, itching, or a small firm lump under the skin. The lump is expected with Sublocade (it’s the medication depot) and usually softens over weeks
Occasional soreness at the injection site for 1–3 days

When to call the clinic:

Severe injection site pain, spreading redness, warmth, or fever
Signs of an allergic reaction (rash, hives, swelling, difficulty breathing)
Withdrawal-like symptoms that don’t improve within a few days of your first injection
Any new symptom that concerns you

Fresh Start Health providers are available by phone during business hours and via our 24-hour on-call line for anything urgent.

Switching between Suboxone, Sublocade, and Brixadi

Many patients start on Suboxone and later switch to an injectable — or switch between injectables — as their needs change. All of these transitions are routine.

Suboxone to Sublocade: People already taking buprenorphine can usually switch directly; people new to buprenorphine need only a single oral test dose first
Suboxone to Brixadi: Works the same way: a direct switch if you already take buprenorphine, or a single oral test dose first if you are new to it
Sublocade to Brixadi (or reverse): Your provider will time the switch based on your last injection date to keep buprenorphine levels stable and avoid withdrawal
Any injectable back to Suboxone: Straightforward once the injection depot has cleared, which takes several weeks after your last Sublocade or monthly Brixadi dose

Your Fresh Start Health provider will map out the timing to keep you comfortable throughout any transition. If you’re worried about withdrawal during a switch, that’s a conversation worth having up front.

Cost and insurance in Kentucky

Fresh Start Health accepts Kentucky Medicaid, Medicare, and most commercial insurance plans. All three medications — Suboxone, Sublocade, and Brixadi — are covered under most plans for opioid use disorder treatment.

As a 340B covered entity serving Eastern Kentucky, we’re able to access discounted medication pricing that we pass through to our patients. Even if you’re uninsured or underinsured, we work with every patient individually to find an affordable path to treatment. If cost is a concern, tell us at your first call — we’ll walk through your options before you commit to anything.

At Fresh Start Health

We provide Suboxone, Sublocade, and Brixadi treatment at all four Fresh Start Health clinics: Ashland, Grayson, Morehead, and Vanceburg — plus telehealth for eligible Kentucky patients. Same-week appointments are usually available, and our on-site team handles insurance verification so you can focus on getting started, not paperwork.

For more on the injectable options specifically, see our Sublocade and Brixadi treatment page.

Frequently Asked Questions

What is the difference between Suboxone, Sublocade, and Brixadi?

All three contain buprenorphine, the medication that reduces opioid cravings and withdrawal. The difference is how they’re delivered. Suboxone is a daily film or tablet you take at home. Sublocade is a once-monthly injection given in the clinic. Brixadi is an injection available in both weekly and monthly forms with more dose options. The best choice depends on how much daily involvement you want and how often you want to dose.

Is Brixadi or Sublocade better?

Neither is universally better. They suit different needs. Sublocade is a monthly-only injection with two dose strengths, so it fits people who are stable and want maximum convenience. Brixadi comes in weekly or monthly strengths with seven dose options, so it fits people who want more frequent check-ins or more flexible dosing. Both can now be started after a single test dose of oral buprenorphine. A Fresh Start Health provider can help you decide based on your treatment plan.

Can I switch from daily Suboxone to a monthly injection?

Yes. Many people start on daily Suboxone and later switch to a long-acting injection once they’re stable. Both Sublocade and Brixadi can be started after a single test dose of oral buprenorphine, and people already taking Suboxone can usually switch directly. Your Fresh Start Health provider will time the switch to keep you comfortable and avoid withdrawal symptoms.

Does insurance or Medicaid cover Suboxone, Sublocade, and Brixadi in Kentucky?

Fresh Start Health accepts Kentucky Medicaid and most commercial insurance plans, and all three medications are covered under most plans for opioid use disorder treatment. As a 340B covered entity serving Eastern Kentucky, we work to keep treatment affordable regardless of your coverage. If cost is a concern, call us at 606-225-8200 or use our chat function and we’ll help you understand your options before you start.

How much does Brixadi cost with insurance in Kentucky?

For most Kentucky Medicaid patients, Brixadi is covered with little to no out-of-pocket cost when prescribed for opioid use disorder. Commercial insurance coverage varies by plan — most cover Brixadi with a specialty medication copay. Fresh Start Health’s 340B status often allows us to reduce costs further. Coverage verification is included as part of your first appointment, so you’ll know your exact cost before your first injection.

How long does Sublocade stay in your system?

Buprenorphine from a Sublocade injection releases steadily over the month following your shot. Even after you stop injections, the depot under the skin can continue releasing medication for 12 months or longer, with buprenorphine detectable in bloodwork for several months. That’s why your provider carefully plans any transition off Sublocade — the medication doesn’t clear quickly like a daily pill.

Can I drink alcohol while on Sublocade or Brixadi?

Alcohol is generally not recommended with buprenorphine because both are central nervous system depressants and combining them increases the risk of sedation, breathing problems, and overdose. Occasional light drinking may be safer than binge drinking, but we recommend talking with your provider about your specific situation. If alcohol use is part of what you’re working through, alcohol use disorder is also something we treat at Fresh Start Health.

Is Brixadi weekly or monthly better?

Weekly Brixadi is often better for patients who are earlier in treatment, want more frequent check-ins with their clinic team, or aren’t yet ready for a long commitment to a single dose. Monthly Brixadi is often better for patients who are stable, want maximum convenience, and don’t want weekly clinic visits. Many patients start with weekly Brixadi and transition to monthly once they’ve found their stable dose.

Your privacy is protected

Everything you share with us about opioid use, medication history, and treatment is protected under federal privacy law — including 42 CFR Part 2, which provides stronger confidentiality protections than standard HIPAA rules for addiction treatment records. Your employer, family, and insurance company cannot access your records without your explicit written consent.

Ready to talk through your options?

Choosing between Suboxone, Sublocade, and Brixadi is a conversation, not a test. Our team at Fresh Start Health will walk you through each option and help you decide what fits your life.

Call us at 606-225-8200 or use our chat function on the site — we’re here to make the first step easy. If you’d rather send a message, contact us here and we’ll get back to you within one business day.

Dr. Jerrel Boyer, D.O. is the Medical Director of Fresh Start Health Centers, a multi-location clinic serving Eastern Kentucky. Board-certified in Neurosurgery, Dr. Boyer transitioned his clinical focus to addiction medicine and specialty care to address the opioid, hepatitis C, and HIV epidemics affecting rural Kentucky communities. He oversees medication-assisted treatment (MAT), hepatitis C cure therapy, PrEP for HIV prevention, and telehealth-delivered care across four locations — Ashland, Grayson, Morehead, and Vanceburg.

This content is for informational purposes only and is not a substitute for professional medical advice. Talk to a Fresh Start Health provider or your own clinician about which treatment is right for you. Individual outcomes vary; treatment is personalized to each patient.