The short version
Choosing among MAT medications comes down to three questions in order: which diagnosis is being treated (opioid use disorder or alcohol use disorder), whether daily oral self-administration or a long-acting injection works better for you, and whether your specific TennCare or commercial plan requires prior authorization for that medication. Suboxone, Sublocade, and Brixadi treat opioid use disorder; all three contain buprenorphine, which the ASAM National Practice Guideline recommends. Vivitrol and Acamprosate treat alcohol use disorder. The two tables below show the clinical details first, then coverage and day-to-day use; the section after them explains which patient situations each medication is built for.
Clinical profile at a glance
The first set of differences is clinical: what each medication does at the receptor level, how it is delivered, and what the safety profile looks like. Source data: FDA labels via DailyMed, the ASAM National Practice Guideline, and SAMHSA TIP 63.
| Opioid use disorder | Alcohol use disorder | ||||
|---|---|---|---|---|---|
| Property | SuboxoneSuboxone: Who it’s for | SublocadeSublocade: Who it’s for | BrixadiBrixadi: Who it’s for | VivitrolVivitrol: Who it’s for | AcamprosateAcamprosate: Who it’s for |
| Generic name | Buprenorphine / naloxone | Buprenorphine ER | Buprenorphine ER | Naltrexone ER | Calcium acetylhomotaurinate |
| Indication at RR | Opioid use disorder | Opioid use disorder | Opioid use disorder | Alcohol use disorder only | Alcohol use disorder |
| Mechanism | Partial mu-agonist with naloxone abuse-deterrent | Partial mu-agonist (extended release) | Partial mu-agonist (extended release) | Mu-opioid antagonist | Modulates GABA & glutamate |
| Route | Sublingual film or tablet | Subcutaneous injection | Subcutaneous injection | Intramuscular injection | Oral tablet |
| Frequency | Daily | Once monthly | Weekly or monthly | Once monthly | Three times daily |
| Typical dose | 8–24 mg/day | 100 mg or 300 mg | 8–128 mg per dose, schedule-dependent | 380 mg | 666 mg (2 × 333 mg) three times daily |
| Ceiling effect on respiratory depression | Yes | Yes | Yes | Not applicable (antagonist) | Not applicable (non-opioid) |
| Initiation requirements | In withdrawal before the first dose; at our clinics, you take that dose at home, and your provider explains when to take it | A buprenorphine dose first; at our clinics, at least a week of Suboxone | At our clinics, Suboxone first, until you are stable and the injection arrives | Past acute withdrawal; not actively drinking at first injection | Abstinent at initiation |
Vivitrol: alcohol use disorder only at RR
The FDA label for Vivitrol includes both opioid use disorder and alcohol use disorder, but at Restoration Recovery, Vivitrol is used exclusively for alcohol use disorder. For opioid use disorder, the buprenorphine-based pathway has a longer evidence base and does not require an extended opioid-free washout, so our clinical team prescribes one of the three buprenorphine options instead.
Practical considerations side by side
The second set of differences is practical: prior authorization, cost, what abuse-deterrent measures look like, and what the day-to-day pattern is.
| Opioid use disorder | Alcohol use disorder | ||||
|---|---|---|---|---|---|
| Consideration | SuboxoneSuboxone: Who it’s for | SublocadeSublocade: Who it’s for | BrixadiBrixadi: Who it’s for | VivitrolVivitrol: Who it’s for | AcamprosateAcamprosate: Who it’s for |
| Where it is filled | Pharmacy | Clinic-administered | Clinic-administered | Clinic-administered | Pharmacy |
| TennCare prior auth | No (generic, BESMART, ≤24 mg/day) | Yes | Yes | Yes | No |
| Typical TennCare member cost | $0 | $0 | $0 | $0 | $0 |
| Commercial / Medicare | Generic-tier copay | Medical benefit per plan | Medical benefit per plan | Medical benefit per plan | Generic-tier copay |
| Abuse-deterrent profile | Naloxone component limits IV misuse | Not stockable; clinic-only administration | Not stockable; clinic-only administration | Antagonist blocks opioid effect | Not abusable |
| Take-home factor | Daily medication at home | No medication at home | No medication at home | No medication at home | Daily medication at home |
| Telehealth-friendly after first visit | Yes | No (injection at clinic) | No (injection at clinic) | No (injection at clinic) | Yes |
| Switching pathway | Standard starting point | At our clinics, switch from Suboxone after at least a week | At our clinics, switch from Suboxone once stable and the injection arrives | Past acute withdrawal; AUD only at RR | Pair with counseling once abstinent |
TennCare and other insurance
For the full TennCare-side picture (BESMART rules, prior-auth criteria, telehealth coverage under the December 2025 DEA permanent buprenorphine rule), see our 2026 TennCare MAT Coverage Tracker. For the all-payer summary, see our insurance at-a-glance comparison.
When each medication is the right fit
Below are short descriptions of the patient situation each medication is built for. Your preferences, such as daily medication at home or an injection at the clinic, are part of the decision.
Suboxone (daily film or tablet)
Suboxone is a good option when a patient wants to get from withdrawal to a stable daily dose quickly, has a supportive home environment and safe medication storage, and is comfortable taking it every day on their own. It is the standard starting point for opioid use disorder — Sordo et al. 2017 BMJ reports overdose deaths at 1.4 per 1,000 patients per year during buprenorphine treatment, against 4.6 per 1,000 after treatment stopped. The film and tablet are bioequivalent at the same dose; choice between them is patient preference. The trade-off is that the medication is in the house every day, which matters for patients in shared housing or with family members in active use.
Sublocade (monthly buprenorphine injection)
Sublocade is a good option when daily medication adherence is the obstacle, when the patient does not want buprenorphine in the home, or when frequent travel makes carrying a controlled substance impractical. The pivotal phase 3 trial (Haight et al., Lancet, 2019) found that participants on Sublocade were opioid-free, by urine test and self-report, in about 41 to 43% of weeks 5 through 24, against 5% of weeks on placebo. Sublocade is not a first-day option. At our clinics, patients take Suboxone for at least a week first, and the first injection usually comes about a month after they start treatment. Once initiated, monthly injections are administered at the Chattanooga, Cleveland, or Ringgold clinic; Soddy-Daisy refers to those locations for the injection.
Brixadi (weekly or monthly buprenorphine injection)
Patients may choose Brixadi when they want a long-acting injection, or when a weekly schedule better matches their stability and follow-up. Lofwall et al. 2018 JAMA Internal Medicine showed Brixadi non-inferior to daily sublingual buprenorphine across responder rate and opioid-free urine endpoints. At our clinics, patients take Suboxone first and switch to Brixadi once they are stable and the injection has arrived. Available at our Chattanooga, Cleveland, and Ringgold clinics (Soddy-Daisy is oral-only).
Vivitrol (monthly naltrexone injection — alcohol use disorder only at RR)
Vivitrol fits when a patient with alcohol use disorder is past acute withdrawal, is ready to pause drinking around the start of treatment, and prefers a long-acting injection over daily medication. Garbutt et al. 2005 JAMA showed approximately 25% fewer heavy-drinking days versus placebo over six months. The injection is given once monthly at the clinic; there is no take-home medication and nothing to take each day. It suits patients who want help with cravings and like the routine of a scheduled clinic visit.
Acamprosate (daily oral — alcohol use disorder)
Acamprosate is a good option when a patient with alcohol use disorder is abstinent at the start of treatment and prefers an oral medication over an injection for ongoing maintenance. The Rösner 2010 Cochrane review of 24 randomized trials with 6,915 patients found a number-needed-to-treat of 9 for continuous abstinence. Acamprosate is meant to be paired with counseling. The 333-milligram tablets are typically taken as two tablets three times daily. Dose adjustment is required for patients with reduced kidney function. Not appropriate during active drinking; it maintains sobriety after a patient has stopped drinking.
Cost and TennCare specifics
For most TennCare members, Suboxone, Sublocade, Brixadi, Vivitrol, and acamprosate are all covered with zero out-of-pocket cost. Generic Suboxone (buprenorphine/naloxone) and acamprosate are on the OptumRx Preferred Drug List. Acamprosate needs no prior authorization, and at BESMART-enrolled clinics generic Suboxone needs none at doses up to 24 mg a day. The three injections (Sublocade, Brixadi, Vivitrol) require prior authorization but are billed under the medical benefit, so there is no pharmacy copay. The full breakdown is in the 2026 TennCare MAT Coverage Tracker.
For commercial insurance, generic Suboxone and acamprosate run at the lowest pharmacy copay tier. Injection coverage and prior-auth criteria vary by plan; the Restoration Recovery patient services team verifies benefits before the first visit. If you reach us by phone, verifying your benefits takes under a minute. If not, we'll get back to you within one business day. If you don't have insurance, you can self-pay $250 per month for the medical visit and treatment management. Medication is billed separately at your pharmacy, and we can give you a free prescription discount card to use there.
Common patient questions
What is the difference between Suboxone, Sublocade, and Brixadi?
All three are buprenorphine-based medications for opioid use disorder, but they differ in delivery and dosing schedule. Suboxone is a daily sublingual film or tablet that combines buprenorphine with naloxone; the patient self-administers each dose. Sublocade is a once-monthly subcutaneous buprenorphine injection given in the office. At our clinics, patients take Suboxone for at least a week first, and the first injection usually comes about a month after they start treatment. Brixadi is a buprenorphine injection available in weekly or monthly schedules. At our clinics, Brixadi patients also start on Suboxone and switch once they are stable and the injection has arrived. Clinical effectiveness is comparable when patients are matched to the right delivery method.
Can Vivitrol be used for opioid use disorder at Restoration Recovery?
No. At Restoration Recovery, Vivitrol is used exclusively for alcohol use disorder. The FDA label allows opioid use disorder, but the buprenorphine pathway is more clinically appropriate at our clinics: longer evidence base and no extended opioid-free washout required. For opioid use disorder, our clinical team recommends one of the three buprenorphine options.
Which MAT medication has the lowest out-of-pocket cost on TennCare?
For most TennCare members, all five medications are $0 out-of-pocket. Generic buprenorphine/naloxone and acamprosate are on the OptumRx Preferred Drug List. Acamprosate needs no prior authorization, and at BESMART-enrolled clinics generic buprenorphine/naloxone needs none at doses up to 24 mg a day. The three injections require prior auth but no pharmacy copay since they are billed under the medical benefit.
What if I want to switch from Suboxone to Sublocade?
Switching from daily Suboxone to monthly Sublocade is a routine clinical decision. At our clinics, patients take Suboxone for at least a week before the first Sublocade 300-milligram injection, which usually comes about a month after they start. Subsequent injections are typically 100 milligrams monthly, with some patients staying at 300 milligrams. The decision is not one-way; if monthly injections are not working for a patient, the clinical team transitions back to daily film or tablet.
Is one MAT medication safer than the others?
All five have strong safety profiles when prescribed and monitored appropriately, but the safety questions differ by class. Buprenorphine medications (Suboxone, Sublocade, Brixadi) have a built-in ceiling effect on respiratory depression that makes them substantially safer than full-agonist opioids; the naloxone in Suboxone is an abuse-deterrent measure that does not affect intended sublingual use. Vivitrol is an opioid antagonist with no respiratory-depression risk, but it can only be started once a patient is off all opioids; otherwise the first injection can trigger sudden withdrawal (precipitated withdrawal). Acamprosate is non-addictive and not abusable but is filtered by the kidneys, so dose adjustment is required for patients with reduced kidney function.
What this comparison cannot do for you
This page can help you narrow the field. Which medication is right for you depends on your diagnosis, medication-adherence pattern, home situation, insurance, and treatment goals, and you make that decision with a clinician. Restoration Recovery's intake process starts with a 2-to-3-hour first visit at one of our four clinics across Southeast Tennessee and Ringgold, Georgia: DSM-5 assessment, COWS score if applicable, counselor conversation, and time with a medical provider. The medication recommendation comes out of that conversation. Request a callback or call 423-498-2000 when you are ready.
After hours? The 988 Suicide & Crisis Lifeline and the free, confidential SAMHSA National Helpline (1-800-662-4357) are available 24/7.
References
Primary clinical, regulatory, and policy sources cited on this page. Updated April 25, 2026.
- Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017. [BMJ 2017]
- 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. [Lancet 2019 (Sublocade)]
- Lofwall MR, Walsh SL, Nunes EV, et al. 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. 2018. [JAMA Intern Med 2018 (Brixadi)]
- Garbutt JC, Kranzler HR, O'Malley SS, et al. Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA. 2005. [JAMA 2005 (Vivitrol)]
- Rösner S, Hackl-Herrwerth A, Leucht S, et al. Acamprosate for alcohol dependence. Cochrane Database of Systematic Reviews. 2010. [Cochrane 2010]
- U.S. Food and Drug Administration. DailyMed (FDA-approved drug labels). [DailyMed]
- American Society of Addiction Medicine. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder — 2020 Focused Update. [ASAM]
- Substance Abuse and Mental Health Services Administration. TIP 63: Medications for Opioid Use Disorder. [SAMHSA TIP 63]
- TennCare. BESMART Program Description. [BESMART PDF]
- U.S. Code of Federal Regulations. 42 CFR Part 2 — Confidentiality of Substance Use Disorder Patient Records. [eCFR]