2026 MAT Medications Compared: Suboxone, Sublocade, Brixadi, Vivitrol, and Acamprosate Side by Side

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 fits your life better, and how prior authorization stacks up against your specific TennCare or commercial plan. Suboxone, Sublocade, and Brixadi treat opioid use disorder. Vivitrol and Acamprosate treat alcohol use disorder. The two tables below show what is clinically true for each medication; 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. These are the medical inputs to the decision. Source data: FDA labels via DailyMed, the ASAM National Practice Guideline, and SAMHSA TIP 63.

One clarification on Vivitrol: the FDA label 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, real cost, what abuse-deterrent measures look like, and what the day-to-day pattern is. These are the life-fit inputs to the decision.

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: short, honest descriptions of the patient situation each medication is built for. None of these preferences are wrong. They are real inputs to a real decision.

Suboxone (daily film or tablet)

Suboxone fits when a patient wants a short ramp-up from withdrawal to a stable daily dose, has a supportive home environment for medication storage, and is comfortable with the daily routine of self-administration. It is the standard starting point for opioid use disorder and the medication with the longest evidence base — Sordo et al. 2017 BMJ shows mortality among patients on buprenorphine maintenance is roughly 70% lower than off-treatment. The film and tablet are bioequivalent at the same dose; choice between them is patient preference. The trade-off: the medication is in the house every day, which is a real consideration for patients in shared housing or with family members in active use.

Sublocade (monthly buprenorphine injection)

Sublocade fits 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 Haight 2019 PROBE trial in The Lancet showed Sublocade roughly tripled opioid-free urine results and doubled treatment success compared with placebo over six months. The catch: it requires seven days of stable Suboxone dosing first, so it is not a first-day option. Once initiated, monthly injections are administered at the Chattanooga, Cleveland, or Ringgold clinic; Soddy-Daisy refers to those locations for the injection.

Brixadi (weekly, bi-weekly, or monthly buprenorphine injection)

Brixadi fits when a patient wants the long-acting profile of an injection but needs a faster onset than Sublocade allows, or when the weekly cadence better matches their stability and follow-up pattern. Lofwall et al. 2018 JAMA Internal Medicine showed Brixadi non-inferior to daily sublingual buprenorphine across responder rate and opioid-free urine endpoints. Same-day initiation is possible for many patients without the 7-day Suboxone pre-dose Sublocade requires — meaningful for patients who want to start a long-acting option without first stabilizing on the daily film. Available at all four Restoration Recovery clinics that offer injections.

Vivitrol (monthly naltrexone injection — alcohol use disorder only at RR)

Vivitrol fits when a patient with alcohol use disorder is past acute withdrawal, wants a non-buprenorphine path forward, and prefers a once-monthly clinical visit 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 no daily decision. The fit is patients who have stabilized off alcohol and want craving-reduction support with the structure of a scheduled clinical visit.

Acamprosate (daily oral — alcohol use disorder)

Acamprosate fits when a patient with alcohol use disorder is abstinent at the start of treatment, prefers an oral medication over an injection, and wants the lowest-friction option 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 — a meaningful clinical advantage when paired with counseling. The 333-milligram tablets are typically taken as two tablets three times daily; the schedule rewards routine. Dose adjustment is required for patients with reduced kidney function. Not appropriate during active drinking; the medication maintains sobriety rather than initiating it.

Cost and TennCare specifics

For most TennCare members, every medication on this page is covered with zero out-of-pocket cost. Generic Suboxone (buprenorphine/naloxone) and acamprosate are on the OptumRx Preferred Drug List with no prior authorization required at BESMART-enrolled clinics. 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, usually within one business day. Patients without insurance can self-pay at $250 per month for the medical visit and treatment management; medication is billed separately through pharmacy or via patient-assistance programs.

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 at the clinic; it requires seven days of stable Suboxone first. Brixadi is a buprenorphine injection that offers weekly, bi-weekly, or monthly schedules and can be initiated the same day for many patients. 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, no extended opioid-free washout required, and lower post-treatment overdose risk if a patient discontinues. 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 without prior authorization at BESMART-enrolled clinics; 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. The standard pathway is at least seven days of stable Suboxone at 8 to 24 milligrams per day, then transition to the first Sublocade 300-milligram injection. Subsequent injections are typically 100 milligrams monthly, with some patients staying at 300 milligrams. The decision is not one-way; if monthly injections do not fit, 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 requires complete opioid-free abstinence at initiation. Acamprosate is non-addictive and not abusable but is filtered by the kidneys, so dose adjustment is required for patients with reduced kidney function. The right safety profile is the one that matches the patient's clinical picture.

What this comparison cannot do for you

This page can narrow the field; it cannot make the decision. The medication that fits is the one that matches your diagnosis, your medication-adherence pattern, your home situation, your insurance, and your treatment goals — in conversation with a clinician who has the full picture. Restoration Recovery's intake process starts with a 60- to 120-minute 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. Book a callback or call 423-498-2000 when you are ready.

References

Primary clinical, regulatory, and policy sources cited on this page. Updated April 25, 2026.

1. 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]
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. [Lancet 2019 (PROBE)]
3. 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)]
4. 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)]
5. Rösner S, Hackl-Herrwerth A, Leucht S, et al. Acamprosate for alcohol dependence. Cochrane Database of Systematic Reviews. 2010. [Cochrane 2010]
6. U.S. Food and Drug Administration. DailyMed (FDA-approved drug labels). [DailyMed]
7. American Society of Addiction Medicine. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder — 2020 Focused Update. [ASAM]
8. Substance Abuse and Mental Health Services Administration. TIP 63: Medications for Opioid Use Disorder. [SAMHSA TIP 63]
9. TennCare. BESMART Program Description. [BESMART PDF]
10. U.S. Code of Federal Regulations. 42 CFR Part 2 — Confidentiality of Substance Use Disorder Patient Records. [eCFR]