Extended-release buprenorphine with flexible dosing intervals — an alternative to daily Suboxone for patients who want the benefits of an injection without waiting a week to start. Administered at our CARF-accredited injection clinics in Chattanooga and Cleveland, TN, and Ringgold, GA.
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At a glance
Who Brixadi is best for
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Brixadi is the long-acting buprenorphine injection that offers weekly or monthly dosing — useful for patients who want flexibility, who are early in stabilization, or who can’t wait the standard 7-day Suboxone induction before switching to a long-acting injectable. Weekly Brixadi (8 mg / 16 mg / 24 mg / 32 mg) is FDA-approved for use after a single dose of transmucosal buprenorphine, enabling faster transition than Sublocade. Monthly Brixadi (64 mg / 96 mg / 128 mg) provides month-long stable buprenorphine levels comparable to Sublocade. D’Onofrio 2024 JAMA Netw Open documented effective initiation patterns in emergency-department settings.
Brixadi injections are administered in clinic by trained providers at Restoration Recovery’s CARF-accredited clinics. Same-day first appointments at our Chattanooga, Cleveland, and Ringgold injection clinics; Soddy-Daisy patients receive their Brixadi injections at our main Chattanooga clinic, about 15 minutes south. TennCare, BlueCare, BCBS, UHC, and most commercial insurance accepted. Brixadi is covered under the TennCare medical benefit with prior authorization (separate from BESMART, which speeds buprenorphine pharmacy coverage).
What Is Brixadi?
Brixadi® is an FDA-approved, extended-release formulation of buprenorphine delivered as a subcutaneous injection for the treatment of opioid use disorder. Unlike daily Suboxone film or tablets, Brixadi is administered by a provider at the clinic on a weekly or monthly schedule — a single injection delivers a steady, controlled dose of buprenorphine over the following days or weeks. Brixadi is manufactured by Braeburn, Inc. and was FDA-approved in 2023 for the treatment of moderate to severe opioid use disorder.
For many patients in medication-assisted treatment, Brixadi is a more flexible path than monthly-only extended-release options. It offers the same benefits of injectable buprenorphine — consistent medication levels, no daily dosing, reduced diversion risk — while giving patients and their providers more control over the dosing interval.
How Brixadi Differs from Sublocade
Both Sublocade and Brixadi are extended-release buprenorphine injections for opioid use disorder, and both are effective treatments. They differ in a few clinically meaningful ways.
Dosing flexibility. Sublocade is administered once per month. Brixadi offers weekly and monthly dosing options — useful for patients who are still finding the right maintenance dose, who prefer more frequent clinic contact, or who are transitioning gradually toward a longer interval.
Time to first injection. Sublocade requires at least 7 days of stable daily transmucosal buprenorphine (Suboxone film or tablets) before the first injection can be given. Brixadi can be initiated after only a single induction dose of transmucosal buprenorphine — eligible patients skip the week of daily-dose stabilization Sublocade requires before moving to an injection. (As with Sublocade, the injection itself is ordered per-patient and given at a scheduled visit.)
Injection site options. Brixadi can be injected into the abdomen, thigh, buttock, or upper arm. Sublocade is labeled for abdominal injection only. This gives Brixadi patients more site-rotation flexibility over time.
Manufacturer. Brixadi is made by Braeburn, Inc. Sublocade is made by Indivior UK Limited. Both are FDA-approved, but availability and insurance coverage may vary by plan.
The choice between Brixadi and Sublocade depends on where you are in treatment, how quickly you want to begin an extended-release option, and what dosing interval works best for you. Our providers will help you weigh the options at your evaluation.
Your options
Buprenorphine, Three Ways
All three of our opioid-use-disorder medications deliver buprenorphine — the same partial-agonist molecule. What changes is the route and the dosing rhythm. Brixadi is the flexible-interval injection for patients who want an extended-release option without committing to a single fixed cadence; Suboxone is the daily film or tablet most patients start on, and Sublocade is the once-monthly injection.
For patients who want a flexible injection interval — or a faster start. A long-acting buprenorphine injection given in clinic on a weekly or monthly schedule. Unlike Sublocade, the weekly form can be started after a single transmucosal induction dose rather than a full week of daily Suboxone, so eligible patients reach an extended-release option sooner.
Daily film or tablet
Suboxone
Sublingual buprenorphine/naloxone · taken once daily under the tongue
For most patients starting OUD treatment. A daily sublingual film or tablet that reduces cravings and prevents withdrawal without the euphoria of full agonists. The medication most patients begin on, and the transmucosal induction step before a first Brixadi or Sublocade injection.
Monthly injection
Sublocade
300 mg ×2 to start (one month apart), then 100 mg or 300 mg monthly
For patients stable on Suboxone who want a single monthly visit. A once-monthly buprenorphine injection. Its FDA label requires at least 7 days of transmucosal buprenorphine first, so it suits patients already settled on daily Suboxone rather than those wanting the fastest start.
We don’t stock injections on-site — your provider orders Brixadi during your visit, and your injection appointment is scheduled once the medication arrives. Weighing the daily film against an injection? Our Sublocade vs. Daily Suboxone comparison lays out the trial evidence and lifestyle tradeoffs, and our MAT Medications Compared tracker puts all five MAT medications side by side.
The evidence
What the Research Shows on Brixadi
Brixadi’s FDA approval in May 2023 was supported by a 428-patient head-to-head trial comparing weekly and monthly depot injections directly against daily Suboxone — the current standard for outpatient medication-assisted treatment. Published in JAMA Internal Medicine in 2018, the trial showed the injection form of buprenorphine is clinically equivalent to the daily film, and on some measures modestly outperforms it.
14 → 17%Treatment responder rate
Brixadi met the FDA’s non-inferiority standard against daily Suboxone on the primary responder-rate endpoint (17% vs 14%). Lofwall MR et al. JAMA Intern Med. 2018;178(6):764–773 — 428 patients, 24 weeks, double-blind.
28 → 35%Urine samples opioid-free
Mean percent of urine samples that came back opioid-free over weeks 4–24 was higher on Brixadi (35%) than daily Suboxone (28%). Lofwall 2018, secondary endpoint.
The largest head-to-head test of depot buprenorphine against the daily film
The Lofwall trial is the largest double-blind, double-dummy active-controlled head-to-head comparison of a depot buprenorphine against daily sublingual buprenorphine. Brixadi met the FDA’s non-inferiority standard on the responder-rate endpoint and exceeded the daily medication on a secondary measure: the percent of urine samples opioid-free during the stabilization-and-maintenance window.
What makes Brixadi structurally different from other depot options is its dosing flexibility. Weekly 8, 16, 24, and 32 mg strengths let the first few weeks of treatment be dialed in carefully; monthly 64, 96, and 128 mg strengths take over once stability is clear. The other notable difference is induction: Brixadi can be started after a single transmucosal test dose, rather than the seven days of daily Suboxone Sublocade requires before the first injection.
The broader buprenorphine evidence base still applies. A Cochrane review of 31 trials and 5,430 participants found patients on buprenorphine-based medications are significantly more likely to remain in treatment than those on placebo.
At Restoration Recovery, Brixadi is offered alongside Suboxone and Sublocade as part of a full outpatient program — the injection keeps buprenorphine steady, and counseling plus regular check-ins address the rest of recovery.
Full citations in References: Lofwall 2018 (JAMA Intern Med), Lofwall 2021 (JAMA Netw Open), Haight 2019 (Lancet), Mattick 2014 (Cochrane).
Starting Brixadi — Your First Appointment
Your first visit typically lasts 2 to 3 hours and follows the same four-step clinical flow we use for all opioid use disorder intake, scoped toward your Brixadi start. Brixadi’s advantage shows up here: the weekly form can be started after a single transmucosal induction dose, so eligible patients reach an extended-release injection sooner than Sublocade allows. Because we don’t stock Brixadi on-site, your provider orders it and the injection is scheduled as a short follow-up once it is approved.
01
Intake
Paperwork and a clinical intake — a DSM-5 assessment to confirm the OUD diagnosis and severity, plus a COWS (Clinical Opiate Withdrawal Scale) score to measure your current withdrawal state.
02
Counseling
You meet with a counselor to discuss your substance use history, any prior treatment, and your goals — including which dosing interval (weekly or monthly) might fit your schedule.
03
Doctor evaluation
A medical provider reviews your intake, COWS score, and counselor notes, confirms you are clinically ready for buprenorphine without risking precipitated withdrawal, and explains the Brixadi induction path for your situation.
04
Induction dose + Brixadi order
You receive a transmucosal buprenorphine induction dose and a period of observation. Because the weekly form can follow a single induction dose, eligible patients move toward the injection without a week of daily stabilization. Your provider orders Brixadi, and your first injection is scheduled once the medication is approved.
About 2–3 hours.Single transmucosal induction dose; first injection scheduled once Brixadi is approved.Bring a photo ID, your insurance card, and a list of any medications.
What ongoing injection visits look like+
Once your schedule begins, you visit the clinic weekly or monthly for your injection, depending on the interval chosen — and each visit is also a check-in with the care team. A typical injection visit includes a brief clinical assessment and vitals check, administration of the Brixadi injection at one of the approved sites (abdomen, thigh, buttock, or upper arm), a short observation period, and a discussion of any side effects, changes in health, or adjustments to the plan. Each visit takes only a few minutes. Once injected, the medication forms a small depot beneath the skin that slowly releases buprenorphine into the bloodstream over the dosing interval; you may notice a small firm area at the injection site, which is normal and resolves over a few days.
Counseling continues alongside the medication. Medication alone is not a complete treatment for opioid use disorder, so patients are encouraged to engage fully in all components of their care plan — individual counseling, IOP where clinically indicated, and integrated care for any co-occurring conditions such as anxiety, depression, or hepatitis C.
Common side effects of Brixadi may include mild pain, redness, or itching at the injection site; these reactions are generally temporary and resolve within a few days. Your provider reviews all potential side effects with you before your first injection. Anything you share during intake, counseling, or your injection visits is protected by HIPAA and 42 CFR Part 2 — the federal rule that specifically shields addiction-treatment records from disclosure without your written consent.
Benefits of Brixadi Treatment
Patients who choose Brixadi for their medication-assisted treatment often report several practical and clinical advantages:
Faster access to injectable buprenorphine. Because the weekly form can be initiated after a single induction dose rather than 7 days on Suboxone, eligible patients get the benefits of extended-release medication much sooner.
Dosing flexibility. Weekly or monthly options let the dosing interval change as the patient’s needs change — more clinical contact early, longer stretches once stable.
Consistent medication levels. The depot delivery system provides steady buprenorphine levels across the dosing interval, which can mean fewer cravings and less day-to-day variability than daily oral dosing.
Reduced diversion risk. Because Brixadi is administered in the clinic and cannot be taken home, it significantly reduces the risk of medication misuse or diversion.
No daily dosing decisions. One injection replaces days or weeks of daily film administration, removing a common source of treatment friction and simplifying travel and daily routines.
Integrates with full recovery care. Brixadi works alongside counseling, IOP, and certified peer support — the medication addresses the physical component of opioid dependence while patients build the skills and support systems for long-term recovery.
Who Is a Candidate for Brixadi?
Brixadi is an option for a broader range of patients than Sublocade because its initiation requirements are less restrictive. Common candidates include:
New patients who want an extended-release option from the start. After an induction dose of transmucosal buprenorphine and a period of clinical observation, eligible patients can transition directly to Brixadi rather than waiting a full week on daily medication.
Patients currently on Suboxone who want to move to an injection but prefer a shorter interval than monthly, or who want to try a weekly cadence first.
Patients returning to treatment after a gap, where a weekly injection offers more consistent medication coverage during early stabilization.
Patients for whom monthly dosing has been difficult, either clinically (breakthrough cravings near the end of the month) or logistically (difficulty keeping a monthly appointment schedule).
Brixadi is not prescribed to patients who have not yet had an induction dose of transmucosal buprenorphine or who are not appropriate candidates for buprenorphine-based medication. Your provider confirms eligibility during your intake evaluation, which includes a DSM-5 assessment and a COWS score to confirm you are clinically ready to begin buprenorphine without risking precipitated withdrawal. Still weighing MAT options? Our Is Suboxone Right For Me? page walks through when daily Suboxone, weekly or monthly injection, and other pathways make clinical sense; for a head-to-head on daily sublingual versus monthly injection, see Sublocade vs. Daily Suboxone.
Want to start without a week of daily dosing?
Brixadi can follow a single induction dose. If you’re new to treatment or ready to move off the daily film, call and our team will confirm your eligibility and get your first visit scheduled — same-day appointments available.
Why Patients Choose Restoration Recovery for Brixadi
Brixadi is a newer medication (FDA-approved May 2023), and a clinic built for long-term, in-person care gets the most out of it. Because the injection is given in clinic, every dose is also a check-in with a provider who knows you. Here is what patients find at Restoration Recovery:
Three injection clinics across Tennessee and North Georgia. Chattanooga, Cleveland, and Ringgold give the injection in-clinic, so each visit is also a check-in with a provider who knows you. If Soddy-Daisy is your home clinic, your provider coordinates the injection visits at the Chattanooga flagship, about 15 minutes south.
MAT-certified providers and a CARF-accredited program. CARF (Commission on Accreditation of Rehabilitation Facilities) is the gold standard in addiction-treatment accreditation — a level of clinical scrutiny most outpatient clinics do not pursue.
One of Chattanooga’s longest-running outpatient clinics. Some of our patients have been with us for more than five years, and our providers have offered injectable buprenorphine since it was first available.
4.6 stars across 49 verified Google reviews. Read a few before you call.
Integrated counseling and behavioral health in-house. Medication without counseling is only part of a treatment plan. We provide both under one roof, and treat co-occurring anxiety, depression, or trauma alongside recovery.
Most major insurance plans accepted. TennCare, Medicaid, Medicare, and commercial carriers. For most patients, out-of-pocket cost is minimal to none.
Confidential by federal law. Your treatment is protected under HIPAA and 42 CFR Part 2, which specifically shields addiction-treatment records from most forms of disclosure.
“I owe my entire recovery to this place. I had tried so many times in the past, but not until I found these guys did I succeed.”
CARF-accredited outpatient addiction care
TennCare, BlueCare, BCBS, UHC, Medicare & most commercial insurance accepted. We verify your benefits before your first visit — no surprises. Licensed in TN & GA · HIPAA · 42 CFR Part 2.
Insurance and Access
Restoration Recovery accepts most major insurance plans for Brixadi treatment, including TennCare, Medicaid, Medicare, and many commercial insurance plans. Our patient services team can verify your coverage and explain any out-of-pocket costs before treatment begins. To check your plan before you book, use our 2-minute insurance verification or visit our insurance page.
For TennCare members specifically, Restoration Recovery is enrolled in TennCare’s BESMART program, which speeds preferred buprenorphine pharmacy coverage (Suboxone film and tablet, generic buprenorphine/naloxone). Brixadi is administered in the clinic rather than filled at a pharmacy, so it is covered under the TennCare medical benefit with its own prior-authorization process — separate from BESMART. Our team coordinates both pathways when clinically appropriate. Prior authorization is usually required, and specific dosing intervals (weekly vs. monthly) may be approved separately by some plans; we don’t stock Brixadi on-site, so the injection is scheduled as a follow-up once it is ordered and approved.
Ready to start Brixadi?
Same-day appointments at our injection clinics. Call and our team will verify your insurance, confirm the right induction path, and get your first visit on the calendar.
Brixadi is administered at three Restoration Recovery clinic locations across Tennessee and North Georgia. Each is staffed by providers experienced in medication-assisted treatment for opioid use disorder, with same-day appointments often available.
Brixadi is an injection, so it is not given at our Soddy-Daisy clinic — if Soddy-Daisy is your home clinic, your provider sets up the injection visits at our main Chattanooga clinic, about 15 minutes south. Phones are answered Monday through Friday, 9am to 4:30pm Eastern. After hours? The 988 Suicide & Crisis Lifeline and the free, confidential SAMHSA National Helpline (1-800-662-4357) are available 24/7.
References
The statistics and clinical findings on this page come from peer-reviewed medical research and authoritative public-health sources. Patients, family members, and providers are welcome to verify any claim against the original source.
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;178(6):764–773. [PubMed]
Lofwall MR, Nunes EV, Oyagbemi B, et al. Patient-Reported Outcomes of Treatment of Opioid Dependence With Weekly and Monthly Subcutaneous Depot vs Daily Sublingual Buprenorphine: A Randomized Clinical Trial. JAMA Network Open. 2021;4(5):e219041. [JAMA]
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. [PubMed]
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews. 2014;(2):CD002207. [Cochrane]
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;357:j1550. [PubMed]
American Society of Addiction Medicine (ASAM). National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. [ASAM]
BRIXADI (buprenorphine extended-release) for injection. Prescribing Information. Braeburn Inc. Accessed via DailyMed, U.S. National Library of Medicine. [DailyMed]
Questions
Frequently Asked Questions
How is Brixadi different from Sublocade?+
Both are extended-release buprenorphine injections for opioid use disorder, but Brixadi offers more dosing flexibility. Brixadi is available in weekly and monthly dose strengths; Sublocade is monthly only. Brixadi can be injected into the upper arm, abdomen, thigh, or buttock with site rotation; Sublocade is abdomen-only. Brixadi is manufactured by Braeburn; Sublocade is manufactured by Indivior. Both deliver steady buprenorphine blood levels that reduce cravings and prevent withdrawal. The choice usually comes down to dosing preference (some patients want more frequent clinical contact; others prefer minimal disruption) and insurance coverage.
Should I choose weekly or monthly Brixadi dosing?+
It depends on your treatment goals, life circumstances, and clinical history. Weekly dosing (8 mg, 16 mg, 24 mg, or 32 mg) provides the highest frequency of clinical contact — useful if you’re in early recovery and benefit from more provider check-ins or if your insurance approves weekly administration. Monthly (64 mg, 96 mg, or 128 mg) gives you the longest stretch between visits and works well for stable patients. Your provider will help you pick a starting interval, and many patients start on weekly and move to monthly once they’re stable.
Can I start Brixadi without first being on daily Suboxone?+
Yes, in many cases. A 2024 JAMA Network Open emergency-department trial (D’Onofrio et al.) showed Brixadi can be initiated at a COWS score under 8 with a precipitated-withdrawal rate around 7% in 100 patients — meaning patients don’t necessarily need to stabilize on daily Suboxone first. This is a meaningful difference from Sublocade, which per FDA label requires prior transmucosal buprenorphine stabilization. For patients currently using fentanyl, a direct Brixadi initiation is sometimes used rather than requiring daily Suboxone stabilization first. Your provider will decide the appropriate induction path based on your specific history.
Does my insurance cover Brixadi, or will I have a copay?+
Most insurance plans cover Brixadi, including TennCare (BlueCare, Wellpoint, UHC Community Plan), traditional Medicare, Medicare Advantage, and most commercial plans. Prior authorization is usually required, and specific dosing intervals (weekly vs. monthly) may be approved separately by some plans. TennCare members typically have $0 out-of-pocket for both the office visit and the medication. Commercial copays vary. Our intake team verifies your specific Brixadi coverage before your first injection, and we don’t stock Brixadi on-site — the injection is scheduled as a follow-up appointment once the medication is ordered and approved. See our insurance page for carrier details.
What happens if I miss a Brixadi injection?+
Call us as soon as possible. For weekly Brixadi patients, even a few days’ delay is worth catching up on quickly since your blood level is designed to run on a 7-day cadence. Monthly patients have more buffer (buprenorphine’s long half-life provides residual protection), but beyond the scheduled interval you may start experiencing breakthrough cravings or mild withdrawal symptoms. We may recommend a brief transition back to daily Suboxone until your next injection, or we may reschedule promptly. Missing multiple doses is a significant clinical concern and worth discussing with your provider right away.
Can I switch between Brixadi and Sublocade?+
Yes. Switching between extended-release buprenorphine formulations is clinically straightforward. Because both deliver the same active medication at similar steady-state blood levels, transitioning from monthly Sublocade to a Brixadi interval (or vice versa) requires coordinated timing — usually starting the new injection at the end of the prior medication’s coverage window. Your provider calculates the right switch window. Common reasons for switching: wanting more frequent clinical contact (Sublocade → Brixadi weekly), wanting fewer injections (Brixadi → Sublocade), insurance changes, or injection-site preferences.
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Ask about Brixadi at your first visit
New to treatment? Brixadi doesn’t require a week of Suboxone stabilization first. Same-day appointments available.
