Medication-Assisted Treatment · Updated April 2026

Brixadi Treatment (Weekly, Bi-Weekly & Monthly Injection)

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 four CARF-accredited outpatient clinics across Tennessee and Georgia.

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Same-day appointments available in most cases · TennCare, BlueCare, BCBS, UHC, and most commercial insurance accepted.

At a glance

Who Brixadi is best for

Brixadi is the long-acting buprenorphine injection that offers weekly OR monthly dosing options — 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 (8mg / 16mg / 24mg / 32mg) is FDA-approved for use after a single dose of transmucosal buprenorphine, enabling faster transition than Sublocade. Monthly Brixadi (64mg / 96mg / 128mg) 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-week first appointments at our Chattanooga and Cleveland clinics; Soddy-Daisy does not offer injection services and our Ringgold clinic is preparing to begin scheduling. 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, bi-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 represents 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, bi-weekly, and monthly dosing options — useful for patients who are still finding the right maintenance dose, patients who prefer more frequent clinic contact, or patients 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, meaning eligible patients can often start Brixadi the same day or within a day or two of presenting for treatment — a significant clinical advantage for patients who want to move quickly to an injection.
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 your treatment journey, how quickly you want to begin an extended-release option, and what dosing interval fits your life. Our providers will help you weigh the options at your evaluation.

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 or bi-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 will confirm eligibility during your intake evaluation, which includes a DSM-5 assessment and a COWS (Clinical Opiate Withdrawal Scale) score to confirm you are clinically ready to begin buprenorphine without risking precipitated withdrawal.

Patients still weighing MAT options often find our Is Suboxone Right For Me? page helpful — it walks through when daily Suboxone, weekly/bi-weekly/monthly injection, and other pathways make clinical sense for different situations. For a head-to-head comparison of daily sublingual versus monthly injection specifically, see Sublocade vs. Daily Suboxone. For all five MAT medications side by side — Suboxone, Sublocade, Brixadi, Vivitrol, and Acamprosate — in two scannable tables, see our MAT Medications Compared tracker.

How the Brixadi Injection Works

The Brixadi injection is administered by a healthcare provider at the clinic. It cannot be self-administered or taken home. Each visit takes only a few minutes.

During the injection, the provider delivers Brixadi subcutaneously into one of four approved sites: the abdomen, thigh, buttock, or upper arm. Once injected, the medication forms a small depot beneath the skin that slowly releases buprenorphine into the bloodstream over the approved dosing interval. Patients may notice a small firm area at the injection site for a period after the dose, which is normal and resolves over time.

Brixadi comes in multiple FDA-approved strengths. Weekly doses are available in 8, 16, 24, and 32 mg. Monthly doses are available in 64, 96, and 128 mg. Your provider selects the dose and interval based on your clinical response, prior Suboxone dose (if applicable), and treatment goals. Many patients begin on a weekly schedule for the first several weeks to dial in the right dose, then transition to a longer interval as their treatment stabilizes.

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 Brixadi 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, bi-weekly, or monthly options let the treatment plan adapt to the patient rather than forcing the patient to adapt to the medication’s schedule.
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 continue building the skills and support systems needed for long-term recovery.

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 gold standard for outpatient medication-assisted treatment. Published in JAMA Internal Medicine in 2018, the trial showed that the injection form of buprenorphine is clinically equivalent to the daily film, and on some measures it modestly outperforms.

Brixadi matches daily Suboxone on the FDA’s primary measure

Treatment responder rate, 24-week trial

14% Daily Suboxone

17% Brixadi injection Non-inferior (+3 pts)

Source: Lofwall MR et al. JAMA Internal Medicine. 2018;178(6):764–773. 428 patients, 24 weeks, double-blind.

Patients on Brixadi test opioid-free more often

Mean % of urine samples opioid-free, weeks 4–24

28% Daily Suboxone

35% Brixadi injection +7 percentage points

Source: Lofwall MR et al. JAMA Internal Medicine. 2018;178(6):764–773.

Dosing designed around real patients, not a one-size schedule

Brixadi’s FDA-approved dose strengths

7 Weekly + monthly strengths Weekly: 8/16/24/32 mg · Monthly: 64/96/128 mg

Source: BRIXADI Prescribing Information, Braeburn Inc. Accessed via DailyMed.

Why Brixadi is a meaningful step forward

The Lofwall trial is the largest placebo-controlled head-to-head comparison of any depot buprenorphine against daily sublingual buprenorphine. Brixadi met the FDA’s non-inferiority standard on the responder-rate endpoint, and it exceeded the daily medication on a secondary measure: the percent of urine samples that came back 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 allow the first few weeks of treatment to be dialed in carefully. Monthly 64, 96, and 128 mg strengths take over once stability is clear. No other buprenorphine injection offers that degree of fit-to-patient adjustment.

The other notable difference: Brixadi can be started after a single transmucosal test dose on the same day. Sublocade requires seven days of daily Suboxone before a patient is eligible for the first injection. For a patient ready to move past the daily film, Brixadi removes that waiting period.

The broader buprenorphine evidence base still applies. A Cochrane review of 31 clinical trials and 5,430 participants found that patients on buprenorphine-based medications are significantly more likely to remain in treatment than those on placebo. (Full citations in References.)

At Restoration Recovery, Brixadi is offered alongside Suboxone and Sublocade as part of a full outpatient treatment program. The medication gets patients stable. Our team keeps them there.

What to Expect During Treatment

Patients receiving Brixadi at Restoration Recovery will visit the clinic weekly, every other week, or monthly for their injection, depending on the dosing interval chosen. Each visit also serves as an opportunity to check in with the care team and discuss progress. A typical injection visit includes:

A brief clinical assessment and vitals check
Administration of the Brixadi injection at one of the approved sites
A short observation period following the injection
Discussion of any side effects, changes in health, or adjustments to the treatment plan

Counseling and peer support continue alongside medication. Medication alone is not a complete treatment for opioid use disorder, and patients are encouraged to engage fully in all components of their care plan — including individual counseling, group 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 will review all potential side effects with you before your first injection.

Anything you share during intake, counseling, or your Brixadi 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.

Why Patients Choose Restoration Recovery for Brixadi

Brixadi is a newer medication (FDA-approved May 2023), and the clinic you choose to receive it at matters. Here is what patients find at Restoration Recovery:

Four physical clinics across Tennessee and Georgia. Chattanooga, Cleveland, Soddy-Daisy, and Ringgold. Brixadi is administered in-clinic, so each injection visit is also a check-in with a provider who knows you.
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. Our providers have been offering injectable buprenorphine since it was first available.
4.5 stars across more than 40 verified Google reviews. Real patients, real experiences.
Integrated counseling and behavioral health in-house. Medication without counseling is only part of a treatment plan. We provide both under one roof.
Most major insurance plans accepted. TennCare, Medicaid, Medicare, and commercial carriers.
Confidential by federal law. Your treatment is protected under HIPAA and 42 CFR Part 2.

Insurance and Access

Restoration Recovery accepts most major insurance plans for Brixadi treatment, including TennCare, Medicaid, and many commercial insurance plans. Our patient services team can verify your coverage and explain any out-of-pocket costs before treatment begins. Visit our insurance page for the full list of accepted carriers, or contact us directly to have our team check your benefits.

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.

If you have questions about cost or coverage, call before your appointment. Our goal is to make sure that financial concerns do not stand in the way of effective treatment.

Our Clinic Locations

Brixadi injections are available at all four Restoration Recovery clinic locations across Tennessee and Georgia:

Chattanooga, TN — Main clinic at 6141 Shallowford Rd, Suite 100
Cleveland, TN
Soddy-Daisy, TN
Ringgold, GA

Each location is staffed by providers experienced in medication-assisted treatment for opioid use disorder. Same-week appointments are often available for new patients looking to begin treatment.

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, bi-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.

Which Brixadi dosing interval should I choose — weekly, bi-weekly, or monthly?

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. Bi-weekly (16 mg, 24 mg, 32 mg) balances clinical touch with convenience. 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. Many patients start on weekly or bi-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, direct Brixadi initiation is an increasingly common first-line approach. 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. Bi-weekly and 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 less (Brixadi → Sublocade), insurance changes, or injection-site preferences.

Taking the Next Step

If you are currently on daily Suboxone and interested in whether Brixadi could simplify your treatment, bring it up with your provider at your next appointment. If you are new to treatment and want to learn about all of your medication options — daily Suboxone, monthly Sublocade, and weekly or monthly Brixadi — our team is ready to help you understand the path forward.

Restoration Recovery offers a full range of outpatient treatment services for opioid use disorder, including medication management, individual counseling, IOP, and peer support. Every treatment plan is built around the individual patient, and our providers will work with you to find the approach that best fits your life and your goals.

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]

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New to treatment? Brixadi can often start within a day or two — no week-long Suboxone stabilization required. Same-week appointments available.

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