What Are Sublocade and Brixadi, Who Do They Suit, and How Do You Taper Off of a Buprenorphine Depot?

What are Sublocade and Brixadi?

Sublocade and Brixadi are buprenorphine, the same medication found in Suboxone, ZubSolv, and the old Subutex tablets, given as an injection under the skin instead of a film or tablet under the tongue. Sublocade, made by Indivior, was approved by the US Food and Drug Administration, or FDA, in 2017 and is given once a month. Brixadi, made by Braeburn, was approved by the FDA in May 2023 and comes in a weekly form and a monthly form.

Both are what pharmacists call a depot, a small reservoir of medication that sits under the skin and lets buprenorphine out slowly. In fact, both are approved for moderate to severe opioid use disorder, which is the label’s name for opioid addiction, and both do the job that buprenorphine has always done in the treatment of opioid and opiate dependence and addiction.

Neither one is a new drug. If you have taken Suboxone, you already know what buprenorphine does for you and how it feels. What changes with a depot is the delivery, the timing, and how long the medication stays in your body after the last dose.

So, is the shot better than the strip? It depends on who you are, what your life looks like between doctor visits, and what you plan to do next.

How does a liquid injection turn into a month of medicine?

Sublocade is buprenorphine dissolved in a carrier called Atrigel, a biodegradable polymer in a solvent. In the syringe it is a thick liquid. When it meets the water in your tissue, the solvent drifts away and the polymer sets into a solid, with the buprenorphine trapped inside.

From then on, the depot gives up buprenorphine a little at a time from its surface. Brixadi uses a different carrier that forms a gel on contact with body fluids, in a much smaller volume, but the idea is the same. The medication leaves the depot slowly rather than in the daily peak and trough of a film.

While this is not a perfect analogy, a depot is a bit like a sugar cube dropped into a cup of tea. It dissolves from the outside in, and the tea keeps getting sweeter for as long as the cube lasts. Once it is in the cup, you cannot fish it back out, and stirring harder does not make it disappear.

So, be sure that buprenorphine agrees with you before the cube goes in.

Is Sublocade an implant, and what is the lump under the skin?

This is an excellent question, and the honest answer is yes and no. Nothing is cut, nothing is placed with instruments, and no device has to come out later. Yet, if you press on the injection site a few weeks later, you will feel a firm disc under the skin, and so will your doctor.

In effect, Sublocade is a non-surgical implant. You get the once-a-month, hard-to-divert benefits of an implanted device without an incision, a scar, or the nerve and infection risks that come with cutting through skin. The depot gets smaller over time and dissolves on its own.

Two practical truths are worth knowing before the first shot. The injection stings for a few minutes, because it is turning from a liquid into a solid as it goes in, and the sting fades quickly. And, the lump is expected. Do not rub or massage the site, and keep belts and waistbands from rubbing against it.

While the abdomen is the classic spot, the Sublocade label now allows the thigh, the buttock, or the back of the upper arm as well, and Brixadi lists the same four areas. What if it has to come out? The Sublocade prescribing information allows the depot to be surgically removed under local anesthesia within 14 days of the injection, and no later. After that, it stays until it dissolves.

Why would you choose a depot over daily films?

Taking a film every day is a ritual. You place it under your tongue, wait up to ten minutes for it to dissolve, and live with the aftertaste. You keep track of the foil packets, you lock them up, you make the pharmacy run, and you hope nothing gets lost or stolen.

While a film asks something of you every morning, a depot asks for one appointment a week or a month. There is nothing to dissolve, nothing to carry, nothing to lock up, and no pharmacy counter to stand at. You show up for your appointment, get the injection, and go back to your life.

There is a quieter benefit as well. Nobody in your household has to think about your dosing between visits, because there is no dosing between visits. Your spouse stops counting films, because there are no films to count.

Patients have told me that the strangest part of the first month on a depot was that there was nothing to do. Some say the medication feels more even without the daily rise and fall of a film, and others notice no difference at all.

Why would you not want a monthly injection?

Sublocade is relatively expensive, and so is Brixadi. If your insurance covers it without a fight, the cost may not matter to you. Unfortunately, many plans require prior authorization, and the syringe is shipped from a specialty pharmacy to your doctor rather than handed to you. Specialty pharmacies ship on their own calendar, which is rarely yours.

Yet, daily Suboxone gives you a flexibility that a depot cannot. You can find the least expensive pharmacy, pick up a partial fill when money is tight, and change your dose with your doctor from one week to the next. Because a depot is long-acting, a dose change is slow to show up in your blood, and the Sublocade label says so plainly.

Both products are also given only by a doctor or nurse, never dispensed to you, under a restricted FDA program called a Risk Evaluation and Mitigation Strategy, or REMS. The pharmacy ships the syringe to a certified clinic and the injection is given there, which means an in-person appointment every week or every month, with no telemedicine shortcut for the shot itself.

And, some patients simply prefer the product that has been around longer. That is a perfectly good reason.

Who do Sublocade and Brixadi suit, and who do they not?

The best candidate is a person who is already stable on buprenorphine, tolerates it well, and is tired of the daily ritual. If films get lost, stolen, or argued over in your house, if your job or your travel makes daily dosing awkward, or if you simply want your treatment to be invisible, a depot solves a real problem. A person who is already taking films or tablets can be switched directly to the injection.

The worst candidate is a person who has never taken buprenorphine. Both labels require at least one dose of buprenorphine under the tongue before the first injection, and the Brixadi label says its monthly form is not intended for people who are not already taking buprenorphine. A month of medicine is a big commitment to make on a drug you have never tried.

In between are the judgment calls. While a film lets you adjust a dose that is still moving, a depot does not. If you plan to be off of buprenorphine within a few months, the depot’s long tail may work against you, and if you cannot reliably get to an in-person appointment, or you have significant liver disease, the conversation with your doctor gets longer.

None of this is one-size-fits-all. It is a decision to make with a doctor who knows you and who will still be there next month, and Brixadi versus Sublocade is a fair place to start.

When can the first injection be given, and what is precipitated withdrawal?

Buprenorphine is a partial agonist. It binds to the opioid receptor tightly, holds on, and activates the receptor only part of the way. If it arrives while a full agonist such as fentanyl, oxycodone, heroin, or methadone is still sitting on those receptors, it shoves the full agonist off and replaces a strong signal with a weaker one.

The result is sudden, severe withdrawal, known as precipitated withdrawal. With a film, a mistake in timing is miserable for a day. With a depot, the medicine that caused the problem cannot be taken back, and that is the whole reason the labels are so careful about the first dose.

So, both labels build in a test. A person new to buprenorphine takes a single small dose under the tongue, is watched for about an hour, and gets the injection only if that dose was tolerated. Since a label change in February 2025, Sublocade can follow that single dose on the same day, and the old rule of a full week on films first is gone.

Timing the test dose is the hard part. The Sublocade prescribing information gives the floor: at least six hours after a short-acting opioid, at least 24 hours after a long-acting one such as methadone, and only once clear signs of withdrawal have appeared. In my experience, people who have used fentanyl daily often need far longer than that. That is why many doctors now start buprenorphine in very small doses over several days, a method called low-dose initiation, long before anyone talks about a depot.

The same mechanism runs in reverse when you leave. An opioid blocker started while buprenorphine is still on the receptor will pull it off and cause withdrawal, and after a depot that tail lasts many months. Your doctor must account for it before any switch.

What does a taper off of a depot look like?

Going back to the sugar cube, you cannot take it out, but you can decide not to drop in the next one. The Sublocade label puts the half-life of buprenorphine from a depot at 43 to 60 days, and once a person has had four to six monthly injections, it says buprenorphine can be detectable in blood and urine for twelve months or longer after the last one.

Brixadi fades faster. Its label gives a half-life of three to five days for the weekly form and 19 to 26 days for the monthly form, with levels detectable for about a month and about four months respectively.

Long-term buprenorphine produces physical dependence of the opioid type, and both labels say so. Physical dependence is not addiction. It is the reason you taper off of a medication instead of stopping it, and a depot tapers itself, slowly, whether you planned it that way or not.

Of course, a slow fade cuts both ways. Withdrawal after the last injection, if it comes at all, tends to be milder than after a full agonist and slower to arrive, and doctors are told to watch for several months and to treat it with buprenorphine films if it shows up. I do not know how quickly any one person’s depot will fade. The label gives a range, and patients fall all over it.

Fortunately, there are three ways to come off of a depot, and none of them involves a scalpel. A doctor can simply stop the injections and let the last depot fade on its own schedule. Or, the doctor can step down first, to the lower strength of Sublocade or from monthly Brixadi to the weekly form with its smaller steps, and then stop. Or, a person can return to films or tablets and taper those the ordinary way, as slowly as they need.

Which route is right, and how slowly, is a decision for you and your prescriber together, not a schedule to copy from a website.

Unfortunately, the fade is slow enough that the moment you are truly off of buprenorphine is hard to feel, and that is when a return to opioids is most dangerous. Both labels tell doctors to strongly consider prescribing naloxone at the start of treatment and at every renewal. Keep it in the house.

Can a monthly injection protect you from outside pressure?

Imagine you are doing well on Suboxone. You have a job again, your family has noticed, and your doctor is pleased. And, that is exactly when the questions start. “You seem fine, are you ready to stop taking that stuff yet?” “Is your doctor ever going to lower your dose?” “Why do you need a drug to get better when your brother is doing fine going to meetings?”

There is the pharmacist, too, giving your prescription a long look over his bifocals. There is the abstinence-only group that does not count your recovery as recovery. These people are not your doctor, and when people who are not your doctor start making medical decisions for you, the result can be deadly.

While none of those people can write a prescription, they can wear you down between visits. A depot takes the decision out of their hands, and, just as important, out of the reach of your own worst moments. The month’s dose is already given. It cannot be cut in half to please a relative, skipped to satisfy a sponsor, or handed over to anyone, and there is no foil packet to find.

While many people do well in 12-step groups, no one outside the exam room gets a vote on your prescription. Privacy and respect are not luxuries in this treatment. They are safety features, and your medical condition is between you and your doctor.

Should your family or spouse help to make the decision?

You are an adult and it is your body. Unless someone else has the legal right to make healthcare decisions on your behalf, the choice between a film and a depot is yours.

Still, you may choose to bring the people who love you into the conversation, and there is nothing wrong with that. What a depot must never become is a way for anyone to check up on you. It is a way for you to stop being checked up on.

What should you ask any prescriber before the first injection?

Start with tolerance. Ask how long you have been on buprenorphine, whether the dose has been steady, and what the plan is if the first injection turns out to be too much or too little, since neither can be changed for a month.

Ask about the site and the lump, and ask what happens if you miss an appointment. The Sublocade label says a missed dose is given as soon as possible, with at least 26 days between injections, but hear the plan in your own doctor’s words. Ask whether you will still have a film prescription as a backup for the day the shipment is late.

And, ask how you would get off of it before you get on it. How would we come off of this, by which route, how slowly, and what if I change my mind in month two? I believe this is the most important question on this page, because a prescriber who has a clear answer to it has thought about you rather than about the injection.

Ask for naloxone, too. Both labels tell your prescriber to strongly consider it. Whatever else you decide, that one is easy.

Where does Dr. Leeds fit into this decision?

Dr. Leeds’ practice does not offer Sublocade or Brixadi injections as a service. Dr. Leeds prescribes buprenorphine films and tablets by telemedicine for new patients in Florida, with induction done at home with phone support and a low-dose start when fentanyl is involved, and in-office visits are available in Fort Lauderdale.

He can discuss the injections, including which product might fit, how to time a first dose, and how a taper off of a depot would work, along with the rest of a person’s opioid treatment, in a consultation. Consultations are educational and do not create a physician-patient relationship.

To ask about a consultation, send a message through the contact form.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.