Sublocade vs. Suboxone: How the Monthly Shot Compares

If you take Suboxone every day, you have probably wondered whether the monthly shot is just the same medicine in a needle. In part, it is. Both deliver buprenorphine, but the way it gets into your body changes almost everything else: how you start, how often you see a provider, what happens if you miss a dose, and how long the drug lingers after you stop. Comparing Sublocade vs. Suboxone side by side makes it easier to see which trade-offs matter for your routine and how each one fits with the addiction solutions in Florida.

Sublocade vs. Suboxone: Key Differences at a Glance

The active ingredient is the same, so the table below focuses only on what is different. Figures come from the FDA prescribing information for Suboxone film and Sublocade.

What Do Sublocade and Suboxone Have in Common?

Both medications deliver buprenorphine, so once it reaches the brain, they work the same way. Buprenorphine attaches to the same receptors as heroin, fentanyl, and oxycodone but only partly activates them. SAMHSA’s treatment protocol explains that past a certain point, a higher dose of a partial agonist produces no additional effect. Therefore, both medications treat opioid use disorder only, so alcohol, cocaine, or meth use needs its own treatment plan. And because the drug is the same, someone stable on Suboxone can move to Sublocade without starting treatment over.

The same protocol links buprenorphine treatment to a lower risk of overdose death and finds that sublingual buprenorphine keeps people in treatment and reduces illicit opioid use better than placebo. Both medications treat opioid use disorder only, so alcohol, cocaine, or meth use needs its own treatment plan.

How Do You Start Suboxone or Sublocade?

The first doses work differently for each medication. Suboxone is started on its own, while Sublocade requires buprenorphine in your system first.

Starting Suboxone

The Suboxone label says the first dose should be taken when objective signs of moderate opioid withdrawal appear, and no sooner than 6 hours after the last opioid use. Taking it too early can trigger precipitated withdrawal, a sudden and intense version of withdrawal. On day one, the label allows up to 8 mg/2 mg. On day two, it allows a single dose of up to 16 mg/4 mg.

Because waiting for withdrawal is difficult, some prescribers use a low-dose buprenorphine start, often called microdosing in rehab, where small doses overlap with other opioids before the switch.

Starting Sublocade

Until early 2025, people needed at least seven days on daily buprenorphine before their first Sublocade injection. In February 2025, the FDA approved label changes that shortened this step. Under the current label, a person receives an initial dose of transmucosal buprenorphine, such as 4 mg, and is observed for one hour before the first injection.

The first two injections are 300 mg each. The second can be given as early as one week after the first. After that, maintenance is usually 100 mg a month, with at least 26 days between injections. The shot can go under the skin of the abdomen, thigh, buttock, or back of the upper arm.

Sublocade is distributed through an FDA safety program called REMS. Only certified healthcare settings and pharmacies can order it, and it is dispensed directly to the provider for administration.

Is Sublocade More Effective Than Suboxone?

The FDA lists methadone, buprenorphine, and naltrexone as safe and effective treatments for opioid use disorder, and its list includes both Sublocade and Suboxone. The more specific Sublocade vs. Suboxone question is whether the monthly injection keeps people in treatment better than daily films.

A pilot trial published in JAMA Network Open in 2021 tested this question with 52 adults in New York City jails. All of them were already on daily buprenorphine-naloxone, and half were switched to Sublocade before release. Eight weeks after release, 69% of the Sublocade group were still taking buprenorphine, compared with 35% of the daily group. Opioid-negative urine tests were 55% and 38%, respectively.

Other head-to-head research involves different extended-release products. A 2026 trial in JAMA Internal Medicine compared a weekly buprenorphine injection with daily sublingual buprenorphine in 140 pregnant adults. Sublocade has no weekly form, so this was a different medication. During pregnancy, 82.5% of the injection group and 72.6% of the daily group stayed abstinent from illicit opioids.

These studies are small or focused on specific groups, such as people leaving jail and pregnant patients. They suggest that removing the daily dose can help some people stay in treatment, but they don’t show that one medication is better for everyone.

What Daily Life Looks Like on Each Medication

The real difference often shows up in an ordinary week. One option asks for a small task every day; the other asks for a clinic visit every month:

• Suboxone: you place a film under your tongue once a day and keep it there until it fully dissolves, without eating or drinking. You pick up refills at a pharmacy, carry the films when you travel, and store them safely at home. The upside is flexibility: if cravings return or side effects appear, your prescriber can change the dose quickly.
• Sublocade: there’s nothing to take at home and nothing to store. You schedule an injection about once a month. According to the label, you may have a lump at the injection site for several weeks that shrinks over time. The trade-off is less flexibility, because the dose is set for the month and adjustments generally wait until the next injection.

Side Effects and Safety Warnings

Both medications carry the same core risks because both are buprenorphine. Each form also adds risks of its own.

Side effects they share

The labels for both medications list constipation, headache, nausea, and vomiting among the most common side effects. In Sublocade’s Phase 3 trials, people on the 300 mg maintenance dose reported constipation (8%), nausea (8%), headache (8.5%), vomiting (5.5%), and fatigue (6%). Both labels also warn that combining buprenorphine with benzodiazepines or other central nervous system depressants, including alcohol, raises the risk of overdose, slowed breathing, and death.

Because both contain buprenorphine, questions about how Suboxone affects blood pressure and heart rate apply to Sublocade as well.

Suboxone-specific risks

In January 2022, the FDA warned about dental problems with buprenorphine dissolved in the mouth. The agency identified 305 cases of tooth decay, infections, fractures, and tooth loss, including 131 classified as serious. The FDA recommends swishing a large sip of water after the film dissolves, waiting at least one hour before brushing, and telling your dentist you take buprenorphine.

The Suboxone label also lists mouth numbness, tongue pain, and redness inside the mouth. The naloxone in Suboxone is there to discourage injection misuse: the label says the product is likely to cause withdrawal if it is injected.

Sublocade-specific risks

Sublocade carries a boxed warning that serious harm or death could result if it is injected into a vein, because it forms a solid mass in contact with body fluids. Injection site reactions affected 16.5% of people across the Phase 3 trials, including pain (7.2%) and itching (6.6%). The label also recommends liver function tests before starting and monthly monitoring, so it helps to understand how opioids affect the liver.

What Happens When You Stop Each One?

Stopping either medication should be planned with a prescriber. Physical dependence on buprenorphine is different from addiction, but it still means the body needs time to adjust.

Stopping Suboxone

The Suboxone label recommends a gradual taper because stopping suddenly can cause withdrawal. The pace depends on your dose and how long you have been stable, so deciding when to taper off Suboxone is a conversation to have with your prescriber before changing anything.

Stopping Sublocade

Stopping Sublocade doesn’t happen on a single day the way stopping a film does. In its trials, withdrawal signs were not seen in the month after the last injection, and the label says any withdrawal would be expected to start later than the usual Suboxone withdrawal timeline because the drug leaves the body slowly. The label advises monitoring for several months after the final dose.

Buprenorphine may also stay detectable in blood and urine for 12 months or longer after stopping Sublocade. That can matter for future drug tests.

Sublocade or Suboxone: Which One Fits Your Situation?

There’s no single right answer, and the choice belongs to you and your prescriber. These questions can help structure that conversation:

• Do you take a daily medication reliably, or do missed doses happen often?
• Is your current dose stable, or is it still being adjusted?
• Would keeping medication at home be a risk for you or someone you live with?
• How do you feel about injections and monthly clinic visits?
• Do you travel often, or have a schedule that makes pharmacy trips difficult?
• Has dental health been a concern for you?
• How does your insurance cover each option?

Other options: Brixadi, naltrexone, and methadone

If the idea of an injection appeals to you but Sublocade’s monthly schedule or set doses don’t fit, Brixadi is another extended-release buprenorphine injection. The FDA approved it in May 2023 in weekly doses of 8, 16, 24, and 32 mg and monthly doses of 64, 96, and 128 mg. The weekly version can be started after a single dose of transmucosal buprenorphine, and the lower doses may suit people who don’t tolerate higher ones. In the 428-person trial behind the approval, 16.9% of the Brixadi group met the study’s responder definition, compared with 14.0% on daily sublingual buprenorphine.

Brixadi is still buprenorphine, so it won’t help if buprenorphine itself isn’t working for you. The other FDA-approved options are naltrexone and methadone. Naltrexone blocks opioids instead of activating receptors, so switching from Suboxone to Vivitrol, the monthly naltrexone shot, takes a planned transition with a prescriber. Methadone is a full opioid agonist dispensed through certified opioid treatment programs, and long-term methadone use comes with its own trade-offs to weigh.

Medication Is One Part of Opioid Addiction Treatment

A daily film or a monthly injection treats the physical side of opioid use disorder: cravings and withdrawal. It doesn’t work through what drove the use, whether that’s stress, relationships, depression, or trauma. That’s why SAMHSA recommends prescribing buprenorphine as part of a treatment plan that includes counseling, and that applies equally to Sublocade and Suboxone.

For someone already on Sublocade, adding therapy doesn’t mean changing medication. Bright Futures Treatment Center in Boynton Beach, Florida, uses Suboxone and naltrexone and doesn’t administer Sublocade. People who get the injection from an outside prescriber can still join addiction treatment programs and keep their monthly appointments with that prescriber. Every client shares a full medication list at admission, so the clinical team knows what each person is taking.

Insurance and cost

The FDA approved the first generic versions of Suboxone film in June 2018, while Sublocade has no generic. Because Sublocade is dispensed directly to the provider instead of to you, ask your plan how it covers the injection and whether prior authorization is required. You can also check which insurance plans Bright Futures accepts before calling.

Choosing the Treatment That Fits Your Recovery

The difference between Sublocade vs Suboxone is less about strength and more about how treatment fits into your life. Daily films offer control and quick dose changes, while the monthly shot removes the daily decision. Whichever you choose, recovery is stronger with support around the medication. Bright Futures Treatment Center combines MAT with therapy in PHP, IOP, and virtual IOP. Contact the admissions team to talk through your options and verify your insurance.

References

Indivior Inc. (2025a). SUBLOCADE (buprenorphine extended-release) injection, for subcutaneous use, CIII: Full prescribing information [Revised February 2025]. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/209819Orig1s031lbl.pdf

Indivior Inc. (n.d.). SUBOXONE (buprenorphine and naloxone) sublingual film, CIII: Prescribing information. Drugs.com. https://www.drugs.com/pro/suboxone.html

Lee, J. D., Malone, M., McDonald, R., Cheng, A., Vasudevan, K., Tofighi, B., Garment, A., Porter, B., Goldfeld, K. S., Matteo, M., Mangat, J., Katyal, M., Giftos, J., & MacDonald, R. (2021). Comparison of treatment retention of adults with opioid addiction managed with extended-release buprenorphine vs daily sublingual buprenorphine-naloxone at time of release from jail. JAMA Network Open, 4(9), e2123032. https://doi.org/10.1001/jamanetworkopen.2021.23032

Substance Abuse and Mental Health Services Administration. (2021). Medications for opioid use disorder (Treatment Improvement Protocol [TIP] Series 63, Publication No. PEP21-02-01-002). https://library.samhsa.gov/sites/default/files/pep21-02-01-002.pdf

Substance Abuse and Mental Health Services Administration. (n.d.). What is buprenorphine? https://www.samhsa.gov/substance-use/treatment/options/buprenorphine

U.S. Food and Drug Administration. (2022, January 12). FDA warns about dental problems with buprenorphine medicines dissolved in the mouth to treat opioid use disorder and pain [Drug safety communication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-dental-problems-buprenorphine-medicines-dissolved-mouth-treat-opioid-use-disorder

U.S. Food and Drug Administration. (2023, May 23). FDA approves new buprenorphine treatment option for opioid use disorder [Press release]. https://www.fda.gov/news-events/press-announcements/fda-approves-new-buprenorphine-treatment-option-opioid-use-disorder

U.S. Food and Drug Administration. (n.d.-a). Information about medications for opioid use disorder (MOUD). https://www.fda.gov/drugs/information-drug-class/information-about-medications-opioid-use-disorder-moud

U.S. Food and Drug Administration. (n.d.-b). Timeline of selected FDA activities and significant events addressing substance use and overdose prevention. https://www.fda.gov/media/126835/download

Winhusen, T. J., Lofwall, M. R., Kropp, F., Lewis, D., Smid, M. C., Young, J. L., Hodgkins, C., Krans, E. E., Hansen, Z., Wachman, E. M., Schiff, D. M., Guille, C., Rudolf, V., Chowdhury, T., Leeman, L., Lewis, M., Matthews, A. G., Cochran, G., King, J., . . . Rosa, C. (2026). Extended-release vs sublingual buprenorphine in pregnancy through 12 months post partum: A randomized clinical trial. JAMA Internal Medicine, 186(5), 533–543. https://doi.org/10.1001/jamainternmed.2026.0057

FAQs

Is Sublocade the same as Suboxone?

No. Both contain buprenorphine, but Suboxone is a daily film that also contains naloxone and is taken at home. Sublocade is a monthly injection of buprenorphine alone, given by a healthcare provider. They treat the same condition, opioid use disorder, through different delivery methods and dosing schedules.

Does Sublocade have naloxone in it?

No. Sublocade contains only buprenorphine. Suboxone adds naloxone to discourage injection misuse, but Sublocade controls misuse differently: it is dispensed only to certified healthcare providers through an FDA safety program and is never handed to the patient.

Can you switch from Suboxone to Sublocade?

Yes. People already taking buprenorphine films or tablets can move to Sublocade with their prescriber’s approval. The first two injections are 300 mg each, followed by monthly maintenance doses, usually 100 mg. People who aren’t on buprenorphine yet first receive a single dose of buprenorphine film or tablet, such as 4 mg, and are observed for one hour.

Does Sublocade cause withdrawal?

Withdrawal after stopping Sublocade tends to be delayed rather than immediate. In clinical trials, withdrawal signs were not seen in the month after the last injection, because buprenorphine leaves the body slowly. The FDA label advises that providers monitor patients for several months after the final dose.

Can you drink alcohol on Sublocade?

Drinking alcohol on Sublocade is risky. The FDA label warns that combining buprenorphine with central nervous system depressants, including alcohol, can lead to slowed breathing, coma, and death. Anyone on Sublocade who drinks should tell their prescriber so the risk can be discussed openly.