Recovery
Long-acting injectables in Maine

Sublocade®, Brixadi®, and Vivitrol® in Augusta and Sanford, Maine.

About 40% of our MAT clients are on a long-acting injectable. One appointment a month, or one a week, instead of a daily decision. Buprenorphine and naltrexone in a depot form that releases steadily, so the medication stays in the background while you carry on with your life.

Start Intake Call (207) 245-1800
An empty seven-compartment weekly pill organizer with all lids open and every compartment empty on a worn wood desk in soft morning Maine window light, with a stoneware mug at the edge of frame
What long-acting injectables are

One shot. Steady release. The daily decision goes away.

Long-acting injectable MAT is the same medication category as oral Suboxone®, delivered in a depot form that releases the active drug evenly over a week or a month. The clinical effect is the same. The lived experience is different.

A client on daily Suboxone makes a medication decision every morning. A client on Sublocade or monthly Brixadi makes that decision once, in clinic, then carries on. For people in shared-living situations, on shift work, juggling family routines, or anyone for whom a daily pill is a daily reminder of why they need it, the injectable version is often the right call.

Three medications cover the long-acting injectable category at Enso. Buprenorphine in its extended-release forms (Sublocade and Brixadi) for opioid use disorder. Naltrexone in its extended-release form (Vivitrol) for opioid use disorder after detox, or for alcohol use disorder at any phase. All three are administered in clinic by a medical provider.

The three medications

Sublocade, Brixadi, and Vivitrol.

Three FDA-approved long-acting injectable medications cover almost every clinical scenario we treat. The medical provider picks the one that fits the dose history, the cadence preference, and the insurance picture. None of these is started without a conversation.

Monthly injection

Sublocade

Buprenorphine extended-release

A subcutaneous injection administered once every 28 to 30 days in clinic. Sublocade forms a small depot under the skin that releases buprenorphine at a steady plasma level for the entire month. We start clients on Sublocade after 7 days or so of stable oral buprenorphine to confirm tolerance and dose. The most-prescribed long-acting injectable at Enso.

Best for: clients stable on daily Suboxone® who want the daily decision gone.

Weekly injection

Brixadi (weekly)

Buprenorphine extended-release

A subcutaneous injection administered once a week, available in five dose strengths so the medical provider can fine-tune the level. Brixadi weekly can be started earlier in induction than Sublocade because it does not require the same lead-in on oral buprenorphine. Useful when we want to move a client onto a long-acting shot without delay.

Best for: new MAT starts who need to avoid daily oral dosing from the beginning.

Monthly injection

Brixadi (monthly)

Buprenorphine extended-release

The same Brixadi medication delivered on a monthly cadence once the right weekly dose has been established. Same active drug as Sublocade but a different release profile. Clinical choice between Sublocade and Brixadi monthly is usually made by the medical provider based on dose history, formulary, and what works on insurance.

Best for: clients who started on Brixadi weekly and are ready to extend cadence.

Monthly injection

Vivitrol

Naltrexone extended-release

An intramuscular injection administered once every 28 days. Vivitrol is not an opioid. It blocks opioid and alcohol receptors so neither produces the reinforcing effect that drives use. Because it is a full opioid antagonist, a client must be opioid-free for 7 to 10 days before the first dose to avoid precipitated withdrawal.

Best for: clients past detox, clients managing alcohol use disorder, clients who prefer not to take an opioid-receptor agonist.

How the switch works

From oral to injectable in three clinic visits.

Switching to a long-acting injectable is a medical decision the provider walks through with you. Nobody is rushed onto a shot. We confirm the right medication for the right person, then we administer it in clinic and check in within the week.

  1. Step 01

    Stable on what you started with

    For Sublocade®, we want roughly 7 days of stable dosing on oral buprenorphine before the first injection so the medical provider knows the dose and the body has cleared induction-phase shifts. For Vivitrol® the lead-in is different: 7 to 10 days opioid-free, verified by a urine screen and a naloxone challenge.

  2. Step 02

    The first injection in clinic

    A medical provider administers the injection in a quiet exam room. Sublocade and Brixadi® go subcutaneously into the abdomen or upper arm. Vivitrol goes intramuscularly into the upper outer buttocks. Whichever it is, the appointment is short, the conversation around it is not.

  3. Step 03

    Monthly visits become the cadence

    After the first injection, your monthly clinic visit is the injection plus the medical check-in plus whatever therapy or case-management work fits the day. We do not stack appointments artificially. The visit is the rhythm. The rest of the month belongs to you.

Switching mid-treatment

Already on Suboxone® or another MAT medication and want to talk about moving to a long-acting injectable? Bring it up at your next visit, or call (207) 245-1800.

Common questions about injectables

Questions people ask before they switch.

Yes. MaineCare covers all three long-acting injectables in full. Medicare covers them under Part B (the office-administered category). Most major private plans cover them with a prior authorization step that our case managers handle. Out-of-pocket cost on a covered plan is typically zero. If you are uninsured, OHH and STR pathways cover injectables for qualifying clients.

Two reasons. Tolerance verification and dose confirmation. The medical provider wants to know your body is processing buprenorphine without adverse effects and what daily dose is keeping you stable, so the first Sublocade dose lands at the right level. The lead-in is usually a week, sometimes less if you have a documented buprenorphine history.

In many cases yes. Brixadi weekly has a less restrictive induction protocol than Sublocade and can be started in early MAT with a brief oral buprenorphine confirmation step. Whether it is the right choice for you specifically is a conversation with the medical provider on day one.

Yes. Naltrexone (the active ingredient in Vivitrol) blocks both opioid and alcohol receptors. The same monthly injection that treats opioid use disorder treats alcohol use disorder, and at Enso it is one of the front-line options for clients managing alcohol on its own or alongside an opioid history.

It is similar to other injections. Sublocade and Brixadi are subcutaneous (under the skin) and form a small soft depot at the injection site that resolves over the month. Vivitrol is intramuscular and feels like a typical IM shot. Some clients have soreness for a day or two. Bruising is uncommon but possible.

Call us. We reschedule within the safe window for each medication. For Sublocade, the next-month appointment has flexibility on either side. For Brixadi monthly, similar. Missing more than the cushion window can require a step back through oral buprenorphine before resuming injections. None of this is a punishment, it is just how the medication pharmacology works. We do not discharge people for missing a visit.

Yes. Many clients change long-acting medications during the course of treatment. Switching between Sublocade and Brixadi is straightforward because both are buprenorphine. Switching from a buprenorphine injectable to Vivitrol (or back) requires an opioid-free interval first because Vivitrol is an antagonist. The medical provider plans any switch with you in advance.

Better is the wrong word. Different. Oral and injectable buprenorphine produce equivalent clinical outcomes when adherence is held constant. The injectable advantage is removing the daily decision and the bottle-on-the-counter visibility, which for many clients improves adherence by removing friction. The right medication is the one a person can sustain.

One conversation, one shot

Ask about a long-acting injectable at your next visit, or start now.

New clients start with a medical visit either way, and the conversation about Sublocade®, Brixadi®, or Vivitrol® happens there. Existing clients on oral Suboxone® can bring it up at any check-in. MaineCare covers all three in full. Admissions runs Monday through Friday, 8:00 AM to 4:30 PM.

Start Intake Call (207) 245-1800