Medication Reference Card — Opioid Use Disorder

Buprenorphine Long-Acting Injectable

Buvidal® (weekly / monthly) & Sublocade® (monthly) · SC injection · S100 (MATOD) · Authorised prescriber required

Dr Basanth Kenchaiah
FRANZCP · MBBS · DPM · DNB (Psychiatry) · Cert. Addiction Psych. Addiction Psychiatrist v1.0 · May 2026

Audience Clinicians

Purpose Prescribing quick-reference for extended-release subcutaneous buprenorphine (Buvidal®, Sublocade®) in opioid use disorder.

Key messages

Subcutaneous depot formulation — eliminates daily dosing burden and reduces diversion and misuse risk
Transition from established sublingual buprenorphine dose; do not initiate in opioid-naive patients
S100 (MATOD) in Victoria; PBS listed; requires authorised prescriber status; inject SC only — never IV or IM

For Patients

Long-acting injectable buprenorphine works the same way as the sublingual film, but is given as an injection that lasts a week or a month. This means there is no daily medication to remember, and no risk of the medication being lost or misused. It is a good option for people who find daily medication challenging.

Particularly useful when comorbid with / indicated by:

Adherence difficulties (homelessness, cognitive impairment, chaotic lifestyle) Diversion risk (no take-home supply) Rural / remote patients (monthly injection reduces travel) Justice-involved individuals (prison / parole continuity) Stigma concerns (discreet — no visible daily medication) Comorbid stimulant use with opioid use disorder Moving away from daily clinic attendance

For Clinicians

Mechanism

Same pharmacology as sublingual buprenorphine (partial mu-opioid agonist, high receptor affinity, ceiling effect for respiratory depression). Depot formulation provides sustained plasma levels without peaks and troughs of sublingual dosing. Subcutaneous injection creates a polymer matrix/reservoir releasing buprenorphine continuously over 1 week or 1 month.

Dosing

Buvidal Weekly (CAM2038)

8, 16, 24, or 32 mg SC weekly
Abdomen, upper arm, buttock, or thigh
Rotate injection sites

Buvidal Monthly (CAM2038)

64, 96, 128, or 160 mg SC monthly
Abdomen (preferred site)
Large volume — trained clinician required

Sublocade (RBP-6000)

300 mg SC monthly × 2 doses (loading)
Then 100 mg SC monthly (maintenance)
Abdomen only — do not massage or rub

Transition from SL

Establish stability on SL buprenorphine 8–24 mg/day first. Give first injection when next SL dose would be due. No SL top-up once on injectable.

Evidence

Lintzeris et al. Drug Alcohol Depend 2018 (CACTUS study): Buvidal non-inferior to daily SL buprenorphine for illicit opioid use with significantly higher patient satisfaction scores. Haight et al. NEJM 2019 (Sublocade RCT): significantly reduced illicit opioid use vs placebo. Both formulations TGA approved and PBS listed in Australia under specific prescribing criteria.

Cautions

Cannot be rapidly removed if adverse reaction occurs (unlike sublingual formulation) — counsel patients before initiation
Injection site reactions (nodule, induration, pain) common but usually mild and self-resolving
Must be initiated and administered by an authorised prescriber or trained nurse under their supervision
Monthly formulations involve large injection volumes — correct technique essential to avoid complications
PBS listed in Australia under specific criteria — check current PBS schedule for eligibility requirements
Concurrent benzodiazepines: significant respiratory depression risk — monitor closely; consider supervised dispensing of any take-home benzodiazepines