Medication Reference Card: Opioid Use Disorder

Buprenorphine Long-Acting Injectable

Buvidal® (weekly / monthly) & Sublocade® (monthly; ends 31 Dec 2026) · SC injection · S8 · PBS s100 · Vic permit

Dr Basanth Kenchaiah
FRANZCP · Cert. Addiction Psych. · MBBS · DPM · DNB (Psychiatry) Addiction Psychiatrist v1.3 · October 2026

Audience Clinicians

Purpose Prescribing quick-reference for extended-release subcutaneous buprenorphine (Buvidal®, Sublocade®) in opioid use disorder, as part of opioid dependence treatment (ODT, also called opioid substitution therapy, OST).

Key messages

Subcutaneous depot formulation: eliminates daily dosing burden and reduces diversion and misuse risk
Some patients start after a period on sublingual buprenorphine; check each product's information for starting requirements; do not initiate in opioid-naive patients
Victoria: Schedule 8 permit for each patient through SafeScript (no prescriber training course required; know each product's injection technique); PBS s100; inject SC only; never IV or IM
Sublocade® is discontinued in Australia after 31 December 2026 (final orders 11 December; a commercial decision, not a safety concern). Victorian guidance: no new starts without a documented plan to switch before supply ends; for most patients Buvidal® is likely the least disruptive switch (see the department's transition guidance)

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

Some patients start after a period on SL buprenorphine; check each product's information for starting requirements. When switching from SL, give the first injection when the next SL dose would be due. Extra LAIB or SL buprenorphine may be offered while the dose is being stabilised (Victorian ODT Guidelines).

Evidence

Lofwall et al. JAMA Intern Med 2018: Buvidal non-inferior to daily SL buprenorphine for illicit opioid use with significantly higher patient satisfaction scores. Haight et al. Lancet 2019 (Sublocade RCT): significantly reduced illicit opioid use vs placebo. Both formulations TGA approved and PBS listed in Australia under specific prescribing criteria (Sublocade® until 31 December 2026).

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
Prescribed by a medical or nurse practitioner with a Victorian permit; given by a medical practitioner, nurse practitioner, registered nurse or approved pharmacist trained in that product's technique; the first administration must be observed by one of these competent providers
Re-induction may be needed if more than 14 days pass between Buvidal® Weekly doses, or more than 8 weeks between monthly Buvidal® or Sublocade® doses (clinical assessment)
Never dispensed to or handled by the patient; for travel longer than the dosing interval, arrange a local prescriber and administration, or convert to SL buprenorphine-naloxone
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

Key References: Lofwall MR et al. JAMA Intern Med 2018;178:764–773 (Buvidal non-inferiority RCT); Haight BR et al. Lancet 2019;393:778–790 (Sublocade RCT); TGA Approval 2018–2019; PBS listing criteria: current schedule; Victorian Department of Health. Victorian Opioid Dependence Treatment Guidelines. 2026; Victorian Department of Health. Sublocade® discontinuation: guidance for health professionals. 2026. For clinician reference only. Not a substitute for clinical judgement. Information current as of October 2026.

Dr Basanth Kenchaiah · basanthkenchaiah.com.au