Long-Acting Buprenorphine Use Grows but Still Trails Pills

Use of long-acting injectable buprenorphine, a medication used in medical detox and ongoing opioid treatment, has grown roughly tenfold nationwide since 2021.

Yet fewer than 5% of patients prescribed buprenorphine actually choose the injectable form, according to a new Rutgers University study.

What the Study Found

Researchers from Rutgers and Columbia University examined nearly 2.3 million buprenorphine prescriptions issued nationwide between 2021 and 2024, published this month in the journal Health Affairs.

The long-acting injectable version grew from barely 0.5% of all buprenorphine prescriptions to nearly 4.3% over that period. In New Jersey specifically, injectable use rose from 0.7% to almost 5% of buprenorphine prescriptions.

Use varied widely by state. As of 2024, the injectable accounted for just 0.2% of prescriptions in Puerto Rico and 0.3% in Nebraska, compared with 10.2% in Ohio and 13.4% in Pennsylvania, a gap researchers say likely reflects differences in how insurance plans cover the medication.

“Sustained levels of medication, potentially reducing cravings for illicit drugs and assured protection for a full month may reduce the risk of overdose, particularly for individuals at high risk, such as those treated for prior overdose or in unstable living situations,” said Stephen Crystal, co-author of the study and director of the Rutgers Center for Health Services Research.

Understanding Buprenorphine and Medical Detox

Buprenorphine is one of the medications used in medication-assisted treatment for opioid use disorder. It works by reducing drug cravings and blocking the chemical pathway opioids use, making it harder to get high if someone does use drugs during treatment.

It comes in a daily tablet, a film patients place under the tongue, and the long-acting injectable form approved by the FDA in 2018. Clement Chen, a pharmacist with the Northern New Jersey Medication-Assisted Treatment Center of Excellence at Rutgers, said the injectable was originally expected to be a “game changer” because it delivers a steadier level of medication than a daily dose.

That makes it especially useful for people with a history of overdose, people who are unstably housed, or people recently released from incarceration, who face a heightened overdose risk due to reduced tolerance.

“This is where the injectable can really buy them time,” Chen said, referring to the period when someone leaving the correctional system is working to get program support and housing in place.

Why Uptake Remains Low

Despite those advantages, Chen said many patients decline the injectable. Some fear needles. Others prefer the daily dose because it offers more flexibility, or because the ritual of taking a dose reminds them of the routine of illicit drug use.

Some patients also want the option of selling extra doses if they are short on cash, something the injectable form does not allow. “With the sublingual they can divert. They can’t do that with an injectable,” Chen said.

Finding Medical Detox

Fatal overdoses in New Jersey have declined since peaking near 3,200 deaths in 2022, though recent declines have lagged among Black and Hispanic residents.

State budget data shows more than 81,000 people sought treatment in the state last year, including roughly 30,000 for heroin or other opioid addictions.

Call to find medically supervised detox programs that offer both daily and long-acting buprenorphine options, so you can discuss which form fits your circumstances with a provider.