When You Can't Fill Your Buprenorphine/Naloxone Prescription

Being unable to find your Buprenorphine/Naloxone prescription is more than an inconvenience — it can feel like a threat to your recovery. Whether your pharmacy is out of stock, your insurance won't cover it, or you're facing other access barriers, the most important thing is that you don't go without treatment.

The good news is that Buprenorphine/Naloxone isn't the only medication approved to treat opioid use disorder (OUD). There are several evidence-based alternatives, each with its own benefits and considerations. This guide will help you understand your options so you can have an informed conversation with your provider.

What Is Buprenorphine/Naloxone and How Does It Work?

Buprenorphine/Naloxone — sold under brand names like Suboxone, Zubsolv, and Bunavail — is a combination medication used to treat opioid use disorder. It's classified as a Schedule III controlled substance.

Buprenorphine is a partial opioid agonist. This means it activates the same brain receptors as opioids like Heroin or Fentanyl, but only partially. It's enough to reduce cravings and prevent withdrawal symptoms, but it doesn't produce the same intense high. It also has a "ceiling effect" — after a certain dose, taking more doesn't increase its effects, which makes overdose less likely.

Naloxone is an opioid antagonist added to discourage misuse. When taken under the tongue as directed, Naloxone has minimal effect because it's poorly absorbed that way. But if someone tries to inject the medication, the Naloxone activates and blocks opioid receptors, causing withdrawal symptoms.

For more details, see our full guide on what Buprenorphine/Naloxone is and how to take it.

Alternative 1: Methadone

Methadone is a full opioid agonist that has been used to treat opioid addiction since the 1960s. It's one of the most well-studied medications for OUD and is equally effective as Buprenorphine in reducing opioid use.

How it works: Methadone fully activates opioid receptors, eliminating withdrawal symptoms and cravings. Because it's long-acting, it's taken once daily.

Key differences from Buprenorphine/Naloxone:

• Methadone must be dispensed through a certified opioid treatment program (OTP), not a regular pharmacy. This means daily clinic visits at first, though take-home doses become available as you progress in treatment.
• It carries a higher risk of overdose than Buprenorphine because it's a full agonist.
• It's a Schedule II controlled substance with stricter regulations.

Best for: Patients who haven't responded well to Buprenorphine/Naloxone, those with severe OUD, or patients who benefit from the structured environment of a clinic.

Alternative 2: Naltrexone (Vivitrol)

Naltrexone is an opioid antagonist — it works by completely blocking opioid receptors in the brain. The extended-release injectable form, sold as Vivitrol, is given as a monthly shot.

How it works: Instead of partially activating opioid receptors like Buprenorphine, Naltrexone blocks them entirely. This means opioids have no effect if you use them while on Naltrexone. It also reduces cravings over time.

Key differences from Buprenorphine/Naloxone:

• You must be completely free of all opioids for 7-10 days before starting Naltrexone. Starting too soon causes severe withdrawal.
• Naltrexone has no abuse potential and is not a controlled substance.
• It's available as a monthly injection (Vivitrol) or daily pill, though the injection is much more effective.
• Vivitrol typically costs $1,500-$1,800 per injection before insurance, though most insurance plans cover it.

Best for: Patients who have completed detox, those who prefer a non-opioid treatment, or patients who want a monthly injection rather than daily medication.

Alternative 3: Sublocade (Extended-Release Buprenorphine Injection)

Sublocade is a monthly injection of Buprenorphine that forms a solid deposit under the skin, slowly releasing medication over 30 days. It eliminates the need for daily sublingual dosing.

How it works: It delivers the same active ingredient as Buprenorphine/Naloxone (without the Naloxone component) through a once-monthly injection given by a healthcare provider.

Key differences from Buprenorphine/Naloxone:

• Must be stable on sublingual Buprenorphine for at least 7 days before starting.
• Given as an injection in a healthcare setting — you can't take it home.
• Eliminates the daily routine of dissolving films or tablets under your tongue.
• Available in 100mg and 300mg doses.

Best for: Patients who are stable on Buprenorphine but want the convenience of monthly dosing, or those who struggle with medication adherence.

Alternative 4: Brixadi (Extended-Release Buprenorphine Injection)

Brixadi is a newer option approved by the FDA in 2023. Like Sublocade, it's an extended-release Buprenorphine injection, but it comes in both weekly and monthly formulations.

How it works: Brixadi delivers Buprenorphine subcutaneously, providing steady medication levels without daily dosing.

Key differences from Buprenorphine/Naloxone:

• Available in weekly and monthly injection options, providing more flexibility.
• Can be used for both induction and maintenance — unlike Sublocade, which requires prior stabilization on sublingual Buprenorphine.
• Given by a healthcare provider in a clinical setting.

Best for: Patients who want flexible injection scheduling or those just starting Buprenorphine treatment who prefer not to take daily sublingual medication.

How to Decide Which Alternative Is Right for You

Choosing the right OUD medication depends on several factors:

• Where you are in recovery. If you're still using opioids, Methadone or Buprenorphine-based options may be easier to start. Naltrexone requires full detox first.
• Your daily routine. If you struggle with daily medication, a monthly injection like Sublocade, Brixadi, or Vivitrol may be a better fit.
• Insurance and cost. Generic Buprenorphine/Naloxone tablets can cost as little as $40-$80 per month with a discount card. Injectable options tend to be more expensive but are often covered by insurance.
• Access. Methadone requires clinic visits. Buprenorphine can be prescribed by many providers, including via telehealth.

Talk to your prescriber about which option makes the most sense for your situation. You can also find a provider who prescribes medications for OUD near you.

Final Thoughts

Not being able to fill your Buprenorphine/Naloxone prescription is stressful, but it doesn't mean you're out of options. Methadone, Naltrexone (Vivitrol), Sublocade, and Brixadi are all FDA-approved alternatives that can help you stay in recovery.

If you're still looking for Buprenorphine/Naloxone specifically, try using Medfinder to find it in stock near you. And if cost is a barrier, explore our guide to saving money on Buprenorphine/Naloxone.

Whatever medication you choose, the most important step is staying in treatment. Recovery is possible, and there's a medication that can work for you.