Long-Acting Injectable Treatment (LAIs)
Long-acting injectable (LAI) medications are formulations designed to deliver consistent medication levels over an extended period of time, reducing the need for daily oral dosing.
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LAIs are used in both psychiatric care and substance use disorder treatment to support adherence, improve stability, and reduce the risk of relapse.
What Are Long-Acting Injectables
Long-acting injectable medications are administered at regular intervals depending on the medication and are designed to maintain more consistent therapeutic exposure than daily oral dosing.
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This approach helps eliminate the “up and down” often associated with missed doses or inconsistent oral medication use and supports more stable, predictable treatment outcomes.
Use in Substance Use Disorder Treatment
Examples:
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Long-acting buprenorphine (Sublocade, Brixadi)
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Extended-release naltrexone (Vivitrol)
Clinical Benefits:
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No daily dosing requirements
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Reduced risk of misuse or diversion
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Consistent medication coverage
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Greater flexibility for travel, work, and daily life
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Support during early recovery and stabilization
Some long-acting buprenorphine formulations also allow medication levels to decline gradually after discontinuation rather than stopping abruptly.
Use in Psychiatric Treatment
LAIs are widely used in the treatment of serious psychiatric illness, including schizophrenia, schizoaffective disorder, and in selected cases bipolar disorder.
Potential Benefits:
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Improved medication adherence
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Reduced relapse and hospitalization rates
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More consistent symptom control
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No daily medication burden
Clinical Benefits of LAIs
Evidence supports the use of long-acting injectable medications in appropriate patients.​ Research has shown that LAIs are associated with:
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Lower rates of hospitalization and emergency visits
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Improved treatment adherence
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Reduced relapse risk
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More consistent therapeutic drug levels
​Real-World Outcomes: Sublingual vs Long-Acting Buprenorphine Retention (Treatment Continuity)
Sublingual Buprenorphine (Suboxone):
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~75% retention at 30 days
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Drops to ~50% by ~4–5 months
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More than 50% discontinue within 12 months
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Median treatment duration as low as 38–50 days in some data
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People fall off treatment quickly when medication depends on daily adherence.
Long-Acting Buprenorphine (XR-Buprenorphine):
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Higher sustained engagement once initiated
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Real-world data shows ~80% receive at least 2 injections and ~54% receive 7 or more
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Designed to improve retention and reduce dropout
People stay in treatment longer because they do not have to make a daily decision to take medication.
Safety and Continuity of Treatment
Treatment only works if patients are able to stay on it.
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Long-acting injectable medications support consistent medication coverage and improve retention in care—two factors strongly associated with reduced relapse and overdose risk.
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Considerations
LAIs are not appropriate for every patient and should be considered based on diagnosis, clinical history, treatment response, patient preference, and medical appropriateness.
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Initiation, monitoring, and follow-up should be directed by our provider.
Integration with Care
Long-acting injectable treatment is often most effective when integrated into a broader care plan that may include psychiatric evaluation, medication management, therapy, case coordination, and follow-up support.
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Selected References
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Samples H, et al. (2022). Buprenorphine Treatment Duration and Retention Among Patients With Opioid Use Disorder. JAMA Network Open.
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Sordo L, et al. (2017). Mortality risk during and after opioid substitution treatment. BMJ.
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Haight BR, et al. (2019). Efficacy of monthly buprenorphine depot injection for opioid use disorder. The Lancet.
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Lofwall MR, et al. (2018). Weekly and monthly subcutaneous buprenorphine depot formulations. JAMA Internal Medicine.
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National Institute on Drug Abuse (NIDA). (2020–2024). Medications for Opioid Use Disorder Research and Outcomes.