Long-acting buprenorphine uptake surges, but access hinges on state

Clinical takeaway: Long-acting injectable buprenorphine is reaching more patients, mostly through Medicaid and advanced practice clinicians. But availability varies sharply by state, so coverage rules may matter as much as clinical fit.

Daily sublingual buprenorphine works only as long as patients take it. But the patients at highest overdose risk such as those with unstable housing, recent overdose, or chaotic fentanyl use are also the most likely to miss doses. A monthly injectable approved by FDA in 2018 was intended to help close that gap by delivering steady drug levels without daily usage. A new claims analysis shows the formulation is finally taking off, but where a patient lives may determine whether it's within reach or not.

By 2024, the injectable's share of buprenorphine prescribing ranged from under 1% in some states to nearly 13% in others. The highest rates clustered in Pennsylvania, Louisiana, Alaska, and Ohio, which researchers attribute in part to Medicaid plan policies that eased access. Medicaid emerged as the dominant payer nationally, covering 71% of injectable episodes by 2024.

Nationally, injectable prescriptions rose tenfold from 2021 to 2024, though they still made up under 2% of the 2.3 million buprenorphine episodes analyzed. Advanced practice clinicians drove a disproportionate share of the growth. By 2024, nurse practitioners and physician assistants accounted for 62% of injectable episodes.

Researchers examined nationwide pharmacy prescription claims from IQVIA for 2021 through 2024, classifying buprenorphine episodes by formulation, insurance payer, and prescriber type across states.

What remains untested is whether the uneven uptake translates into differentiated outcomes. The claims data capture who received the injectable, not whether those patients stayed in treatment or avoided overdose. Linking formulation to retention and mortality across states is the obvious next question to answer.

"Given the variation across states, it's evident that state-level policy decisions and insurance plan designs have a meaningful impact on expanding access to lifesaving opioid-use disorder treatment," said Arthur Robin Williams, MD, MBE, associate professor of clinical psychiatry at Columbia University and lead author of the study.

Source: Williams AR, et al. (2026 Jul 7) Health Aff. Long-Acting Injectable Buprenorphine: Uptake Was Rapid But Uneven, 2021–24