Use of long-acting injectable buprenorphine—the most common medication for treating opioid use disorder (OUD)—grew substantially in the United States from 2021 to 2024, but with sharp state-level differences driven by Medicaid policy and insurance plan design, according to a Rutgers Health study published in Health Affairs.1 In some states, fewer than 1% of buprenorphine prescriptions dispensed were in long-acting injectable form; in others, injectable buprenorphine accounted for close to 13% of all buprenorphine prescriptions by 2024.
The FDA approved the first long-acting injectable formulation of buprenorphine in 2018. Unlike sublingual or oral formulations requiring daily self-administration, injectable buprenorphine is administered monthly by a clinician, providing steady-state medication delivery and removing the adherence burden of daily dosing—an advantage relevant to patients whose OUD treatment has been complicated by inconsistent oral adherence.1 As a partial agonist at the opioid receptor, buprenorphine blocks the effects of opioids such as heroin and fentanyl and substantially reduces overdose risk.
What Infectious Disease Specialists Should Know
What is long-acting injectable buprenorphine and how does it differ from oral formulations?
Long-acting injectable buprenorphine is a monthly clinician-administered formulation of buprenorphine for OUD, approved by the FDA in 2018. Unlike daily sublingual tablets or films, it provides a steady drug level throughout the month, removing the adherence burden of daily dosing and reducing diversion risk.
Which states had the highest rates of long-acting injectable buprenorphine prescribing?
Pennsylvania, Louisiana, Alaska, and Ohio had the highest rates, with researchers attributing higher access to state Medicaid plan policies making the injectable formulation more accessible and covered. In some states, fewer than 1% of buprenorphine prescriptions were in injectable form by 2024.
What role do advanced practice clinicians play in buprenorphine prescribing?
The study found nurse practitioners and physician assistants accounted for disproportionately large increases in long-acting injectable buprenorphine prescriptions, suggesting advanced practice clinicians are a key workforce for expanding OUD medication access in underserved settings.
Study design, prescription data, and state-level variation in long-acting injectable buprenorphine
Researchers examined pharmacy prescription claims from 2021 to 2024, including more than 4 billion prescriptions dispensed annually.1 The analysis found overall growth in long-acting injectable buprenorphine prescriptions across the study period, with disproportionate increases observed among patients covered by Medicaid and among patients prescribed by advanced practice clinicians, including nurse practitioners and physician assistants, rather than physicians.
Pennsylvania, Louisiana, Alaska, and Ohio had the highest rates of long-acting injectable buprenorphine prescriptions, with researchers attributing this in part to state Medicaid plan policies making the formulation more accessible.1 States with the lowest injectable buprenorphine rates had fewer than 1% of all buprenorphine prescriptions in injectable form, suggesting large unmet access potential within states where the medication has not been prioritized or covered.
Medicaid, advanced practice clinicians, and the ID clinician’s role in OUD treatment access
The finding that Medicaid patients and advanced practice clinicians accounted for disproportionate gains in injectable buprenorphine prescribing has direct implications for how access programs should be structured and which clinical settings are most likely to reach underserved populations.1 OUD intersects heavily with infectious disease burden—including HCV, HIV, and serious bacterial infections such as endocarditis and skin and soft tissue infections—making ID clinicians frequent entry points into OUD treatment discussions for patients who may not have established care with a primary prescriber.
"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," wrote Arthur Robin Williams, MD, MBE, associate professor at Columbia University and lead author of the study, and colleagues.1
"These findings highlight the crucial role of Medicaid, as well as advanced practice clinicians rather than physicians, in combating the opioid crisis," wrote Stephen Crystal, PhD, distinguished research professor at Rutgers School of Social Work and senior author, et al.1
The study authors noted substantial unresolved gaps: even in states with higher injectable buprenorphine rates, the formulation remains a small fraction of overall buprenorphine prescribing, and prior analyses suggest only about 25% of adults with OUD receive any medication-based treatment.1,2 The data reinforce the ongoing need to reduce structural and policy barriers to OUD medication access, particularly in Southern and rural states where Medicaid expansion gaps compound existing treatment shortfalls.
References
Williams AR, Crystal S, Olfson M, Samples H, Hua J. Uptake of long-acting injectable buprenorphine for opioid use disorder in the United States, 2021-2024. Health Affairs. 2026. doi:10.1377/hlthaff.2025.01584
Han B, Jones CM, Einstein EB, et al. Treatment for opioid use disorder: population estimates, United States, 2022. MMWR Morb Mortal Wkly Rep. 2024;73(6):113-118. doi:10.15585/mmwr.mm7306a1
