Comparative Effectiveness of Long-Acting Injectables vs. Oral Medications for the Treatment of Substance Use Disorder

This literature review examines the comparative effectiveness of long-acting injectable (LAI) medications – such as Sublocade, Brixadi, and Vivitrol – versus oral formulations for treating substance use disorder (SUD), with a focus on opioid use disorder. Drawing on recent clinical trials, real-world studies, and economic analyses, it evaluates outcomes across five domains: clinical effectiveness, adherence, relapse prevention, cost-effectiveness, and patient satisfaction. The review finds that LAIs often improve adherence and retention, reduce relapse risk, and generate downstream cost savings, especially among high-risk or justice-involved populations, while patients report higher satisfaction with the convenience and discretion of injections. Despite barriers such as cost, provider hesitancy, and equity gaps in access, the report concludes that LAIs represent a critical innovation in modern SUD care and calls for policy reforms, expanded infrastructure, and further long-term research to maximize their impact.

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