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Per current guidelines, the first two doses recommended are 300 mg each with the following monthly maintenance dose of 100 mg each.4,6,7 The monthly formulation of extended-release buprenorphine produces a sufficient steady-state blood level and may be more favorable for persons who have difficulty adhering to daily sublingual forms.4,5,10 The most common adverse drug reactions of extended-release buprenorphine injection are injection site pain, injection site pruritus, constipation, sweating, nausea, vomiting, headache, fatigue, and sedation (more than 5%).3,4,11–14 The majority of injection-site adverse reactions are mild to moderate in severity and include pain, hives, and erythema.3,4,12–13 These side effects are usually temporary and appear most commonly with the first injection and decrease in frequency with subsequent injections.4,15 Our case report was unique as an injection site reaction appeared in a patient 14 days after her second injection of extended-release buprenorphine, following unintentional scratching of the injection site with an acrylic nail while in the shower

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