This randomized clinical trial and supporting evidence demonstrate that long-acting injectable buprenorphine is a safe and well-tolerated treatment for opioid use disorder, with adverse effects largely limited to mild injection-site reactions. Patients receiving long-acting injections reported significantly higher treatment satisfaction, a factor strongly associated with improved adherence and reduced relapse risk. These findings, reinforced by systematic reviews and FDA safety evaluations, support long-acting injectable buprenorphine as a safe, patient-centered option that may enhance long-term treatment engagement.