Vivitrol vs Suboxone: The Shot, and What It Is Actually Like
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Vivitrol is extended-release naltrexone: a 380 mg injection given into the buttock every four weeks by a clinician, which blocks opioid receptors and produces no opioid effect. Suboxone is buprenorphine with naloxone, a film taken daily that partially activates the same receptors and relieves withdrawal. The practical differences are larger than the pharmacological ones. Vivitrol cannot be started until you have been off opioids for 7 to 10 days, cannot be given in the arm, cannot be self-administered, and cannot be removed once it is in. Suboxone can be started while withdrawal is under way and stopped whenever a prescriber decides. And in pregnancy the comparison reverses entirely.
The short version
- Dosing interval: Every 4 weeks vs Daily — 380 mg deep gluteal injection
- Wait before starting: 7–10 days vs None — start in withdrawal — the single biggest practical difference
- Reversible once given: No vs Yes — the depot releases for about a month
- Recommended in pregnancy: No vs Yes — buprenorphine or methadone is the guidance
Side by side
How it is taken
- Vivitrol (naltrexone)
- 380 mg injection, every 4 weeks
- Suboxone (buprenorphine)
- Film or tablet, daily
Where it goes
- Vivitrol (naltrexone)
- Deep gluteal muscle, alternating sides
- Suboxone (buprenorphine)
- Dissolved under the tongue
Who administers it
- Vivitrol (naltrexone)
- A healthcare provider, in a clinic
- Suboxone (buprenorphine)
- You, at home
Before the first dose
- Vivitrol (naltrexone)
- 7–10 days opioid-free, tramadol included
- Suboxone (buprenorphine)
- Started once withdrawal has begun
Can it be undone?
- Vivitrol (naltrexone)
- No: the depot cannot be removed
- Suboxone (buprenorphine)
- Yes — stop or taper at any point
Effect on withdrawal
- Vivitrol (naltrexone)
- None; it can cause withdrawal
- Suboxone (buprenorphine)
- Relieves it, that is the point
Effect on craving
- Vivitrol (naltrexone)
- Blocks reward rather than wanting
- Suboxone (buprenorphine)
- Dampens craving directly
Treats alcohol use disorder
- Vivitrol (naltrexone)
- Yes, FDA-approved
- Suboxone (buprenorphine)
- No
In pregnancy
- Vivitrol (naltrexone)
- Starting it is not recommended
- Suboxone (buprenorphine)
- Recommended treatment
Facilities offering it (our count)
- Vivitrol (naltrexone)
- 47.5%
- Suboxone (buprenorphine)
- 59.2%
In numbers
Dosing interval
Every 4 weeksvsDaily
380 mg deep gluteal injection
Wait before starting
7–10 daysvsNone — start in withdrawal
the single biggest practical difference
Reversible once given
NovsYes
the depot releases for about a month
Recommended in pregnancy
NovsYes
buprenorphine or methadone is the guidance
Vivitrol (naltrexone) makes sense when
- You are already past the opioid-free window, or leaving a controlled setting
- You want a medicine with no opioid effect at all, for work, a licence or personal reasons
- The daily decision is the thing that keeps failing
- Alcohol is part of the picture: this is the one that treats it
- Monthly clinic attendance is realistic for you
Suboxone (buprenorphine) makes sense when
- You are using opioids now and cannot stop for 7 to 10 days unaided
- You are in withdrawal today and need it to stop today
- Treatment needs to start this week rather than after an arranged gap
- A pharmacy prescription fits your life better than monthly appointments
- You are pregnant — guidance points to buprenorphine or methadone
How available the injection actually is
Our analysisThe monthly shot is widely assumed to be a specialist product available at a handful of centres. It is not, and the surrounding figures matter for the choice, because the alternative injection nobody mentions is available almost as widely.
- 47.5%
- offer extended-release injectable naltrexone
- 4,863 of 10,233 facilities: the Vivitrol form specifically
- 33.7%
- offer extended-release injectable buprenorphine
- the monthly option that does not require an opioid-free interval first
- 59.2%
- offer buprenorphine in any form
- against 53.1% for naltrexone in any form
How we got this: we pulled the full public listing from SAMHSA’s FindTreatment.gov on , removed duplicate entries by name, street and ZIP, and counted how many of the 10,233 remaining facilities report each service. SAMHSA publishes the directory; it does not publish these proportions — see how the count is made. Repeat the pull and you will get the same numbers, give or take facilities that opened or closed since.
What these numbers cannot tell you: they are self-reported by facilities, they describe availability rather than quality, and a national proportion says nothing about what is open near you this week. Use them to know what to ask for, not to decide where to go.
What each one is, in one paragraph each
The pharmacology is covered in more depth in our comparison of the two medications generally. This page is about what actually happens to you, so the summary here is deliberately short.
Vivitrol
Extended-release naltrexone, 380 mg, delivered as a deep intramuscular gluteal injection every four weeks. It is an opioid antagonist: it occupies the receptor without activating it, so opioids taken on top produce little or no effect. It is not an opioid, it produces no high, and stopping it causes no withdrawal because there is no dependence to withdraw from. It is also approved for alcohol use disorder, which buprenorphine is not.
Suboxone
Buprenorphine combined with naloxone, taken daily as a film or tablet dissolved under the tongue. Buprenorphine is a partial agonist: it occupies the same receptors and partially activates them, which relieves withdrawal and craving without the escalating effect of a full opioid. The naloxone component does almost nothing when taken as directed and is there to discourage injection.
The gate that decides most cases
Before any comparison of experience, one fact settles a large share of decisions: you cannot start Vivitrol while opioids are still in your system. The label specifies an opioid-free interval of 7 to 10 days, tramadol included, and states the reason plainly — to avoid precipitation of opioid withdrawal that may be severe enough to require hospitalisation. Suboxone is started in the opposite state, once withdrawal has already begun. So for someone using today, this is not a choice between two options; it is one option now and another after a supervised gap.
What that means practically
The Vivitrol route needs something to happen first: a detox, or a planned taper, with somebody supervising the interval and an appointment booked for the end of it. A great many intended Vivitrol starts fail in that gap rather than at the injection. If nobody has been assigned to supervise those days, the plan has a step in it that does not exist yet.
The injection itself
This is what people actually search for, and most pages skip it. Everything below is from the prescribing information rather than from anecdote.
It cannot be given in the arm
The label is unusually direct: Vivitrol must ONLY be administered as a deep intramuscular gluteal injection. Not the arm, not the thigh. Sites alternate between buttocks at each subsequent injection, because the volume is substantial and repeating the same site every four weeks invites trouble. A provider offering an arm injection is not following the labelling.
You cannot give it to yourself
The label states that Vivitrol must be prepared and administered by a healthcare provider. That is partly the depth of the injection and partly the consequences of getting it wrong. Practically it means a clinic appointment every four weeks for as long as you are on it, and that logistics question belongs in the decision from the beginning rather than after the first month.
Does it hurt?
It is a deep intramuscular injection of a substantial volume, so discomfort at the site is common and expected. Pain at the injection site and itching at the injection site both appear among the reactions reported in at least 5% of people in the label. The alternating-buttocks instruction exists partly for this reason. Most descriptions place the discomfort in the range of an unpleasant but ordinary injection rather than something exceptional.
The lump is expected
The label instructs the provider to tell you that you may have a lump for several weeks which will decrease in size over time, and to avoid rubbing or massaging the site or letting belts, waistbands or sleeves press against it. That lump is the depot doing what it is designed to do — releasing over the month. Knowing it is expected prevents a good deal of alarm around week two, and it is one of the most searched things about this medicine.
Can the shot be reversed?
No, and this is the most important sentence on the page. Once the depot has been placed it cannot be removed, and it will continue releasing for roughly a month. The label instructs providers to examine the site at each visit for evidence of tampering or attempts to remove the depot, which tells you that people try. If side effects appear, they are managed rather than undone. That irreversibility is precisely the trade for not having to decide anything daily, and it is the reason the first injection deserves a longer conversation than a first prescription would.
Early, late, or missed
The labelled interval is every four weeks or once a month. Whether a specific appointment can move is a question for the prescriber, because the answer depends on how much time has passed and what has been used in the meantime. What is worth understanding is the shape of the risk: the blockade lasts roughly 28 days and then fades, so a late appointment is not merely a gap in treatment. It is a period in which protection is falling while tolerance is still low.
What the label warns about
Four warnings matter enough to know before the first injection rather than after.
Vulnerability to opioid overdose
The first warning section, and the one most often left out of promotional material. After detoxification, tolerance is reduced. Vivitrol blocks opioids for approximately 28 days, and as that blockade wanes and dissipates, someone returning to a previously ordinary dose is doing so without the tolerance that made it ordinary. The label advises strongly considering prescribing naloxone or nalmefene alongside. Attempting to overcome the blockade with large amounts of opioids may lead to fatal overdose.
Injection site reactions
The label states that in some cases these may be very severe, and that some cases have required surgical intervention. It also notes the likelihood increases with inadvertent intramuscular or intradermal administration into the wrong plane. Ordinary tenderness and a firm lump are expected; a site that is spreading, hot, or worsening rather than settling should be looked at rather than waited out.
Liver and mood
Cases of hepatitis and clinically significant liver dysfunction have been observed, and the label instructs discontinuation on signs of acute hepatitis. Separately, clinicians are directed to monitor for the development of depression or suicidal thinking. Neither is a reason to avoid the medicine and both are reasons to ask a prescriber how they intend to monitor.
If you need pain treated
Naltrexone antagonises opioid-containing medicines generally, and the label names cough and cold remedies and antidiarrhoeal preparations alongside opioid analgesics. For emergency pain management the label suggests approaches such as regional analgesia. Carrying something that states you are on naltrexone is a practical step, because in an emergency the usual first response will not work as expected.
Side effects people actually ask about
The reactions reported in at least 5% of people in the label are constipation, headache, nausea, injection site itching, vomiting, raised liver enzymes, fatigue and injection site pain. Several other questions come up constantly and deserve direct answers.
Tiredness and energy
Fatigue is on the label list, and it is among the more commonly reported effects. For many people it is worst in the first days after an injection and eases across the month; for some it does not. What it is not is a sign that the medicine is sedating in the way an opioid is — naltrexone produces no opioid effect at all. If tiredness is persistent and unmanageable, that is a prescriber conversation rather than something to endure for four weeks at a time.
Weight
Weight gain is not among the commonly reported effects, and nausea and reduced appetite point the other way if anything. Weight changes during recovery are common for reasons unrelated to the medication: alcohol carries substantial calories, appetite returns, and eating patterns change considerably. Attributing that to the injection is a frequent misattribution, though any unexpected change is worth mentioning.
Sexual side effects
Not among the effects reported in at least 5% of people in the label. The endorphin system is involved in reward generally, so individual reports exist, and there is no reason to dismiss them. The useful framing is that this is not a documented common effect, which means an individual experience of it is worth raising specifically rather than assumed to be expected.
Constipation and nausea
Both are on the label list. Nausea is most often reported early and tends to ease; constipation is worth managing rather than tolerating, since it is one of the effects most likely to make someone quietly stop attending. Neither is a reason to stop without discussion, and both are the sort of thing a prescriber can act on if told.
Blocking is not the same as reducing craving
One of the most searched questions is whether Vivitrol helps with cravings, and the honest answer separates two things that get merged. Blocking means an opioid taken on top produces little or no effect. Craving is the wanting, and it is a different mechanism.
What each medicine does about wanting
Buprenorphine partially occupies the receptor, which relieves withdrawal and dampens craving directly, that is a substantial part of why people find it easier to stay on. Naltrexone leaves the receptor blocked but empty, so it removes the payoff without providing anything. Some people find the wanting fades once using produces nothing; others experience the blockade and the craving simultaneously, which is uncomfortable and is a recognised reason people stop.
Where naltrexone does reduce something measurable
With alcohol the picture is clearer: naltrexone dampens the endorphin-mediated part of the reward, and its approved use in alcohol use disorder rests on reducing heavy drinking rather than on blocking intoxication. So the answer to whether it helps with cravings depends on which substance you mean, which is not a distinction most pages make.
Alcohol, where only one of these applies
Suboxone treats opioid use disorder. Naltrexone is approved for both opioid dependence and alcohol use disorder, and where alcohol is part of the picture that single fact frequently decides the comparison before any consideration of injections.
Does it make you sick if you drink?
No. That is disulfiram, marketed as Antabuse, which works by a completely different mechanism. Naltrexone does nothing of the kind: it makes drinking less rewarding rather than punishing it. People avoid naltrexone surprisingly often because they have been told the Antabuse story about it, which is a decision made on the wrong information.
Does it block alcohol?
Not in the sense of preventing intoxication. Alcohol still affects you; what is dampened is part of the reward. The practical effect described in the alcohol literature is fewer heavy drinking days rather than an inability to drink, and expecting a wall rather than a dampener sets people up to conclude it is not working.
Pregnancy, where the comparison reverses
This is the one situation that overturns everything above, and it is absent from almost every page competing for this search. Both American obstetric guidance and federal treatment guidance point the same way: for opioid use disorder in pregnancy, buprenorphine or methadone is the recommended treatment and should be offered as early as possible.
What the Vivitrol label itself says
That the available data from published case series in pregnant women are insufficient to identify a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes; that reproduction and developmental animal studies have not been conducted for Vivitrol specifically; and, on breastfeeding, that naltrexone and its major metabolite are present in human milk with no data on effects on the breastfed infant or on milk production. That is not a warning of harm. It is an absence of evidence, and it is why the guidance says what it does.
Starting against continuing
Clinical guidance distinguishes the two. Initiating naltrexone during pregnancy is not recommended given the limited data, and the monthly injectable form specifically is not recommended for want of pharmacokinetic and safety data. Continuing it in someone who becomes pregnant while already established on it is treated as a case-by-case decision requiring careful discussion. Those are different questions and they get different answers.
What that means if you are pregnant and choosing
It means the comparison on this page is largely not the comparison you are having. Buprenorphine and methadone are described as safe and effective in pregnancy and breastfeeding by the relevant obstetric guidance, and single-agent buprenorphine without naloxone is used in this setting. This is a decision to make with an obstetric provider and an addiction specialist together, not from a comparison page \u2014 including this one.
How to actually get it, and what it costs
A practical cluster that most comparisons skip entirely, and where the money question has a specific twist.
Who can give it
A prescriber writes for it and a healthcare provider administers it in a clinical setting; there is no route in which you collect it and inject it yourself. In our count of the federal treatment directory, 47.5% of facilities report offering extended-release injectable naltrexone, which is far more than most people assume \u2014 it is not a niche product available only at specialist centres.
The billing question that changes the number
The same injection can be billed under the pharmacy benefit or under the medical benefit, and which one applies changes what you owe, sometimes substantially. It also generates two charges rather than one: the medication and its administration. Ask the clinic which benefit they bill under and whether the administration is billed separately, before the first appointment rather than after.
If cost is the obstacle
Manufacturer assistance programmes exist for the branded product and are worth asking about by name. Beyond that, the ordinary routes apply: in our count 83.4% of facilities accept Medicaid, 54.5% take state funding outside Medicaid and 40.0% operate a sliding fee scale. Oral naltrexone is available as a generic and is a substantially cheaper way to take the same molecule, if the daily decision is workable for you.
Which one the situation usually points to
Not a self-assessment tool, and a prescriber weighs these together with a history no page has access to. But the pattern is consistent enough to describe.
Vivitrol tends to fit
Someone already through detox or leaving a controlled setting where opioids were unavailable; someone who wants no opioid effect at all for reasons of work, licence or personal preference; someone for whom a daily decision is the thing that keeps failing; and anyone where alcohol is part of the picture, since buprenorphine does nothing for that.
Suboxone tends to fit
Someone using now who cannot realistically stop for 7 to 10 days unaided; someone in withdrawal today; someone who needs treatment to start this week rather than after an arranged gap; someone for whom monthly clinic attendance is not practical; and anyone pregnant, for the reasons above.
And the option people forget
Extended-release buprenorphine exists too. If the appeal of Vivitrol is that there is nothing to take daily, that same appeal is available on the buprenorphine side without the opioid-free interval \u2014 offered by 33.7% of facilities in our count. Being clear about whether you want an injection or want no opioid effect usually settles the choice faster than any table.
How long people stay on either, and stopping
There is no fixed course for either medicine, and both are treatments for a chronic condition rather than programmes to complete. What differs is what stopping feels like, and that difference is deceptive.
Stopping Vivitrol produces no withdrawal
Because there is no dependence. That sounds like an advantage and contains the catch: nothing marks the transition, nobody has to be told, and protection simply ends while tolerance sits at its lowest. The absence of a withdrawal syndrome is precisely what makes drifting away from appointments easy.
Stopping Suboxone does
Which is why it is tapered, and why stopping involves a clinical conversation by necessity rather than by discipline. Paradoxically that gives the process a structure the Vivitrol exit lacks.
Either way, plan the exit before it happens
The period after stopping is the high-risk window for both, and for the injection it arrives on a schedule you can predict — roughly a month after the last dose. Naloxone in the house through that period is a concrete precaution, not a prediction of failure.
What this page cannot tell you
Which of these is right for a specific person, because that depends on history, other conditions, other medications and what is available nearby. Nothing here is a recommendation to start, stop or change a medication, and no doctor has reviewed this page. What it can do is set out exactly what the prescribing information says about the injection \u2014 where it goes, who gives it, what it feels like, and that it cannot be taken back \u2014 so that the first appointment is not the first time you learn any of it.
Where this sits in the system of care
Addiction treatment is organised into levels of care, and clinicians choose between them using the ASAM criteria (six dimensions covering withdrawal risk, medical and psychiatric conditions, readiness, relapse risk and, decisively, the environment you return to. Facilities are licensed by the state and many hold additional accreditation from bodies such as the Joint Commission or CARF; that status is worth confirming for any specific programme. Percentages below are our count of how many facilities in the federal directory report offering each level of care.
- Detox19.5% of facilitiesmedical withdrawal management, 3–7 daysDetox vs rehab
- Residential21.4% of facilitieslive on site, 24-hour staffingInpatient vs outpatient
- PHP20–30 structured hours a week, sleep at homePHP vs IOP
- IOP9–19 hours a week, usually compatible with workPHP vs IOP
- Standard outpatient85.4% of facilities1–8 hours a week, the maintenance levelMutual aid options
“Remaining in treatment for an adequate period of time is critical.”
Programmes for specific groups
Facilities also report dedicated programming, and the coverage is wider than most people expect, worth asking about before assuming a programme will not fit. From our count: 42.7% run programmes for adolescents, 39.2% for veterans, 38% for pregnant and postpartum women, and 25% provide services in Spanish. Medication for opioid use disorder is available at 59.2% (buprenorphine) and 13.7% (methadone).
Cost and coverage vary by level: residential care is the tier insurers scrutinise most and almost always requires prior authorisation before admission. See what your plan covers and how to pay without insurance. Family involvement is a standard part of most programmes, and aftercare planning ( step-down to a lower level, sober living, relapse prevention) should be discussed before admission, not at discharge. If a mental health condition is also present, ask specifically whether the programme is staffed for co-occurring disorders: 69.5% of facilities in the directory report treating them, but that is a self-reported field worth confirming.
Common questions
Can the Vivitrol shot be given in the arm?
No. The prescribing information states that Vivitrol must only be administered as a deep intramuscular gluteal injection, with sites alternating between buttocks at each subsequent dose. It also cannot be self-administered: the label requires that it be prepared and given by a healthcare provider.
Can a Vivitrol shot be reversed or removed?
No. Once the depot is placed it releases over roughly a month and cannot be taken back; the label instructs providers to check the site for evidence of attempts to remove it. Side effects are managed rather than undone. That irreversibility is the trade for having nothing to decide daily.
Do Vivitrol shots hurt, and is a lump normal?
Discomfort is common — injection site pain and itching are both among the reactions reported in at least 5% of people. A lump for several weeks is expected: the label instructs providers to tell you so, and to avoid rubbing or massaging the site or letting clothing press on it. A site that is spreading, hot or worsening rather than settling should be looked at.
How long does the Vivitrol shot last?
The label states it blocks the effects of opioids for approximately 28 days, which is why the interval is every four weeks. The blockade does not stop abruptly, it wanes, and that fading period, when protection is falling while tolerance is still low, is what the label singles out as carrying overdose risk.
Is Vivitrol better than Suboxone?
Neither is better in the abstract; they suit different situations. If you are using opioids now, only Suboxone can be started — Vivitrol requires 7 to 10 days opioid-free first. If alcohol is part of the picture, only naltrexone treats it. If a daily decision is what keeps failing, the monthly injection addresses that, though extended-release buprenorphine does too without the waiting period.
Does Vivitrol help with cravings?
It blocks the effect rather than removing the wanting, and those are different mechanisms. Some people find craving fades once using produces nothing; others experience the blockade and the craving at once, which is a recognised reason people stop. With alcohol the effect on drinking is more direct — its approved use rests on reducing heavy drinking rather than blocking intoxication.
Can I have the Vivitrol shot while pregnant?
Guidance points elsewhere. Buprenorphine or methadone is the recommended treatment for opioid use disorder in pregnancy and should be offered as early as possible. Initiating naltrexone in pregnancy is not recommended given limited data, and the injectable form specifically is not recommended for want of pharmacokinetic and safety data. Continuing it in someone who becomes pregnant while already on it is a case-by-case decision to make with a clinician.
Will Vivitrol show up on a drug test?
Not on the standard panels people usually worry about. Naltrexone is not an opioid, and standard opiate immunoassays are built around morphine-like compounds. If a test is being run for a job, a court or a programme, tell whoever ordered it what you are prescribed and ask which panel they run.
Sources
- DailyMed (NLM) — VIVITROL prescribing information, Alkermes
- NCBI Bookshelf (NIH) — Naltrexone, StatPearls
- MedlinePlus (NLM) — Naltrexone injection
- DailyMed (NLM) — SUBLOCADE prescribing information, Indivior
- NIDA — Medications for Opioid Use Disorder
- NIDA — Principles of Effective Treatment
- NIAAA — Alcohol Treatment Navigator
- SAMHSA — FindTreatment.gov, the federal treatment locator
- PMC — Safety and efficacy of buprenorphine-naloxone in pregnancy: a systematic review
- PubMed — Use of naltrexone in treating opioid use disorder in pregnancy
How this page was made
- Who wrote it:
- the Westbrook Recovery editorial team : researchers and writers, not clinicians. No doctor has reviewed this page, and we do not claim otherwise. What that means in practice: we report what public clinical sources say and show you where to read them, rather than offering a clinical opinion of our own.
- Checked against:
- 10 primary sources listed above: federal agency material and published clinical criteria. Where a figure varies by state, plan or facility, we say so instead of publishing a number that looks authoritative and is not.
- Original analysis:
- the facility proportions on this page are our own count of SAMHSA’s public directory. The full method is documented , including what we count, what we deliberately do not publish, and an error the approach caught. You can repeat the pull and check the numbers.
- Last reviewed:
- . This date changes when the content is actually re-checked, not automatically on every visit.
- What this page is not:
- a medical recommendation, a diagnosis, or a referral. Decisions about levels of care and medication belong with a clinician who knows your history. We do not operate facilities, take placement fees, or receive payment for sending anyone anywhere.
Related comparisons
- Sober Living Home vs Halfway HouseSober living is privately paid and open-ended; a halfway house is usually assigned with a fixed time limit. Cost, rules, testing and stay length compared.
- PHP vs IOPPHP runs 20-30 structured hours a week and IOP runs 9-19. The real question is whether home can hold the other 148 hours.
- Detox vs RehabDetox manages withdrawal safely, rehab treats why the drug or alcohol use started, and detox alone rarely holds. What each stage does, how long, and when.
Practical guides
- How to get someone into rehab
- How to pay for rehab without insurance
- Rehab rules: phones, visitors, leaving early
- Opioid withdrawal timeline
- Relapse warning signs
- Rehab for professionals
- What happens in rehab
- Court-ordered rehab
- Sober living rules
- How long Suboxone stays in your system
Check your coverage
This page is information, not medical advice. Treatment decisions belong with a qualified clinician who knows your history. If you are in crisis, call or text 988 in the US, or reach the SAMHSA National Helpline at 1-800-662-4357 — free, confidential, 24/7.