Naltrexone vs Suboxone: Which One Can You Actually Start?
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They are opposites at the receptor: naltrexone blocks opioid receptors and produces no opioid effect, while Suboxone contains buprenorphine, a partial opioid agonist that occupies the same receptors and relieves withdrawal. The practical consequence decides most real cases. Naltrexone cannot be started until you have been off opioids — tramadol included — for at least 7 to 10 days, because giving it sooner precipitates withdrawal that the FDA label says can be severe enough to require hospitalisation. Suboxone is started while withdrawal is already underway. So the honest question is rarely which medicine is better; it is which one you can get to from where you are standing today. Naltrexone also treats alcohol use disorder, which buprenorphine does not.
The short version
- Wait before first dose: 7–10 days vs None — start in withdrawal — the single biggest practical difference
- Dosing interval: Every 4 weeks (injection) vs Daily — 380 mg deep gluteal injection
- Blockade duration: ≈28 days, then fades vs Not a blockade — overdose risk rises as it wanes
- Treats alcohol use disorder: Yes vs No — FDA-approved indication for naltrexone
Side by side
What it does at the receptor
- Naltrexone (Vivitrol)
- Blocks it (antagonist)
- Suboxone (buprenorphine)
- Partially activates it (partial agonist)
Before the first dose
- Naltrexone (Vivitrol)
- 7–10 days opioid-free, tramadol included
- Suboxone (buprenorphine)
- Started once withdrawal has begun
Forms
- Naltrexone (Vivitrol)
- 50 mg tablet daily, or 380 mg injection monthly
- Suboxone (buprenorphine)
- Film or tablet, usually daily
Where you get it
- Naltrexone (Vivitrol)
- Injection given in a clinic by staff
- Suboxone (buprenorphine)
- Pharmacy, on prescription
Relieves withdrawal
- Naltrexone (Vivitrol)
- No — it can cause it
- Suboxone (buprenorphine)
- Yes, that is the point
Treats alcohol use disorder
- Naltrexone (Vivitrol)
- Yes, FDA-approved
- Suboxone (buprenorphine)
- No
If you miss it
- Naltrexone (Vivitrol)
- Blockade fades, overdose risk rises
- Suboxone (buprenorphine)
- Withdrawal returns
Misuse potential
- Naltrexone (Vivitrol)
- None — no opioid effect
- Suboxone (buprenorphine)
- Some, which is why naloxone is added
Main starting obstacle
- Naltrexone (Vivitrol)
- Getting through 7–10 days first
- Suboxone (buprenorphine)
- Finding a prescriber and a pharmacy
Facilities offering it (our count)
- Naltrexone (Vivitrol)
- Counted below
- Suboxone (buprenorphine)
- 59.2% of US facilities
In numbers
Wait before first dose
7–10 daysvsNone — start in withdrawal
the single biggest practical difference
Dosing interval
Every 4 weeks (injection)vsDaily
380 mg deep gluteal injection
Blockade duration
≈28 days, then fadesvsNot a blockade
overdose risk rises as it wanes
Treats alcohol use disorder
YesvsNo
FDA-approved indication for naltrexone
Naltrexone (Vivitrol) makes sense when
- You have already completed detox and are past the opioid-free window
- You want a medicine with no opioid effect at all, for work, licence or personal reasons
- A monthly injection suits you better than remembering a daily dose
- Alcohol is part of the picture — this is the one that treats it
- You are leaving a controlled setting such as incarceration or residential treatment
Suboxone (buprenorphine) makes sense when
- You are using opioids now and cannot realistically stop for 7 to 10 days unaided
- You are in withdrawal today and need it to stop today
- A pharmacy prescription fits your life better than monthly clinic visits
- Previous attempts failed at the gap between detox and the first naltrexone dose
- You need something that holds craving steady rather than blocking a reward you may not seek
How available each medication actually is
Our analysisComparisons of these two medicines are everywhere; a count of how many US facilities actually offer each of them is not. We counted, because availability is what turns a comparison into a decision — and because the injectable form, which people assume is niche, turns out to be offered by nearly half the directory.
- 53.1%
- of facilities offer naltrexone
- 5,430 of 10,233 — against 59.2% for buprenorphine and 13.7% for methadone
- 47.5%
- offer the extended-release injection
- 4,863 facilities report the Vivitrol form specifically
- 54.3%
- offer oral naltrexone
- the tablet is marginally more common than the injection, not dramatically so
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 naltrexone actually is
Naltrexone is an opioid antagonist. It occupies the same mu-opioid receptors that heroin, oxycodone or fentanyl act on, but it does not activate them — it sits there and blocks. There is no high, no sedation, no relief of withdrawal, and no dependence: stopping it produces no withdrawal of its own. The US National Library of Medicine describes it as an FDA-approved opioid antagonist used for both alcohol use disorder and opioid dependence, which is worth noting because the second indication is the one people search for and the first is the one that quietly matters more.
The two forms, and why they behave differently
Oral naltrexone is a 50 mg tablet taken daily; published dosing guidance for alcohol treatment describes 50 to 100 mg, usually starting at 25 mg. The extended-release form is a 380 mg injection given once every four weeks. The pharmacology is the same molecule, but the failure mode is not: a tablet can be skipped tomorrow morning after a bad evening, and an injection cannot. That difference — not potency — is why the injection exists.
What naltrexone does not do
It does not relieve withdrawal, it does not reduce a physical dependence you currently have, and it is not a detox medication. Taken while opioids are still in the body it does the opposite of relief: it displaces them and triggers withdrawal deliberately. This is the single most misunderstood thing about the medicine, and the reason the next section exists.
What Suboxone actually is
Suboxone is a brand name for buprenorphine combined with naloxone. Buprenorphine is the working component: a partial opioid agonist, meaning it occupies the same receptors and activates them, but only partially and with a ceiling on that effect. That is what lets it relieve withdrawal and craving without the escalating effect a full agonist produces, and why it can be dispensed through ordinary pharmacies rather than only in a clinic. In our count of the federal directory it is available at 59.2% of US facilities.
Why naloxone is in the film at all
Taken as directed — dissolved under the tongue — the naloxone component does essentially nothing, because it is poorly absorbed that way. It is included to discourage injection: injected, naloxone precipitates withdrawal. So the same molecule that makes naltrexone dangerous to start too early is doing deterrent duty inside Suboxone. Single-agent buprenorphine without naloxone also exists and is used in specific circumstances, pregnancy among them.
The waiting period is the whole difference
Everything practical about this comparison comes down to one gate. Before a first dose of naltrexone you must be opioid-free — tramadol included — for at least 7 to 10 days. Suboxone is started in the opposite state: once withdrawal has already begun. So for someone using opioids today, these are not two options on a menu. One can be started this week and the other cannot, and no amount of preference changes that.
Why the gap has to be that long
Naltrexone binds the receptor more tightly than the opioid already occupying it. Introduce it while opioids are still on board and it does not politely wait its turn — it displaces them at once, and the withdrawal that would have unfolded over days arrives in minutes. The FDA label for the extended-release injection states the 7 to 10 day interval exactly, and gives the reason plainly: to avoid precipitation of opioid withdrawal that may be severe enough to require hospitalisation. People transitioning from buprenorphine or methadone can remain vulnerable for longer, because both leave the system slowly.
The naloxone challenge
Because the calendar can lie — someone may have used more recently than they said, or a long-acting opioid may still be present — clinical guidance describes a naloxone challenge before the first naltrexone dose. A small dose of naloxone is given and the person is observed for withdrawal signs. Nothing happens if the receptors are clear; if they are not, what follows is unpleasant but short and controlled, which is precisely the point of doing it deliberately rather than discovering it after a 380 mg injection that cannot be taken back.
Why Suboxone is easier to start and naltrexone is easier to continue
This is the trade-off in one line. Suboxone has almost no starting barrier and a continuing one: it is a daily medicine, it is a controlled substance, and it requires an ongoing prescription relationship. Naltrexone has a hard starting barrier — those days — and then almost no continuing one, especially as a monthly injection with nothing to remember and nothing to divert. A great many treatment failures happen in the gap between detox and a first naltrexone dose, which is a scheduling problem as much as a clinical one.
Vivitrol: what the monthly injection actually involves
Vivitrol is the brand name for extended-release injectable naltrexone. The prescribing information is specific in ways that answer most of what people ask before their first appointment, so it is worth quoting rather than paraphrasing: 380 mg delivered intramuscularly, deep, as a gluteal injection, every four weeks or once a month, alternating buttocks for each subsequent injection.
Can it be given in the arm?
No. The label is unusually blunt about this: Vivitrol must ONLY be administered as a deep intramuscular gluteal injection. It is not an arm shot, and a provider offering one is not following the labelling. The alternating-buttocks instruction exists because the injection volume is substantial and the same site every four weeks is asking for trouble.
Can you give it to yourself?
No. The label states that Vivitrol must be prepared and administered by a healthcare provider. That is partly the injection depth and partly the consequence of getting it wrong, which the next subsection covers. Practically, it means a clinic appointment every four weeks, and that logistics question belongs in the decision from the start rather than after the first month.
What if the appointment is early, late, or missed?
The dosing interval in the label is every four weeks or once a month; timing questions belong with the prescriber rather than a web page, because the answer depends on how much time has passed and on 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. A late appointment is not simply a gap in treatment — it is a period during which protection is falling while tolerance is still low.
Injection site reactions
The label carries a specific warning here, and it is stronger than most people expect: in some cases injection site reactions may be very severe, and some cases have required surgical intervention. That is not a reason to avoid the medicine — the same label sets out the benefits — but it is a reason to report a site that is worsening rather than waiting for the next monthly visit.
The overdose risk that gets least attention
This is the part of the naltrexone conversation that is most often skipped, and the label devotes its first warning section to it. After opioid detoxification, patients are likely to have reduced tolerance. Vivitrol blocks the effects of exogenous opioids for approximately 28 days after administration — and as that blockade wanes and eventually dissipates, someone who returns to a dose that was once ordinary is doing so with a tolerance that no longer matches it.
What the label recommends because of it
It says to strongly consider recommending or prescribing an opioid reversal agent — naloxone or nalmefene — for the emergency treatment of overdose. In plain terms: the medicine designed to block opioids comes with advice to keep an overdose antidote in the house. That is not a contradiction. It is an honest acknowledgement that treatment is not a guarantee and that the riskiest moment is the one after protection ends.
Attempting to override the blockade
The label also warns that trying to overcome the blockade with large amounts of opioids may lead to fatal overdose. This is worth saying plainly because the reasoning that leads there is understandable — if a normal dose does nothing, take more — and the outcome is not proportionate to the mistake.
What else the label warns about
Two further warnings are worth knowing before starting, because both are things you would otherwise attribute to something else and mention to nobody.
Liver
Cases of hepatitis and clinically significant liver dysfunction have been observed with Vivitrol, both in the clinical development programme and after approval, and the label instructs discontinuation in the event of symptoms or signs of acute hepatitis. Elevated liver enzymes were more commonly reported in the treatment group than on placebo in a trial population where hepatitis C was common. If you have existing liver disease, that is a conversation to have before the first injection rather than after.
Mood
The label directs clinicians to monitor patients for the development of depression or suicidal thinking. Nobody is well served by discovering that instruction after the fact, and it is a reasonable thing to ask a prescriber how they intend to monitor.
Planned surgery, and emergencies
If an operation is scheduled, the anaesthetic team needs to know about naltrexone well in advance, because the medicines they would normally rely on for pain will not work as expected while the blockade holds. When and whether to stop it beforehand is their decision together with the prescriber, and it is not something to arrange by stopping the medicine yourself. For unplanned emergencies the label suggests approaches such as regional analgesia, which is another reason to carry something that states you are on it.
Benzodiazepines and other sedatives
Naltrexone does not block benzodiazepines such as alprazolam or clonazepam, and it does not reduce their risk. That matters because the combination people most often underestimate is sedatives with anything else that depresses breathing. Being on an opioid blocker changes nothing about that, and a false sense of general protection is exactly the misreading worth naming out loud.
If you need pain treated
Naltrexone antagonises opioid-containing medicines generally — the label names cough and cold remedies, antidiarrhoeal preparations and opioid analgesics. For emergency pain management in someone on Vivitrol, the label suggests approaches such as regional analgesia. The practical step is carrying something that says you are on naltrexone, because in an emergency the usual first response will not work as expected.
Naltrexone and alcohol: the part Suboxone does not do at all
Buprenorphine treats opioid use disorder. Naltrexone is FDA-approved for both opioid dependence and alcohol use disorder, and if alcohol is part of the picture that single fact often settles the comparison before any other consideration. It is also the biggest reason the two medicines are not really interchangeable: they overlap on one condition and diverge entirely on another.
Does it make you sick if you drink?
No — and this is the most common confusion on the topic. The medicine that causes a violent reaction to alcohol is disulfiram, sold as Antabuse, and it works on a completely different mechanism. Naltrexone does nothing of the kind. It dampens the reward, so drinking tends to feel less rewarding and heavy drinking days tend to reduce, rather than being punished. People sometimes avoid naltrexone because they have been told the Antabuse story about it, which is a decision made on the wrong information.
Does it treat alcohol withdrawal?
No, and this matters more than the previous question because getting it wrong is dangerous. Alcohol withdrawal is one of the few withdrawals that can be medically serious, and it is managed with different medicines under supervision. Naltrexone is for what comes after that — reducing the pull of drinking — not for the first days of stopping. Anyone stopping heavy daily drinking needs that assessed separately, and the two things being confused is a real hazard rather than a technicality.
The tablet or the injection
Once naltrexone is the direction, a second choice appears, and it is genuinely about circumstances rather than chemistry. In our count of the federal directory, 54.3% of facilities report offering oral naltrexone and 47.5% offer the extended-release injectable form, so both are widely available and neither is exotic.
What each form is actually good at
The tablet is flexible and cheap, requires no appointment, and can be stopped the moment someone changes their mind — which is its weakness as well as its strength. The injection removes the daily decision entirely for four weeks, which is exactly what some people need and exactly what others find intolerable. There is no adherence problem to solve with an injection, and no way to undo it either if side effects appear.
Drug tests, and what the blockade does not cover
Two practical questions come up constantly and both have clear answers.
Will naltrexone show up on a drug test?
Not on the standard panels people are usually worried about. Naltrexone is not an opioid and standard opiate immunoassays are designed around morphine-like compounds; it is not something a routine workplace screen looks for, and it does not produce an opioid-positive result. If a test is being run for a job, a court or a treatment programme, the useful step is the same as with any medication: tell whoever ordered it what you are prescribed, and ask which panel they run.
What naltrexone does and does not block
It blocks opioids. It does not block benzodiazepines such as alprazolam, it does not block alcohol from making you drunk, and it does not block stimulants — different receptors entirely. Kratom is a partial exception in that some of its activity is at opioid receptors, so a blockade would affect that part of it. Assuming the medicine is a general shield is a mistake, and the risks that come with sedatives are unchanged by it.
Taking both, and switching between them
These two questions get asked together and have almost opposite answers.
Can you take naltrexone and Suboxone together?
No, and the reason is mechanical rather than a matter of policy. One blocks the receptor and the other needs to occupy it; giving an antagonist to someone maintained on a partial agonist precipitates withdrawal, which is the same event the 7 to 10 day rule exists to prevent. They are not a combination. They are alternatives, and the transition between them is a supervised process rather than an overlap.
Switching from Suboxone or methadone to naltrexone
It is done, and it is the slowest part of this whole comparison. Both medicines leave the body gradually, so the opioid-free interval is measured from when they are actually cleared rather than from the last dose, and published guidance notes that people transitioning from buprenorphine or methadone can remain vulnerable to precipitated withdrawal for as long as two weeks. In practice this is a planned taper followed by a monitored gap, frequently with a naloxone challenge at the end of it. It is not something to attempt by simply stopping and waiting alone.
Side effects, and whether they settle
The commonly reported effects of naltrexone are nausea, headache, tiredness, dizziness and trouble sleeping, and for many people they are worst in the first days and ease afterwards. That pattern is common enough to be worth knowing, because it changes what an unpleasant first week means: often it is the adjustment rather than the verdict. It is not universal, and the label warnings above sit alongside this — a symptom that fits the liver or mood warnings is a reason to contact the prescriber rather than to wait it out.
How this compares with the other medicine
Buprenorphine has its own profile, including constipation, sedation early on and, per the FDA warning of January 2022, dental problems with the forms dissolved in the mouth. Neither medicine is side-effect-free, and comparing lists is less useful than most pages suggest. What actually differs is the shape of the risk: with buprenorphine it is mostly what the medicine does while you take it, and with naltrexone it is mostly what happens if the blockade ends and use resumes.
How long do people stay on either one?
There is no fixed course, and the honest answer disappoints people who want one. Both are treatments for a chronic condition rather than a programme to be completed, and the evidence on duration points the same way for both: longer is generally better, and the risk concentrates around stopping. NIDA states the principle without hedging — remaining in treatment for an adequate period of time is critical.
What stopping looks like for each
Stopping naltrexone produces no withdrawal, because there is no dependence to withdraw from. That sounds like an advantage and contains the catch: nothing marks the transition, tolerance is low, and the protection simply ends. Stopping buprenorphine does produce withdrawal and is therefore usually tapered, which paradoxically gives the process a structure and a clinical conversation attached to it. Either way the period after stopping is the high-risk window, and planning for it belongs in the decision to stop rather than after.
What the research actually says about effectiveness
Comparing the two fairly requires separating two questions that are usually merged. Once someone is successfully started on either medicine, outcomes are broadly comparable — that is the finding people quote. But getting started is not equally likely: the opioid-free interval means a meaningful share of people who intend to start naltrexone never reach the first dose, while the barrier to starting buprenorphine is administrative rather than physiological. So the medicine that performs equally well in those who start it can perform worse across everyone who intended to, purely because of the gate at the entrance.
What that means for a real decision
It means the question to ask is not which is more effective in the abstract, but whether the starting conditions for the more demanding option actually exist for you right now — a completed detox, a supervised gap, an appointment booked at the end of it. Where they do, naltrexone is a serious option with a real advantage in simplicity. Where they do not, choosing it is choosing a plan with a step in it that nobody has arranged.
Cost and coverage
Oral naltrexone is available as a generic and is among the less expensive medications in this field. The extended-release injection is substantially more expensive per month, and it is administered in a clinic, which means the cost can arrive as both a medication charge and an administration charge. Because prices vary so widely by plan and by site of care, a specific figure is worth less than knowing which questions produce one.
The routes that reduce it
In our count of the federal directory, 83.4% of facilities accept Medicaid, 54.5% accept state funding outside Medicaid and 40.0% operate a sliding fee scale. For the injection specifically, ask whether the medication is billed under the pharmacy benefit or the medical benefit, because the answer changes what you owe and is a question most people do not know to ask. Manufacturer assistance programmes exist for the branded injection and are worth asking about by name.
Where each sits in the system of care
Neither medicine is a level of care, and both are used across several of them. Naltrexone is frequently started at the end of a residential stay or a detox admission, precisely because that setting solves the opioid-free interval — the gap has already been served under supervision. Buprenorphine is started anywhere, including in an emergency department or an outpatient appointment on the same day. That difference in where they naturally begin explains much of who ends up on which.
Leaving a controlled setting
The strongest practical case for the injection is the transition out of a place where opioids were unavailable — residential treatment, incarceration, a hospital admission. The opioid-free window is already complete, tolerance is low, and the weeks that follow are the highest-risk period in the whole episode. A medicine that provides roughly four weeks of blockade with nothing to remember fits that moment better than anything requiring a daily decision.
The monthly injection is not only a naltrexone option
One assumption runs through most comparisons of these two medicines and it is wrong: that choosing the injection means choosing naltrexone. Extended-release buprenorphine exists — marketed as Sublocade and Brixadi — and in our count of the federal directory 33.7% of facilities report offering it, against 47.5% for the naltrexone injection. A further 10.4% report a buprenorphine implant. So if the appeal of Vivitrol is that there is nothing to take daily, that same appeal is available on the other side of the comparison without the 7 to 10 day gate.
What that changes about the decision
It separates two things people merge. If the real problem is remembering a daily dose, extended-release buprenorphine solves it while keeping the easy start. If the real requirement is a medicine with no opioid effect at all — for a licence, a job, a court, or a personal line someone has drawn — then naltrexone is the answer and the interval has to be served. Being clear about which of those two is driving the preference usually settles the choice faster than any comparison table.
Naltrexone for alcohol: dose, timing and what to expect
Because naltrexone is the only one of the two approved for alcohol use disorder, the practical questions people ask about it are mostly alcohol questions. Published dosing guidance describes the oral form as a 50 mg tablet, with 50 to 100 mg described for alcohol treatment and an initial 25 mg dose. The extended-release injection is the same 380 mg every four weeks used for opioid use disorder. Actual dosing is a prescribing decision, and the reason to state the published range here is that people otherwise assume the alcohol dose is something different.
Morning or night?
Both are used, and the honest answer is that it depends on how it affects you. Nausea and drowsiness are among the more common early effects, so some people take it in the evening for that reason and others avoid the evening because of trouble sleeping. This is a genuinely individual adjustment rather than a rule, and it is worth raising at the first follow-up rather than quietly enduring whichever was suggested initially.
How quickly does it work?
The blocking action begins with the dose — this is not a medicine that has to build up over weeks. What takes longer is the part people actually care about: the reduction in how rewarding drinking feels, and the change in patterns that follows from it. Expecting an immediate absence of craving sets people up to conclude it does not work after three days. The injection reaches its effect over a similar timescale and then holds it for the four-week interval rather than fluctuating daily.
Does it cause weight gain?
Weight gain is not among the commonly reported effects; nausea and reduced appetite point the other way if anything, particularly early on. Weight changes during recovery from alcohol use disorder are common for reasons that have nothing to do with the medication — alcohol carries substantial calories, appetite returns, and eating patterns change. Attributing that to naltrexone is a frequent misattribution, though any unexpected change is still worth mentioning to the prescriber.
How naltrexone works, in plain terms
Opioids and alcohol both act, by different routes, on the same reward circuitry, and the endorphin system is part of what makes both feel worth repeating. Naltrexone sits on the mu-opioid receptor and prevents that signal. With opioids the effect is direct: the drug cannot produce its effect because the receptor is occupied. With alcohol it is indirect: alcohol still intoxicates, but the endorphin-mediated part of the reward is dampened, so the drink delivers less of what the brain was seeking. This is why the same molecule can be a blockade in one condition and a reward-dampener in the other, and why it treats both while buprenorphine treats only one.
Questions worth asking before you start either one
Both medicines are prescribed after an assessment, and the assessment goes better when you arrive with the specifics. Ask how the opioid-free interval will be handled and who supervises it, whether a naloxone challenge will be used, what happens if the first injection appointment slips, how the prescriber monitors liver function and mood, what to do about pain treatment in an emergency, whether the clinic bills the injection under the pharmacy or medical benefit, and what the plan is for the period after the medicine stops. A prescriber who answers those plainly is telling you something about how the rest of it will go.
What this page cannot tell you
Which of these two is right for a specific person is a clinical decision that depends on the substance, the history, other conditions, other medications and what is realistically available nearby. Nothing here is a recommendation to start, stop or change a medication, and no doctor has reviewed this page. What we can do is show what the federal label and the public clinical sources actually say, count what the national directory actually contains, and be clear about which parts are settled and which are not — so that the conversation with a prescriber starts further along than it otherwise would.
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
Is naltrexone the same as Suboxone?
No — they are opposites at the receptor. Naltrexone blocks opioid receptors and produces no opioid effect at all. Suboxone contains buprenorphine, which partially activates the same receptors and relieves withdrawal. The confusion is understandable because both are used for opioid use disorder and both are taken long term, but a medicine that blocks and a medicine that partially activates cannot be swapped for one another, and they cannot be taken together.
Can I drink alcohol while taking naltrexone?
Naltrexone does not cause a violent reaction to alcohol — that is disulfiram, a different medicine. What naltrexone does is reduce the reward from drinking, which is why it is FDA-approved for alcohol use disorder in the first place. Whether drinking at all is advisable while being treated for a drinking problem is a different question, and one for the prescriber rather than a comparison page. What is settled is that the medicine is not designed to punish a drink.
How long does the Vivitrol shot last?
The label states that it blocks the effects of opioids for approximately 28 days after administration, which is why the dosing interval is every four weeks. What matters more than the number is the shape of it: the blockade does not stop abruptly on day 28, it wanes. That fading period, when protection is falling but tolerance has not returned, is the window the label singles out as carrying overdose risk.
Does the Vivitrol injection hurt, and can it be given in the arm?
It is a deep intramuscular injection of a substantial volume, so discomfort at the site is common and the label instructs alternating buttocks between doses for that reason. It cannot be given in the arm: the prescribing information states that Vivitrol must only be administered as a deep intramuscular gluteal injection, and only by a healthcare provider. Severe site reactions are uncommon but documented, and the label notes that some have required surgical intervention — a worsening site is worth reporting rather than waiting out.
What happens if I use opioids while on naltrexone?
Ordinary doses will produce little or no effect while the blockade holds, which is the intended function. The danger is in the response to that. The label warns that attempting to overcome the blockade with large amounts of opioids may lead to fatal overdose, and separately that the risk rises as the blockade wanes because tolerance has fallen in the meantime. This is the reason the same label advises keeping naloxone or nalmefene available.
How long should someone stay on naltrexone?
There is no fixed course, and the honest answer is that duration is decided clinically rather than by a calendar. Both this medicine and buprenorphine are treatments for a chronic condition, and the evidence consistently favours staying in treatment for an adequate period rather than aiming at an exit date. Because stopping naltrexone produces no withdrawal, there is nothing that forces the conversation — which is exactly why it is worth having deliberately rather than by drifting away from appointments.
How does naltrexone compare with acamprosate for alcohol?
Both are FDA-approved for alcohol use disorder and they work differently: naltrexone reduces the reward from drinking, while acamprosate is aimed at the disrupted state that persists after drinking stops. Acamprosate is taken several times a day and is generally started after abstinence has begun; naltrexone can be used in someone still drinking. They suit different situations and are sometimes used together. Which fits is a prescribing decision, and the relevant point for this page is that neither of them is buprenorphine and neither treats opioid use disorder.
Why is the injection so much more expensive than the tablet?
Oral naltrexone is available as a generic; the extended-release injection is a branded product delivered in a clinic, so the cost includes both the medication and its administration. That split is worth understanding before the first appointment, because the two halves can be billed differently — under the pharmacy benefit or the medical benefit — and which one applies changes what you owe. Manufacturer assistance exists for the branded product, and in our count 40.0% of facilities operate a sliding fee scale.
Sources
- DailyMed (NLM) — VIVITROL prescribing information, Alkermes
- NCBI Bookshelf (NIH) — Naltrexone, StatPearls
- MedlinePlus (NLM) — Naltrexone injection
- NIDA — Medications for Opioid Use Disorder
- NIDA — Is medication treatment replacing one addiction with another?
- NIDA — Principles of Effective Treatment
- NIAAA — Alcohol Treatment Navigator
- SAMHSA — FindTreatment.gov, the federal treatment locator
- SAMHSA — naltrexone overview
- Vermont Department of Health — buprenorphine and oral health (FDA warning, Jan 2022)
How this page was made
- Who wrote it:
- the Treatment Compass 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, but the real question is whether home can hold the other 148 hours. Compared against ASAM levels.
- 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
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.