If you’re fighting opioid addiction, you’ve probably heard about medication-assisted treatment (MAT), which has proven to be one of the most effective tools in combating use disorders. Of the options available for opioid use disorder (OUD), two popular medications are often competing with each other due to their differences: Vivitrol and Suboxone. Both are FDA-approved for treating opioid use disorder, but they work in distinct ways. Understanding the advantages and disadvantages could be the key to finding the right path for your recovery process.
This guide breaks down everything you need to know about Vivitrol vs. Suboxone. We’ll cover how each medication works in your brain, what the side effects feel like, how you take them, and which might work better for your situation.
Quick Takeaways
- Suboxone contains buprenorphine (a partial opioid agonist) that reduces cravings and withdrawal symptoms while you’re still using it daily.
- Vivitrol is an injection of naltrexone (an opioid antagonist) given once monthly that blocks opioid receptors completely.
- You must be completely opioid-free for 7-10 days before starting Vivitrol, while Suboxone can begin during withdrawal.
- Suboxone carries some risk of misuse and physical dependence, while Vivitrol has no abuse potential.
- Both medications work best when combined with behavioral therapy and support groups.
- Success rates improve significantly with either medication compared to no medication-assisted treatment.
- Your choice depends on your detox status, lifestyle, relapse history, and personal preferences.
Understanding Opioid Addiction and Your Brain
Opioid use disorder is so challenging to treat because it drastically changes how your brain works. When you use opioids like heroin, fentanyl, or prescription painkillers, they flood opioid receptors in your brain with feel-good chemicals. Over time, your brain stops making these chemicals on its own, creating a physical dependence where your body literally needs the drug just to feel normal.
Those same affected receptors control pain, mood, breathing, and reward feelings, so when you stop using it, your brain goes haywire and out of your control. Your withdrawal symptoms will kick in within hours. You may feel like you have the worst flu ever, your legs won’t stop moving, you can’t sleep, and the cravings are intense.
Why You Can’t Beat It On Your Own
At the point of physical and mental dependence, opioid addiction becomes so hard to beat on your own. This is something evidenced in the data by the still extremely high relapse rates, which the Food and Drug Administration (FDA) in 2023 put at around 65-70%. While progress has been made on this front in recent years, and overdose deaths dropped sharply in 2024, many patients still struggle with maintaining access to the scientifically proven combination of medication-assisted treatment and follow-through clinical care.
A 2025 study published by Psychiatry Research found that only around 10% of OUD patients who underwent detox were still attending follow-up after 12 months, which raises the risk of relapse significantly. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that medication-assisted treatment (MAT) improves retention in addiction treatment programs and greatly reduces illicit opioid use. Commonly held beliefs about traditional willpower-based approaches have high failure rates because they ignore the biological reality of opioid dependence, making MAT a key part of a successful recovery. Your brain needs time to heal, and that’s exactly what these medications provide.
What is Suboxone and How Does It Work?
Suboxone is a prescription medication that combines two active ingredients: buprenorphine and naloxone. The buprenorphine is the main player here; it’s what we call a partial opioid agonist, which means it activates the same receptors as other opioids, but only partially.
Because buprenorphine partially activates opioid receptors, it does enough to reduce withdrawal symptoms and stop cravings without getting you high. It has a ceiling effect, meaning that taking more doesn’t increase the effects after a certain point. This makes it much safer than full opioid agonists like methadone or the opioids you were using before.
The naloxone in Suboxone is there mainly to prevent misuse. If you try to inject Suboxone, the naloxone kicks in and blocks the opioid receptors, potentially causing immediate withdrawal. However, when you take it correctly as a sublingual film under your tongue, the naloxone barely gets absorbed. The buprenorphine does the work.
What to Expect During Suboxone Treatment
Suboxone treatment typically starts in outpatient settings once you’re in mild to moderate withdrawal, typically between 12 and 24 hours after withdrawal starts. Your healthcare provider will give you your first dose and monitor your response, with many people feeling relief within an hour or two. The medication stays in your system for a long time, so you usually take it once daily. Some people stay on suboxone for months or years, slowly tapering down when they’re ready. Others use it short-term to get through the worst of early recovery.
What is Vivitrol and How Does It Work?
Vivitrol is the brand name for injectable naltrexone, and it works entirely differently from Suboxone. Naltrexone is an opioid antagonist, which means it blocks opioid receptors instead of activating them. If you take Vivitrol and then use opioids, you won’t feel anything; the receptors are occupied and blocked, which eliminates part of the motive for substance abuse.
What to Expect During Vivitrol Treatment
You get Vivitrol as a deep intramuscular shot in your buttock muscle once a month. The medication slowly releases over those 28-30 days, providing continuous protection against relapse. Because it completely blocks opioid receptors for a time, there’s low potential for misuse or getting high from Vivitrol itself. It also helps, by the way it’s administered, that you can’t abuse it, sell it, or use it wrong.
One big catch with Vivitrol is that you must be completely opioid-free for 7-10 days before your first injection. If you still have opioids in your system when you get the shot, it will throw you into sudden, severe withdrawal. This is called precipitated withdrawal, and it’s incredibly uncomfortable. This requirement makes Vivitrol harder to start than Suboxone, but it also means you’ve already cleared the hardest physical hurdle of detox.
What is Vivitrol used for beyond opioid addiction? The medication is also FDA-approved for treating alcohol dependence. Some patients benefit from it for both conditions. The naltrexone blocks the rewarding effects of drinking alcohol as well as opioid use.
Key Differences Between Vivitrol and Suboxone
The biggest difference comes down to how these medications interact with opioid receptors. Suboxone activates them partially, while Vivitrol blocks them completely. This fundamental difference affects everything else: when you can start, how you take them, and what your daily life looks like during treatment.
| Suboxone | Vivitrol |
| Partial opioid agonist | Opioid antagonist |
| Daily sublingual film or tablet | Monthly injection |
| Can start during withdrawal | Must be opioid-free 7-10 days |
| Some potential for physical dependence | No abuse potential |
| Reduces cravings and withdrawal | Blocks the effects of opioids |
| Requires daily commitment | Monthly doctor visits |
| Generic available (Buprenorphine/naloxone), generally lower cost | Brand name only, higher cost per dose |
Suboxone Side Effects: What to Expect During Medication-Assisted Treatment
Starting Suboxone usually feels like relief if you’re in withdrawal, but the medication does come with common side effects. Most people experience some of these, especially in the first few weeks, as their body adjusts to the medication.
The most common side effects include:
- Nausea
- Headache
- Sweating
- Constipation
- Insomnia
The constipation can be particularly frustrating since that’s a common opioid side effect, and buprenorphine is still activating those receptors. Drinking more water, eating fiber, and staying active help manage these symptoms. Some people also feel dizzy or drowsy, especially when they first start or change doses.
One side effect that people don’t often talk about is tooth decay. Keeping the sublingual film in your mouth daily can damage tooth enamel over time. To help manage this, rinse your mouth with water after taking your dose, wait an hour, then brush. People may also experience a decreased libido (sex drive), and lowered sexual function, but this is also a researched symptom of long-term opioid use in general.
A more serious but less common side effect includes breathing problems, especially if you combine Suboxone with central nervous system depressants like alcohol or benzodiazepines. This combination can be life-threatening, and if you or someone you care about shows signs of depressed breathing, you should immediately call for emergency help. Some people also develop allergic reactions or liver problems, which is why your doctor will check liver function tests periodically. If you have existing liver disease, you’ll need closer monitoring.
Vivitrol Side Effects: What You Should Know
Vivitrol side effects differ from Suboxone because you’re getting an injection rather than taking daily medication. The injection itself causes common side effects for many people, such as:
- Pain
- Swelling
- Bruising
- Hardness at the injection site
Some people develop nodules or lumps that last for weeks. Rarely, the injection causes severe reactions like tissue death at the site, though this is uncommon when administered correctly.
Systemic side effects include nausea, headache, dizziness, fatigue, and stomach problems. Some people experience vomiting, decreased appetite, or weight loss during the first month or two. These effects usually improve over time as your body adjusts to having the medication continuously in your system.
Vivitrol can also cause liver damage in rare cases, especially at higher doses. Your healthcare provider should check liver function before starting treatment and periodically during treatment. If you have liver disease already, Vivitrol might not be safe for you.
Some people on Vivitrol report mood changes, depression, or increased anxiety. This gets complicated because people in early recovery often struggle with mental health anyway, so it’s hard to pinpoint if the medication is causing it or if you’re just dealing with the reality of getting sober. Either way, these feelings matter. If you notice worsening depression or suicidal thoughts, call your doctor immediately.
One unique risk with Vivitrol is that if you relapse and try to override the blockade by using massive amounts of opioids, you have a high risk of overdose. The naltrexone blocks receptors, so people sometimes use more and more, trying to feel something. If the Vivitrol wears off or you stop getting injections, your tolerance is much lower than you think. The amount that did nothing a week ago could kill you now.
Addiction Treatment Effectiveness: Which Medication Works Better?
The answer to this question is ultimately up to you; the research supports positive outcomes for both when you want to treat opioid addiction and drug abuse.
The detox requirement is a huge differentiator between the two, and is likely to be a significant factor in your decision. With Suboxone, you can start when you’re already feeling sick from withdrawal, and the medication brings relief relatively quickly. However, with Vivitrol, you have to get through the worst of withdrawal first, either on your own or with medical supervision in a detox facility. For some people, this barrier is too high, though for others, knowing they’ve already made it through detox feels empowering.
Another notable difference is the level of commitment. Suboxone requires you to remember medication every single day. If you miss doses, you might start feeling withdrawal. If you relapse while on Suboxone, you can still get high from other opioids, though you need higher doses. With Vivitrol, you just need to show up once monthly, but if you relapse, the medication blocks the effects entirely.
Frequently Asked Questions About Vivitrol vs Suboxone
Are Vivitrol and Suboxone the same thing?
No, they’re different medications for opioid use disorder. Vivitrol (naltrexone) is a monthly injection that blocks opioid receptors, requiring complete detox first. Suboxone (buprenorphine/naloxone) is a daily sublingual medication that partially activates opioid receptors, preventing withdrawal while reducing cravings. Both are effective but work through different mechanisms.
What is Suboxone used for?
Suboxone treats opioid use disorder by reducing cravings and withdrawal symptoms. It contains buprenorphine (a partial opioid agonist) and naloxone (an opioid blocker). This combination helps people transition off stronger opioids, maintain recovery, and regain stability. It’s part of medication-assisted treatment (MAT) combined with counseling and support.
What is Vivitrol used for?
Vivitrol treats opioid and alcohol use disorders. This monthly injection contains naltrexone, which blocks opioid receptors to prevent euphoric effects and reduce cravings. Importantly, you must be fully detoxed before starting. Vivitrol helps maintain abstinence by removing the rewarding effects of opioids and alcohol, supporting long-term recovery alongside counseling.
What is the three-day rule for Suboxone?
Under the Narcotic Treatment Act, if your provider prescribes narcotics (in this case, Suboxone) for treating opioid addiction, they must first obtain the necessary federal and state registration to ensure requirements for treatment are met. One exception to this is the “three-day rule,” allowing narcotics like Suboxone for treatment up to 72 hours to provide flexibility in emergencies.
Is Suboxone a narcotic drug?
Yes. Suboxone is classified as a controlled substance (Schedule III narcotic) because it contains buprenorphine, a partial opioid agonist. However, it has lower abuse potential than full opioids and is FDA-approved for treating opioid dependence. It’s a safer alternative that reduces cravings while minimizing euphoric effects.
Deciding Between Vivitrol and Suboxone Treatment for Your Opioid Use Disorder
Choosing between the two isn’t about finding the perfect medication, as both Suboxone and Vivitrol are effective treatments while having their own challenges. Instead, it’s about finding what works for you, right now, where you are in your recovery journey. Both medicines have helped thousands of people reclaim their lives from opioid addiction.
If you’re ready to take the next step or just want someone to walk you through your options, we’re here for you. At New Chapter Recovery in New Jersey, we offer medication-assisted treatment, counseling, and personalized support to help you build a safer, steadier path forward. To learn more or start admissions, visit our contact page.
