Vivitrol Treatment: Monthly Injection for Opioid and Alcohol Recovery

Vivitrol is the brand name for extended-release naltrexone, an FDA-approved monthly injection used to treat both opioid use disorder and alcohol use disorder. Approved for alcohol dependence in 2006 and for opioid dependence in 2010, Vivitrol represents a fundamentally different approach to medication-assisted treatment because it is an opioid antagonist—it blocks opioid receptors rather than activating them. This makes Vivitrol the only FDA-approved injectable MAT medication with zero abuse potential.

How Vivitrol Works

Vivitrol for Opioids vs Alcohol

Vivitrol treatment follows a structured process that begins with preparation and assessment, continues through the injection itself, and involves ongoing monthly treatment visits. Understanding each phase helps patients know what to expect and increases the likelihood of successful treatment initiation and long-term adherence.

Before Starting Vivitrol

The Injection Process

Ongoing Treatment

Vivitrol offers a unique set of advantages that make it an attractive treatment option for many patients recovering from opioid or alcohol addiction. Its non-opioid mechanism, monthly dosing schedule, and zero abuse potential distinguish it from other MAT medications and address several common barriers to treatment engagement and adherence.

• Zero abuse potential — As an opioid antagonist, Vivitrol cannot be misused for euphoric effects, eliminating concerns about medication diversion or dependence on the treatment itself
• Monthly dosing eliminates daily decisions — One injection per month removes the burden of daily medication adherence, which is one of the leading causes of treatment failure with oral medications
• No physical dependence — Patients do not develop tolerance or withdrawal symptoms from Vivitrol, making eventual discontinuation straightforward when clinically appropriate
• Treats both opioid and alcohol use disorders — Vivitrol is the only injectable MAT medication FDA-approved for both conditions, making it suitable for patients with co-occurring opioid and alcohol disorders
• No DEA scheduling restrictions — Unlike methadone (Schedule II) and buprenorphine (Schedule III), naltrexone is not a controlled substance, simplifying prescribing and reducing regulatory barriers
• Office-based administration — Vivitrol can be administered in any healthcare setting by any licensed provider, unlike methadone which requires specialized clinic certification
• Compatible with abstinence-based recovery — Because Vivitrol is not an opioid, patients and recovery communities that prefer non-opioid approaches find it more philosophically acceptable

The landmark COMBINE study for alcohol use disorder and the X:BOT trial for opioid use disorder both demonstrated Vivitrol's clinical effectiveness. For patients who can successfully complete the detoxification period required for opioid treatment, Vivitrol provides outcomes comparable to other MAT medications while offering the distinct advantages of non-opioid treatment and monthly convenience.

Vivitrol is generally well-tolerated, though patients should be aware of both common and rare side effects. The most frequently reported side effects are related to the injection site and the body's adjustment to opioid receptor blockade. As with any medication, the benefits of treatment should be weighed against potential side effects, and patients should report any concerning symptoms to their healthcare provider promptly.

Common side effects include injection site reactions (pain, hardness, lumps, or redness at the injection site), nausea, headache, fatigue, dizziness, and decreased appetite. Injection site reactions are the most prevalent, occurring in approximately 70% of patients in clinical trials, though most are mild and resolve within one to two weeks. Nausea is more common after the first injection and typically diminishes with subsequent doses. These common side effects are manageable and rarely require treatment discontinuation.

Serious side effects are rare but important to recognize. The FDA label includes warnings about hepatotoxicity (liver damage), and liver function tests should be monitored periodically during treatment. Injection site reactions can occasionally progress to induration, cellulitis, or in very rare cases, tissue necrosis requiring surgical intervention—patients should contact their provider if they notice increasing pain, swelling, or darkening of the skin at the injection site. Depression and suicidal ideation have been reported in some patients on naltrexone, though causality has not been definitively established.

An important safety consideration is that Vivitrol blocks opioid receptors, which means opioid-based pain medications will not work while the medication is active. Patients should carry a medical alert card or wear a medical alert bracelet indicating they are on naltrexone, so that emergency medical personnel can use non-opioid pain management strategies if needed. Attempting to override the blockade by taking large amounts of opioids is extremely dangerous and can result in fatal overdose once the naltrexone wears off or through non-receptor-mediated mechanisms.

Choosing between Vivitrol, Suboxone, and methadone is one of the most important decisions in opioid addiction treatment. Each medication has a distinct mechanism of action, unique advantages, and specific limitations that make it more or less suitable depending on a patient's circumstances. Ideally, this decision is made collaboratively between the patient and their treatment provider after a thorough clinical assessment.

Vivitrol (naltrexone) is the only non-opioid option among the three. Its antagonist mechanism means it blocks opioid effects entirely rather than activating receptors to any degree. The monthly injection eliminates daily adherence concerns, and it has zero potential for physical dependence or misuse. However, the requirement for 7 to 14 days of opioid abstinence before initiation is a significant barrier—the X:BOT trial found that substantially fewer patients were able to successfully start Vivitrol compared to Suboxone. Vivitrol also does not treat withdrawal symptoms or provide any opioid-receptor-mediated relief from cravings.

Suboxone (buprenorphine/naloxone) is a partial opioid agonist that can be prescribed in office settings and taken at home. It can be initiated during mild withdrawal (no extended detox required), has a ceiling effect that limits overdose risk, and is available in multiple formulations including sublingual films and monthly injections (Sublocade). Suboxone is the most widely prescribed MAT medication and offers the greatest prescribing flexibility. Its limitations include potential for misuse (though lower than full agonists) and the requirement for daily self-administration with the sublingual formulation.

Methadone is a full opioid agonist with the longest evidence base and potentially the greatest efficacy for severe opioid dependence. It can be started immediately without a withdrawal requirement and is effective for patients dependent on high-potency opioids like fentanyl. However, it requires daily clinic visits initially, carries the highest risk of respiratory depression among the three medications, and has potential for misuse and diversion. The choice among these three medications should prioritize the option most likely to engage and retain each individual patient in treatment.

Starting Vivitrol treatment requires meeting specific clinical criteria to ensure patient safety and treatment effectiveness. These requirements differ depending on whether Vivitrol is being used for opioid or alcohol use disorder. Understanding these prerequisites helps patients prepare appropriately and avoid complications, particularly the risk of precipitated withdrawal in opioid-dependent individuals.

For opioid use disorder: Patients must be completely free of all opioids—including heroin, fentanyl, prescription painkillers, methadone, and buprenorphine—for a minimum of 7 to 14 days before the first injection. This is verified through urine drug screening, clinical assessment, and in many cases a naloxone challenge test. Completing medical detoxification under supervised care is the safest pathway to meeting this requirement. Patients transitioning from methadone require an even longer abstinence period due to methadone's long half-life—typically 14 days or more.

For alcohol use disorder: Patients do not need to be abstinent from alcohol before starting Vivitrol, though they should not be in active alcohol withdrawal (which should be medically managed separately). A commitment to abstinence as a treatment goal is important, as Vivitrol reduces cravings and reward but does not prevent the physiological effects of alcohol consumption. Patients actively consuming large amounts of alcohol should discuss a safe plan for reducing or stopping consumption with their provider.

General medical requirements for all patients include adequate liver function (confirmed by blood tests), absence of acute hepatitis, no known hypersensitivity to naltrexone or the injection components, and no current need for opioid pain medications. Patients should provide a complete medication history, as several drug interactions can affect Vivitrol safety. Women who are pregnant or planning to become pregnant should discuss risks with their provider, as naltrexone is classified as FDA Pregnancy Category C, meaning animal studies have shown adverse effects but adequate human studies are lacking.

Vivitrol is a versatile treatment option that can benefit a wide range of individuals recovering from opioid or alcohol addiction. However, its unique characteristics—the detox requirement for opioids, the non-opioid mechanism, and the monthly dosing—make it particularly well-suited for certain patient populations. Identifying the right candidates for Vivitrol helps maximize treatment success and ensures appropriate medication matching.

Patients who have successfully completed medical detox and achieved initial opioid abstinence are strong candidates for Vivitrol. This includes individuals transitioning from residential treatment programs, where the detox period is built into the program structure. Patients who prefer a non-opioid treatment approach—whether due to personal philosophy, concerns about opioid medication dependence, or past negative experiences with agonist therapies—often find Vivitrol aligns well with their recovery values. Criminal justice populations, including those in drug courts or on probation, frequently benefit from Vivitrol's zero abuse potential and verifiable monthly administration.

For alcohol use disorder, Vivitrol is appropriate for individuals at any stage of recovery who want pharmacological support for maintaining abstinence. It is particularly useful for patients who struggle with daily medication adherence, as the monthly injection eliminates the need for a daily pill. Healthcare professionals, pilots, and others in safety-sensitive occupations who require non-opioid treatment options also frequently choose Vivitrol. Adolescents and young adults who are early in their addiction trajectory may also be good candidates, as Vivitrol avoids introducing opioid receptor activation in individuals who may have less severe physical dependence.

Vivitrol can be integrated into virtually any level of addiction treatment, from residential programs to outpatient settings. Its monthly dosing schedule and lack of abuse potential make it one of the most flexible MAT medications in terms of care setting compatibility. Understanding how Vivitrol fits within different treatment levels helps patients and providers plan a cohesive, long-term treatment strategy.

In residential treatment settings, Vivitrol is frequently initiated during the final phase of the program. The residential environment provides the supervised, structured setting ideal for completing the opioid detox required before the first injection. Patients can receive their initial Vivitrol dose before discharge, ensuring they leave with active medication protection against relapse during the vulnerable transition back to community living. This approach has been shown to significantly improve post-discharge outcomes in several clinical studies.

At the intensive outpatient (IOP) level, Vivitrol complements the structured therapy schedule with reliable medication coverage between sessions. Patients attend IOP programming several days per week while receiving monthly Vivitrol injections, creating a comprehensive treatment framework that addresses both pharmacological and psychosocial needs. The minimal time burden of monthly injections means Vivitrol does not compete with therapy scheduling, unlike medications requiring daily clinic visits.

In standard outpatient and primary care settings, Vivitrol serves as a maintenance medication for patients who have progressed through more intensive levels of care. Monthly visits for the injection provide a built-in touchpoint with the healthcare system, ensuring regular check-ins even for patients who have stepped down from structured programming. Any licensed healthcare provider can administer Vivitrol—no special certification, DEA waiver, or clinic accreditation is required—which means patients can receive their injections from their primary care physician, psychiatrist, or addiction specialist, wherever is most convenient.