How to choose Suboxone vs. Vivitrol for opioid use disorder

 

Patients and families wonder what treatments are best for opioid use disorder.  Search online and you will find all kinds of different opinions.  If you stick with professional treatment guidelines, they will typically recommend medication along with therapy, but there are several medications to choose from.

 

Methadone is a strong opioid itself, so the government requires that you have to get it from a special clinical known as an “opioid treatment program,” or sometimes referred to as a “methadone clinic.”

 

Buprenorphine, better known by the brand name Suboxone, is the most popular medicine for opioid addiction.  Suboxone is a partial opioid receptor agonist, so it stimulates the opioid receptor to a partial degree.  This means it feels a little bit like taking a regular opioid.  Because of this, it will help reduce opioid withdrawals and opioid cravings.  Patients taking Suboxone have a much lower relapse rate.

 

Vivitrol, also known as extended-release naltrexone, is a once-a-month injection of naltrexone.  This opioid blocker prevents any opioids from attaching to the receptors, so it blocks all effects from any opioid drug that someone uses.  Because of this strong blocking action, it can work well to help prevent relapses, too.

 

Both Suboxone and Vivitrol have been proven very effective for patients with opioid use disorder.  Unfortunately, Vivitrol requires a period of abstinence from all opioids before it can be started, which is usually several days.  This period can feel like an eternity to someone having withdrawals and cravings, and a lot of people relapse while they are waiting until they can start Vivitrol after being on opioid drugs.

 

Because of this time delay, Suboxone (or Sublocade or Brixadi) is really the best choice for most people starting medication treatment for opioids.  In most cases, Suboxone can be started the same day or the next day after stopping opioid drugs, so it avoids the risky period of waiting that Vivitrol requires.

 

However, Suboxone, itself and opioid, is hard to stop, and many people do not want to take it for that reason.  In that case, Vivitrol remains and important option for patients who simply prefer that treatment approach, even though it is more risky to start.  When facing this situation, I will usually encourage people to go with Suboxone, due to the lower risk of relapse and overdose when starting treatment.  But if someone really wants Vivitrol, I will go ahead and help them with that treatment plan instead.