Vivitrol: Monthly Naltrexone Without the Dependence Risk
RECO Intensive integrates Vivitrol (extended-release naltrexone) into outpatient treatment for alcohol and opioid use disorder. One injection per month blocks the rewarding effects of opioids and alcohol so you can focus on the therapeutic work that creates lasting change.
What Vivitrol is and how it works
Vivitrol is the brand name for extended-release injectable naltrexone (naltrexone XR). Naltrexone is a full mu-opioid receptor antagonist — meaning it occupies opioid receptors in the brain without activating them, blocking any opioid molecule from binding and producing its reinforcing effects. Unlike methadone or buprenorphine, naltrexone has no agonist activity. There is no euphoria, no sedation, and no physical dependence from the medication itself.
The Vivitrol formulation suspends naltrexone in microspheres of a biodegradable polymer (poly-lactide-co-glycolide). When injected into the gluteal muscle once a month, the microspheres release naltrexone steadily over roughly 28–30 days. Peak plasma concentration is reached around 2 hours after injection and remains therapeutically effective for the full month, eliminating the compliance problem that comes with daily oral dosing.
From a pharmacology standpoint, the antagonist occupancy at mu-opioid receptors also attenuates dopamine release in the nucleus accumbens — the mechanism responsible for the "reward" signal that drives craving. For alcohol use disorder, naltrexone reduces the pleasurable effects of drinking through the same opioid-pathway mechanism (alcohol stimulates endogenous opioid release). This is why naltrexone carries two separate FDA indications: opioid use disorder (OUD) and alcohol use disorder (AUD).
Vivitrol for alcohol use disorder
For individuals struggling with alcohol dependence, Vivitrol is one of only three FDA-approved medications for AUD — alongside acamprosate and oral naltrexone. The landmark COMBINE trial (N=1,383) found that naltrexone significantly reduced heavy drinking days and increased the proportion of days abstinent compared to placebo. A 2006 meta-analysis of 19 randomized trials confirmed a reduction in relapse risk of approximately 36% versus placebo over 12 weeks.
The monthly injection form is particularly useful for patients whose drinking is frequent enough that a daily pill becomes something they skip when craving is highest — which is exactly when they most need it. With Vivitrol, the medication is on board regardless of where motivation sits on any given day.
Ideal candidates for Vivitrol in the alcohol track include patients who:
- Have completed a supervised alcohol detox (or do not require one) and are medically cleared
- Have a goal of abstinence — Vivitrol does not require abstinence to start, but works best in that context
- Have previously relapsed during periods when motivation was strong but craving outpaced willpower
- Take other daily medications reliably or, conversely, have poor adherence to daily oral regimens
If you are pursuing alcohol addiction treatment at RECO Intensive, our medical staff will review your liver function tests (LFTs), current medications, and detox timeline before recommending Vivitrol. Acute hepatitis or liver failure is a contraindication; moderately elevated transaminases are not.
Vivitrol for opioid use disorder
Vivitrol received FDA approval for OUD in 2010. For opioid-dependent patients, the requirement that makes Vivitrol different from all other MAT options is this: you must be completely opioid-free for 7–14 days before the first injection. Attempting to administer naltrexone while opioids are still present in receptor tissue will precipitate acute opioid withdrawal — an intensely uncomfortable, potentially dangerous reaction that includes severe cramping, vomiting, sweating, and anxiety that cannot easily be reversed.
This means Vivitrol is not a detox medication. It is a post-detox relapse-prevention medication. Patients who want Vivitrol for OUD must first complete medical detox and allow adequate washout time — at least 7 days from the last short-acting opioid (heroin, oxycodone, hydrocodone) or 14 days from longer-acting ones (methadone, extended-release formulations). Clinicians typically confirm readiness using a naloxone challenge or by ensuring a Subjective Opiate Withdrawal Scale (SOWS) score is minimal before injecting.
Who is the right candidate for Vivitrol in the OUD track?
- Patients motivated to be fully opioid-free and willing to complete supervised detox first
- Patients who have already detoxed and want pharmacological support during outpatient treatment
- Individuals who object to agonist-based therapy (methadone, buprenorphine) on personal, professional, or regulatory grounds (e.g., healthcare workers with licensing concerns, people with drug-free workplace requirements)
- Those transitioning out of incarceration, where agonist therapy was unavailable
For patients pursuing heroin addiction treatment or other opioid use disorder care, the RECO medical team will review your opioid history, detox timeline, and tolerance before scheduling the first injection.
Vivitrol vs oral naltrexone vs Suboxone (buprenorphine)
Patients and families regularly ask how Vivitrol compares to other MAT options. There is no single best answer — the right medication depends on diagnosis, detox status, adherence history, and personal values. Here is an honest comparison.
Vivitrol vs oral naltrexone (ReVia/generic)
Both contain the same active molecule. The difference is delivery. Oral naltrexone is a 50 mg tablet taken daily. In clinical practice, adherence to daily oral naltrexone is poor — studies show 40–60% of patients discontinue within the first month outside of highly supervised settings. Vivitrol removes that daily decision entirely. For patients with strong social support and high intrinsic motivation, oral naltrexone is a cost-effective option. For everyone else, the monthly injection substantially improves adherence and therefore outcomes.
Vivitrol vs buprenorphine/naloxone (Suboxone, Zubsolv)
Suboxone is a partial opioid agonist. It occupies mu receptors and produces mild agonist effects that suppress withdrawal and craving without the high of illicit opioids. Buprenorphine does carry physical dependence — discontinuation requires a taper. Head-to-head trials (including the X:BOT trial, 2018) found roughly equivalent outcomes between extended-release naltrexone and buprenorphine/naloxone when both were successfully initiated, but Vivitrol participants had more difficulty reaching initiation because of the detox requirement. That gap disappeared once patients were past the detox window.
When Vivitrol may be a better fit than Suboxone: patients who have completed detox and want a non-agonist option; patients who previously struggled to taper off buprenorphine; those in professions where opioid agonist use must be disclosed or avoided.
When Suboxone may be a better fit: patients who cannot or will not complete a full detox before starting MAT; patients with severe OUD where the gap to naltrexone initiation poses significant overdose risk; patients who have tried naltrexone and experienced poor tolerability.
Neither option is universally superior. RECO's medical team will work through these considerations with you at admission.
How Vivitrol fits into PHP and IOP at RECO Intensive
RECO Intensive offers both Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) tracks in Delray Beach. Vivitrol integrates into both without disrupting the treatment schedule.
The injection is administered by RECO's medical staff at a scheduled clinic appointment, typically once per month. For patients in PHP (typically 5–6 hours per day, 5 days per week), the injection can be coordinated around the treatment day. For IOP patients (typically 3–4 hours per day, 3–5 days per week), the injection appointment is often scheduled on a non-treatment morning so patients do not miss group sessions.
Injection timing follows a 28-day cycle. Our medical staff tracks each patient's injection calendar and contacts them in advance to schedule the next dose. For patients living in RECO's sober-living residences during outpatient treatment, transportation to the clinic is coordinated through the house manager.
Vivitrol is not a stand-alone treatment. At RECO, it runs alongside individual therapy, group therapy, psychiatric evaluation, family programming, and peer support — all components of the broader IOP and PHP frameworks. The medication is one layer; the clinical and community work is the foundation.
What to expect on injection day
Understanding what happens on injection day reduces anxiety and makes the experience more predictable.
Pre-injection review. A nurse or prescriber will confirm your last opioid use date, review any new medications started since your previous injection, check for pregnancy status if applicable, and review your most recent liver function tests if there are ongoing hepatic concerns.
Injection site. Vivitrol is administered as a deep intramuscular injection into the upper outer quadrant of the gluteal muscle (buttocks). The site alternates between left and right on each injection cycle. The standard needle gauge is 1.5 inches for most patients; a 2-inch needle is available for patients with higher BMI to ensure the medication reaches muscle tissue rather than subcutaneous fat. Subcutaneous injection is associated with a significantly elevated risk of injection-site reactions, so proper IM depth is clinically important.
Immediate post-injection period. Most patients experience mild tenderness at the injection site for 2–5 days. Some experience nausea in the first 24–48 hours. You should not drive yourself to the appointment if nausea or dizziness is a known side effect for you. Normal activities can be resumed immediately. You will feel no euphoria or sedation from the medication.
Who should not receive Vivitrol on a given injection day: anyone currently taking opioids or in opioid withdrawal; anyone with known hypersensitivity to naltrexone, polylactide-co-glycolide, carboxymethylcellulose, or any other component; and anyone with acute hepatitis or liver failure.
Side effects, contraindications, and what to monitor
Injection-site reactions. The most common adverse event with Vivitrol (reported in 5–69% of patients across studies depending on severity threshold) is injection-site reactions: pain, tenderness, induration (hardening), swelling, or bruising. Severe reactions including cellulitis, abscess, or necrosis are rare but have been reported and require prompt medical evaluation. Patients should report increasing pain, warmth, skin darkening, or discharge at the injection site.
Gastrointestinal effects. Nausea is reported in approximately 33% of patients, vomiting in 14%. These effects typically peak in the first week of the first injection and decrease with subsequent doses. Taking Vivitrol on a full stomach does not apply (it is not oral) but eating well on injection day may reduce nausea.
Liver function. Naltrexone has been associated with dose-dependent hepatocellular injury at doses much higher than therapeutic (50 mg/day oral equivalent). At the Vivitrol therapeutic dose, clinically significant hepatotoxicity is uncommon but monitoring is appropriate. RECO's medical team reviews baseline LFTs before initiating treatment and at intervals during prolonged use. Patients with active hepatitis or significant hepatic impairment should not receive Vivitrol.
Psychiatric effects. Depression and suicidal ideation have been reported in post-marketing surveillance. Patients with a current major depressive episode require careful evaluation. RECO's psychiatric staff monitors mood throughout treatment and can adjust the overall treatment plan accordingly.
Opioid sensitivity after discontinuation. After Vivitrol, opioid receptor sensitivity increases. Patients who relapse on opioids after stopping naltrexone are at substantially elevated risk of overdose and death because their tolerance has decreased and their prior dose could now be lethal. This is a critical safety education point covered at every injection visit.
Pregnancy. Vivitrol is category C. Animal studies have shown fetal harm at high doses. There are insufficient controlled human data. Vivitrol is generally not initiated in pregnancy. Patients who become pregnant while on Vivitrol should contact RECO's medical team immediately to discuss risk-benefit. MAT with buprenorphine is considered the standard of care in opioid-dependent pregnant patients.
Cost and insurance coverage for Vivitrol
Vivitrol is covered by most major commercial insurance plans, Medicaid, and Medicare Part D, though coverage varies significantly by payer and state. The list price for a single 380 mg injection is approximately $1,700–$1,900, which puts prior authorization on the radar for most commercial plans.
Prior authorization. Most commercial insurers require prior authorization for Vivitrol. Common requirements include a diagnosis of OUD or AUD, documentation of treatment enrollment (such as IOP or PHP), and in some cases, evidence that a first-line treatment was tried. RECO's administrative and clinical team handles prior authorization paperwork as part of the admissions process — this is not something patients navigate alone.
Copay assistance. Alkermes (Vivitrol's manufacturer) offers a copay assistance program for commercially insured patients. Eligible patients may pay as little as $0 for each injection. Information on eligibility is available through the Vivitrol manufacturer's website or via RECO's billing office.
Medicaid. All 50 states cover Vivitrol under Medicaid to some degree, though prior authorization policies differ. RECO's team can confirm Medicaid coverage specifics for Florida Medicaid beneficiaries during the admissions process.
Uninsured/self-pay. For patients without insurance, cash price is approximately $1,700 per injection. The copay assistance program is typically not available for uninsured patients, but RECO's billing team can discuss payment options and connect patients with the Vivitrol patient assistance program offered by Alkermes for income-qualifying individuals.
To verify your coverage before admission, visit our insurance verification page or call us at (866) 396-2008. You can also review general insurance information on our insurance page.
If you are ready to explore whether Vivitrol is appropriate for your situation, contact RECO Intensive at (866) 396-2008 or begin the admissions process online. Our medical staff will conduct a thorough evaluation and walk you through every step.
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