Vivitrol

Not every path to recovery looks the same. For some Kentuckians in recovery from opioid or alcohol use disorder, a daily controlled-substance medication like Suboxone isn’t the right fit — because of a personal preference for a completely non-opioid approach, requirements from a drug court or parole officer, safety concerns about medication in the household, or a strong personal goal of full abstinence.

Vivitrol is designed for exactly those situations. It’s a once-monthly injection that contains no opioids and is not a controlled substance. It works by blocking opioid receptors in the brain — so if someone uses opioids while on Vivitrol, they don’t get high, and cravings for both opioids and alcohol are significantly reduced.

Fresh Start Health Centers provides Vivitrol injections at all four of our Kentucky locations — Ashland, Grayson, Morehead, and Vanceburg — as part of a comprehensive medication-assisted treatment program that includes medical monitoring, counseling, and long-term support.

What Is Vivitrol?

Vivitrol is the brand name for extended-release naltrexone, a medication approved by the FDA for two uses:

• Prevention of relapse to opioid dependence, following opioid detoxification
• Treatment of alcohol dependence in patients who are able to abstain from alcohol in an outpatient setting prior to initiation of treatment

The medication is delivered as a single 380 mg intramuscular injection into the buttock, given by a clinician every four weeks. One injection provides therapeutic drug levels for a full month, with no daily pills to take and no take-home medication to manage.

Naltrexone is not an opioid. It’s an opioid antagonist — meaning it binds to the same brain receptors as opioids but blocks them instead of activating them. That has three practical consequences:

• It does not produce any euphoria or “high”
• It carries no abuse potential and is not a controlled substance
• Stopping the medication does not cause withdrawal

How Vivitrol Works

The injection uses a specialized polymer-microsphere technology to slowly release naltrexone over 28 days. There’s an initial peak within hours, a second peak around days 2–3, and then a gradual, steady release that maintains full opioid-blocking effect for most of the month, with concentrations tapering during the final week.

While the medication is active, three things happen in the brain:

1. Opioids can’t produce a high. If a person on Vivitrol uses heroin, fentanyl, or prescription opioids, the naltrexone blocks the receptors those drugs target. There is no euphoria and no reinforcement of the addictive cycle.
2. Alcohol becomes less rewarding. Naltrexone dampens the release of endorphins triggered by drinking, which reduces the pleasurable effect of alcohol and, in most patients, reduces both the frequency and quantity of heavy drinking.
3. Cravings are reduced. Both opioid and alcohol cravings tend to diminish significantly during active treatment.

The blocking effect is strongest in the first two weeks after each injection and gradually weakens by day 28. This is why Vivitrol is dosed monthly — and why it’s critical to stay on schedule with follow-up appointments.

Vivitrol vs. Suboxone and Sublocade: The Key Difference

All three medications treat opioid use disorder, but they work in fundamentally different ways. This is one of the most important decisions to think through with your provider.

Feature	Vivitrol	Suboxone / Sublocade
Drug class	Opioid antagonist (blocks receptors)	Opioid partial agonist (activates receptors mildly)
Contains an opioid?	No	Yes (buprenorphine)
Controlled substance?	No	Yes (Schedule III)
Detox required before starting?	Yes — must be opioid-free 7–14 days	No — can start during withdrawal
Effect if you use opioids on it	Nothing (blocked)	Reduced but partial effect possible
Best for	Motivated for abstinence; recently detoxed; concerns about diversion; drug court requirements	Difficulty stopping opioid use; needs help through withdrawal; preference for agonist maintenance

The most significant practical difference is the detox requirement. Suboxone can be started while a patient is still actively using opioids or in early withdrawal. Vivitrol cannot — attempting to start it while opioids are still in the system will cause severe, sudden withdrawal (called precipitated withdrawal), which is medically serious and deeply unpleasant.

That detox hurdle is real. In the XBOT trial published in The Lancet in 2018 — the largest head-to-head comparison of the two medications — only 72% of patients randomized to Vivitrol successfully completed detox and received their first injection, compared to 94% for Suboxone. But once patients did get through detox and receive that first Vivitrol shot, outcomes were essentially the same as with Suboxone.

Newer research is starting to close that gap. A 2024 NIDA-funded trial tested a rapid 5–7 day induction protocol using a one-day buprenorphine transition, and found nearly double the first-injection success rate compared to the standard approach (62.7% vs 35.8%). Fresh Start providers stay current on these protocols and will help you understand the options if Vivitrol is the direction you want to go.

Who Is a Good Candidate for Vivitrol?

Based on FDA labeling, SAMHSA’s TIP 63 guidelines, and clinical experience, Vivitrol tends to be the right choice for patients who:

• Have completed opioid detoxification — opioid-free for at least 7–10 days (or 10–14 days if coming off methadone or other long-acting opioids)
• Are committed to an abstinence-based recovery rather than long-term opioid agonist maintenance
• Have completed inpatient rehab, jail time, or a controlled setting where detox has already happened, and want to protect that progress
• Are involved in drug court, probation, parole, or reentry where a non-controlled, non-diversion-risk medication is preferred or required — Kentucky Department of Corrections’ Community SAMAT program explicitly offers Vivitrol for probation and parole clients
• Have alcohol use disorder and have been able to abstain from alcohol in an outpatient setting before starting treatment
• Have household or personal safety concerns about keeping a controlled substance in the home
• Prefer to avoid a daily medication routine

Vivitrol is not the right choice for someone who is still actively using opioids, hasn’t completed detox, or has active liver disease requiring evaluation.

What Treatment Looks Like at Fresh Start

Vivitrol treatment at Fresh Start Health Centers is a coordinated clinical process, not just a monthly appointment. Here’s what to expect:

Before the first injection

1. Medical evaluation — a full assessment that includes your treatment history, current medications, mental health screening, and a diagnosis review confirming opioid or alcohol use disorder
2. Laboratory testing — baseline liver function tests (naltrexone is processed by the liver, so we verify liver health before starting) and a urine drug screen
3. Confirmation of opioid-free status — via urine drug screen and a Clinical Opiate Withdrawal Scale (COWS) assessment to confirm no active withdrawal is present
4. Informed consent — a detailed discussion of how Vivitrol works, what to expect, injection reactions, and the critical overdose warning
5. Naloxone prescription — we provide naloxone (Narcan) to every Vivitrol patient. This is not optional and it’s not a signal we expect you to relapse. It’s a safety net that saves lives.

The injection itself

The 380 mg dose is given as a deep intramuscular injection into the gluteal muscle by a trained clinician. The injection takes just a few minutes. Injection sites alternate between the left and right buttock each month. Some soreness or bruising for a few days afterward is common. Rare but serious injection-site reactions have been reported — call our office immediately if you develop severe or worsening pain, swelling, redness, or firmness at the injection site after 48 hours.

Ongoing treatment

Follow-up injections are scheduled every 4 weeks. Between injections, we provide:

• Behavioral health counseling — individual and group support, aligned with your recovery goals (learn more about our counseling services)
• Medical monitoring — periodic labs, medication reviews, and coordination with primary care
• Support for co-occurring conditions — depression, anxiety, chronic pain, and other conditions common in recovery

Insurance, Cost, and Kentucky Medicaid Coverage

Kentucky Medicaid covers Vivitrol for eligible patients under both fee-for-service and managed-care plans, per ASAM’s state Medicaid coverage report. It is covered without a requirement that patients show documented enrollment in counseling before starting treatment, though counseling is strongly encouraged as part of comprehensive care.

Kentucky is currently in the process of further reducing prior-authorization barriers for medications treating opioid and alcohol use disorder — House Bill 176 (2026 session) is aimed at eliminating prospective and concurrent review for MAT drugs including naltrexone. Coverage under individual managed care plans (Aetna Better Health, Humana Healthy Horizons, WellCare, UnitedHealthcare Community Plan) can vary, and our staff will verify your specific plan before your first injection.

Without insurance, Vivitrol has a wholesale cost of approximately $1,590–$1,760 per dose, with cash-pay retail sometimes running higher. Manufacturer copay assistance is available for commercially insured patients (typically excluded for Medicaid/Medicare). Our billing team will help you understand your specific costs before treatment begins.

Kentucky Context

Kentucky has made meaningful progress against the overdose crisis. The state’s 2025 Overdose Fatality Report documented 1,110 drug overdose deaths — the fourth consecutive year of decline and the lowest total since 2014. But the burden falls unevenly. Boyd County — where our Ashland clinic is based — had the third-highest overdose death rate in the state at 65.5 per 100,000 residents. Appalachian Kentucky counties collectively had a rate of 35.7 per 100,000, well above the state average of 24.3.

Access to medication-assisted treatment is a defining issue in this region. Fresh Start was built to serve patients across Boyd, Carter, Rowan, Lewis, and surrounding counties, offering all three FDA-approved medications for opioid use disorder — Suboxone, Sublocade/Brixadi injections, and Vivitrol — plus alcohol use disorder treatment and comprehensive primary care under one roof.

Frequently Asked Questions

Will the Vivitrol injection hurt?

The injection is given deep into the gluteal muscle and most patients describe soreness or a bruised feeling for two to three days afterward — comparable to other intramuscular vaccines. Serious injection-site reactions are uncommon but possible. Call our office right away if you develop severe pain, swelling, redness, or a hard mass at the site that doesn’t improve after 48 hours.

Can I drink alcohol on Vivitrol?

Vivitrol is FDA-approved to treat alcohol use disorder, and it works by reducing the pleasurable effects of drinking. That does not make it safe or advisable to keep drinking heavily. Patients starting Vivitrol for alcohol dependence should have already stopped drinking in an outpatient setting before their first injection. Ongoing alcohol use should be discussed openly with your provider.

What if I need pain medication or surgery while on Vivitrol?

Because Vivitrol blocks opioid pain medications for weeks after each injection, elective surgery should be planned around your dosing cycle whenever possible. For emergency pain control, non-opioid options and regional anesthesia are usually effective. In rare cases where opioid pain medication is medically necessary, it must be given in a monitored hospital setting because the amount needed to overcome the blockade can cause dangerous respiratory depression. Always tell any provider treating you that you are on Vivitrol.

What happens if I miss a dose?

The blocking effect gradually weakens after day 28. If you miss an appointment, contact us right away to reschedule — the sooner the better. During the gap between doses, your opioid tolerance is reduced from your pretreatment baseline, which means using opioids during this window carries a significantly elevated overdose risk. This is one of the reasons we prescribe naloxone to every Vivitrol patient.

Can I switch from Suboxone to Vivitrol?

Yes, but it requires a planned transition. You will need to stop Suboxone and complete a fully opioid-free waiting period — typically 7 to 14 days — before your first Vivitrol injection to avoid precipitated withdrawal. Newer rapid-induction protocols can shorten this window in some cases. Your Fresh Start provider will walk you through the safest option based on your current dose and stability.

Is Vivitrol addictive?

No. Naltrexone is not an opioid, is not a controlled substance, and produces no euphoria. Stopping Vivitrol does not cause withdrawal. The medication itself has no potential for abuse or diversion.

How long do most people stay on Vivitrol?

There is no fixed duration. Treatment is individualized. Many patients stay on monthly injections for six months to two years as they build stable recovery, then work with their provider on a plan for continuing or discontinuing. Because opioid tolerance is reduced during treatment, the plan for stopping Vivitrol should be made carefully and with medical guidance.

Does Kentucky Medicaid cover Vivitrol?

Yes. Kentucky Medicaid covers Vivitrol under both fee-for-service and managed care plans. Individual MCO plans may have different processes, and our billing team verifies coverage before your first appointment. Kentucky is also actively reducing prior-authorization barriers for MOUD medications, including naltrexone.

Ready to Talk Through Your Options?

Choosing between Vivitrol, Suboxone, and Sublocade or Brixadi is a decision you shouldn’t have to make alone. Our providers at Fresh Start Health Centers will take the time to understand your history, your goals, and your circumstances — and help you find the medication and support that fits.

Call 606-225-8200 to speak with our team, or visit any of our locations in Ashland, Grayson, Morehead, or Vanceburg. New patients are welcome — most first appointments can be scheduled within a few business days.

Learn more about our other addiction care services, including Suboxone and Sublocade & Brixadi injections.

Medically reviewed by Dr. Jerrel Boyer, D.O. — Medical Director, Fresh Start Health Centers. Last reviewed: July 24, 2026.