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Comparison

Naltrexone vs Suboxone

By Naltrexone Reviews Editorial TeamUpdated 16 sourcesHow we check

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Short answer

Suboxone is buprenorphine plus naloxone. Buprenorphine partly switches on opioid receptors and is a controlled drug; naltrexone blocks them and is not controlled.1,2 Both treat opioid use disorder. Once started, the Vivitrol shot did as well as Suboxone in two trials, but naltrexone needs 7 to 10 opioid-free days first.3-5

Naltrexone

The Vivitrol shot, or a daily tablet

At opioid receptors
Blocks them5
Controlled substance
No2
Before the first dose
7 to 10 days with no opioids5

Suboxone

Buprenorphine and naloxone, a daily film

At opioid receptors
Partly switches them on1
Controlled substance
Yes, Schedule III1
Before the first dose
Wait for moderate withdrawal signs1

Head to headOnce people got the first dose, the Vivitrol shot did as well as Suboxone in two trials. Getting to that first dose is the hard part.3,4

Key takeaways

  • In the largest head-to-head trial, 72% of the people assigned the shot got a first dose, against 94% assigned Suboxone. Nearly all who never got the shot relapsed early.3
  • SAMHSA's guide for clinicians (TIP 63) lists overdose deaths as lower on buprenorphine than without treatment, and as unknown for naltrexone.6
  • The trials on this page tested the monthly shot. The daily pill has weak evidence for opioid use disorder.7,8
  • Stopping either medicine raises the risk of returning to opioids and of overdose.5,6

Side by side

Side by side

  • At opioid receptors

    Naltrexone (Vivitrol shot or tablets)
    Blocks them and causes no opioid effects5,6
    Suboxone (buprenorphine and naloxone)
    Buprenorphine partly switches them on; naloxone is added at 1 part to 4 parts buprenorphine1

  • Controlled substance

    Naltrexone (Vivitrol shot or tablets)
    No2
    Suboxone (buprenorphine and naloxone)
    Yes, Schedule III1

  • FDA-approved for

    Naltrexone (Vivitrol shot or tablets)
    Shot: preventing relapse to opioid dependence after detox. Tablets: blocking the effects of opioids. Both: alcohol dependence5,9
    Suboxone (buprenorphine and naloxone)
    Opioid dependence1

  • Form

    Naltrexone (Vivitrol shot or tablets)
    380 mg shot into the buttock muscle every 4 weeks or once a month, given by a provider; or a 50 mg tablet once a day5,9
    Suboxone (buprenorphine and naloxone)
    A film dissolved under the tongue or inside the cheek once a day1

  • First dose

    Naltrexone (Vivitrol shot or tablets)
    After at least 7 to 10 days without opioids; up to 2 weeks after buprenorphine or methadone5
    Suboxone (buprenorphine and naloxone)
    When clear signs of moderate withdrawal appear, at least 6 hours after the last short-acting opioid1

  • Dependence

    Naltrexone (Vivitrol shot or tablets)
    Not associated with tolerance or dependence5
    Suboxone (buprenorphine and naloxone)
    Causes physical dependence, so doses are tapered rather than stopped suddenly1

  • Overdose deaths (TIP 63)

    Naltrexone (Vivitrol shot or tablets)
    Unknown6
    Suboxone (buprenorphine and naloxone)
    Lower for people in treatment than for those not in it6

  • With alcohol

    Naltrexone (Vivitrol shot or tablets)
    No sickness reaction; also treats drinking9
    Suboxone (buprenorphine and naloxone)
    Can cause breathing problems, coma and death1

  • Liver

    Naltrexone (Vivitrol shot or tablets)
    Hepatitis warning5,9
    Suboxone (buprenorphine and naloxone)
    Hepatitis warning; not recommended with severe liver impairment1

In two trials, the shot did as well as Suboxone once people got the first dose

The X:BOT trial, funded by the National Institute on Drug Abuse, enrolled 570 adults at eight US community inpatient detox programs. They were randomly assigned to the monthly Vivitrol shot or daily Suboxone film for 24 weeks, and everyone knew which drug they had.3

  • Starting. 204 of 283 people (72%) got a first shot; 270 of 287 (94%) started Suboxone. The shot required finishing detox, an opioid-free urine test and a naloxone challenge.3
  • Everyone assigned. 65% on the shot and 57% on Suboxone relapsed within 24 weeks (hazard ratio 1.36). Of the 79 people who never got the shot, 70 relapsed early.3
  • People who started. Relapse was 52% on the shot and 56% on Suboxone, with no significant difference. Opioid-free urine tests and days without opioids were similar too.3
  • Timing. Getting the first shot worked for 53% of people randomized within 72 hours of their last opioid and 84% of those randomized later.3
  • Overdoses. Of 28 overdose events in all, 18 were in the shot group (8 of them in people who never got a shot) and 10 in the Suboxone group; the share of people with an overdose did not differ. Five were fatal: 2 in the shot group and 3 in the Suboxone group. The trial was not powered to detect a difference in overdoses.3

The authors concluded that "once initiated, both medications were equally safe and effective."3

A 12-week trial at five clinics in Norway randomized 159 adults who had just finished detox. Time in treatment on the shot was no worse than on Suboxone (about 69 vs 64 days on average), and people on the shot used heroin and other illicit opioids on fewer days.4

In insurance records, time on buprenorphine was tied to fewer overdoses, and naltrexone's link was not significant.10,11 The one study comparing the shot directly with buprenorphine found a similar risk of overdose or death (Ross 2024, below).12 These are observational studies. People chose their treatment, so the results can't prove cause and effect.

Outside trials, buprenorphine has the clearer link to fewer overdoses

  • Study: Wakeman, 2020

    Who
    40,885 people aged 16 or older with commercial or Medicare Advantage coverage, 2015 to 2017; 963 started on naltrexone
    Result
    Compared with no treatment, buprenorphine or methadone (grouped together) was tied to 76% fewer overdoses at 3 months and 59% fewer at 12 months. Naltrexone was not significantly tied to fewer overdoses (hazard ratio 0.59 at 3 months; 95% CI, 0.29-1.20).11

  • Study: Morgan, 2019

    Who
    46,846 commercially insured people starting medication, 2010 to 2016
    Result
    Compared with time off medication, time on buprenorphine was tied to a lower overdose risk (hazard ratio 0.40). For the shot (0.74) and tablets (0.93), the link was not significant.10

  • Study: Ross, 2024

    Who
    11,641 adult Medicaid patients in California and New Jersey, 2016 to 2019; 1,755 started the shot and 9,886 buprenorphine
    Result
    Within 180 days, overdose or death: 3.9% on the shot vs 3.3% on buprenorphine, a minimal difference. Stopping the medicine or death: 75.9% vs 62.2%.12

  • Study: Morgan, 2018

    Who
    Commercially insured people treated for opioid use disorder, 2010 to 2014
    Result
    Stopped within 30 days: 52% on the shot, 70% on tablets, 31% on buprenorphine-naloxone13

The shot's numbers in these records are small: Morgan 2019 counted 15 overdoses during time on the shot.10 Wakeman's records missed fatal overdoses outside a health care visit.11

The VA/DoD guideline gives buprenorphine-naloxone or methadone its top rating, "Strong for," and the shot a "Weak for" suggestion.8

The daily pill has weak evidence for opioid use disorder

For tablets, a 2011 Cochrane review pooled 13 trials with 1,158 people and found no significant benefit over placebo or no medicine on the main outcomes. Tablets came out ahead on staying in treatment and abstinence only in studies where people were made to take them (risk ratio 2.93).7

The tablet label describes them as "of proven value only when given as part of a comprehensive plan of management that includes some measure to ensure the patient takes the medication."9

The VA/DoD found too little evidence to recommend for or against the tablets for opioid use disorder.8

Vivitrol vs Suboxone: a monthly shot against a daily film

  • Visits. A provider gives the shot every 4 weeks or once a month. Suboxone starts with supervised doses and moves to doses at home as you stabilize, with few refills early on.1,5
  • Side effects. Mild to moderate injection-site reactions were the only adverse-event difference in X:BOT.3 Suboxone carries a warning for tooth decay, some severe, from buprenorphine dissolved in the mouth.1
  • At home. Suboxone films must be locked away, because unsecured films are a deadly risk to children and others in the home.1
  • Pain care. With the shot, the suggested emergency options are regional numbing or non-opioid pain medicine. If an opioid is needed, the patient must be monitored continuously in an anesthesia setting.5
  • A monthly buprenorphine shot exists too. It is an under-the-skin injection for people who have taken buprenorphine film or tablets for at least 7 days.6

Never together: switching from Suboxone to naltrexone takes days

Naltrexone and Suboxone are not taken together. Buprenorphine causes physical dependence, and in anyone physically dependent on opioids, naltrexone brings on precipitated withdrawal.1,5

Coming off buprenorphine or methadone, people "may be vulnerable to precipitation of withdrawal symptoms for as long as two weeks." No systematically collected data cover this switch, and some people in post-approval reports had severe withdrawal. In a few case reports, withdrawal happened despite a clean urine test or a passed naloxone challenge, usually in people coming off buprenorphine.5

This withdrawal can be severe enough to need a hospital stay. Your prescriber decides when the first dose is safe, and may give the first shot in a facility that can treat withdrawal.5 Suboxone itself is stopped with a gradual taper.1

If you also drink alcohol

Naltrexone tablets and the same 380 mg monthly shot are also approved for alcohol dependence, and naltrexone causes no sickness reaction if you drink; see naltrexone for alcohol use disorder.5,9 Suboxone is approved for opioid dependence only, and taken with alcohol it "can cause severe drowsiness, decreased awareness, breathing problems, coma, and death."1

Matching the medicine to the situation

Take these trade-offs to your prescriber. Methadone, the third medicine for opioid use disorder, is given only through opioid treatment programs, with visits 6 to 7 days a week at first.6

Matching the medicine to the situation

  • Your situation: You can't stay off opioids for 7 to 10 days

    Leans toward
    Buprenorphine
    Why
    It is started once withdrawal begins, with no opioid-free wait.1

  • Your situation: You have already been off opioids for a week or more

    Leans toward
    Either
    Why
    In the Norwegian trial of people who had just finished detox, the shot did as well as Suboxone.4

  • Your situation: Your workplace or a controlled setting doesn't allow opioid medicines

    Leans toward
    Naltrexone
    Why
    TIP 63 lists this as a reason for supervised withdrawal, after which the shot should be considered.6

  • Your situation: You also have a drinking problem

    Leans toward
    Naltrexone, as a rule
    Why
    It is approved for both, and buprenorphine with alcohol can be fatal.1,5,9

  • Your situation: Lowering your risk of dying from an overdose comes first

    Leans toward
    Buprenorphine or methadone
    Why
    Both have the stronger overdose record; see the overdose data.6

  • Your situation: You don't want to take an opioid medicine

    Leans toward
    Naltrexone
    Why
    It causes no opioid effects and isn't tied to dependence.5,6

  • Your situation: You're pregnant

    Leans toward
    Buprenorphine or methadone
    Why
    TIP 63 recommends them in pregnancy and advises against starting naltrexone then, because of the risk of withdrawal.6 More: naltrexone and pregnancy.

Stopping either one raises the risk of overdose

After detox, tolerance to opioids drops. As a naltrexone shot wears off, after a missed dose or after stopping, a smaller opioid dose than you used before can be fatal.5 Stopping buprenorphine carries risk too: TIP 63 warns that stopping medication raises the chance of return to use and of overdose death.1,6 In X:BOT, nearly all overdoses came after a failed start or after people dropped out of either treatment.3 Keep naloxone or nalmefene on hand, tell the people close to you, and call 911 for any suspected overdose.1,5 See when the block fades.

Share your experience

Have you taken Suboxone, naltrexone or both? Tell us what happened, or read other people's naltrexone reviews.

Frequently asked questions

Is naltrexone in Suboxone?

No. Suboxone contains naloxone, a different opioid blocker. Under the tongue it has no clinically significant effect; it may deter people from injecting the film. For naloxone itself, see naltrexone vs naloxone.1

Can you take naltrexone with Suboxone?

No. Naltrexone would bring on withdrawal, and switching takes 7 days to 2 weeks off buprenorphine. See switching.5

Does Vivitrol block Suboxone?

One shot blocks the effects of opioids for about 28 days, and the label gives no schedule for starting buprenorphine afterward. Plan any switch with your prescriber.5

Which is easier to stop?

Naltrexone causes no physical dependence; buprenorphine does and is tapered. Overdose risk rises after stopping either one. See stopping.1,5

Is Suboxone a controlled substance?

Yes, Schedule III. Naltrexone is not controlled. See is naltrexone a controlled substance?1,2

Are naltrexone pills as good as the shot for opioids?

The evidence for the pills is weaker; the head-to-head trials against Suboxone used the shot. See the daily pill.3,4,7

How we checked

  • Sources: current DailyMed labels for Suboxone film (December 2025), Vivitrol and naltrexone tablets; full texts of X:BOT, Wakeman 2020 and Morgan 2018 and 2019; abstracts of Tanum 2017, Ross 2024 and the 2011 Cochrane review; TIP 63; the 2021 VA/DoD guideline.1,3-13

  • Two randomized head-to-head trials are counted; the four records studies are observational. Wakeman 2020 grouped buprenorphine with methadone.

  • Every figure above was checked against the saved files on October 17, 2026.

Getting treatment

FindTreatment.gov, run by SAMHSA, lists treatment facilities and the medicines they offer.14

SAMHSA's National Helpline, 1-800-662-4357, gives free, confidential treatment referrals 24 hours a day.15

If you are thinking about suicide, call or text 988, the Suicide & Crisis Lifeline.16

Related guides

References

16 sources, numbered in the order they are first cited (AMA style). Each is labelled by type so you can weigh it; commercial and media sources are never the only support for a clinical claim.

  1. 1.Suboxone (buprenorphine and naloxone) sublingual film, CIII. Prescribing information and Medication Guide. Indivior Inc.; revised December 2025. DailyMed SPL version 37. Accessed October 17, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8a5edcf9-828c-4f97-b671-268ab13a8ecdFDA drug label
  2. 2.Schedule II, 21 CFR §1308.12 (2026). eCFR version as of October 1, 2026. Accessed October 17, 2026. https://www.ecfr.gov/current/title-21/chapter-II/part-1308/section-1308.12Government source
  3. 3.Lee JD, Nunes EV, Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial. Lancet. 2018;391(10118):309-318. doi:10.1016/S0140-6736(17)32812-XRandomized controlled trial · Our summary of this study
  4. 4.Tanum L, Solli KK, Latif ZE, et al. Effectiveness of injectable extended-release naltrexone vs daily buprenorphine-naloxone for opioid dependence: a randomized clinical noninferiority trial. JAMA Psychiatry. 2017;74(12):1197-1205. doi:10.1001/jamapsychiatry.2017.3206Randomized controlled trial · Our summary of this study
  5. 5.Vivitrol (naltrexone for extended-release injectable suspension). Prescribing information and Medication Guide. Alkermes, Inc.; revised May 2026. DailyMed SPL version 39. Accessed October 17, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cd11c435-b0f0-4bb9-ae78-60f101f3703fFDA drug label
  6. 6.Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63. Publication No. PEP21-02-01-002. SAMHSA; 2021. Accessed October 17, 2026. https://library.samhsa.gov/sites/default/files/pep21-02-01-002.pdfClinical guideline
  7. 7.Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev. 2011;(4):CD001333. doi:10.1002/14651858.CD001333.pub4Systematic review / meta-analysis · Our summary of this study
  8. 8.US Department of Veterans Affairs; US Department of Defense. VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders. Version 5.0. 2021. Accessed October 17, 2026. https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/MH/sud/VA-DoD-SUD-CPG_Final_for-508_v3.pdfClinical guideline
  9. 9.Naltrexone hydrochloride tablets USP, 50 mg. Prescribing information. SpecGx LLC; revised May 2026. DailyMed SPL version 15. Accessed October 17, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=06ff2d5a-e62b-4fa4-bbdb-01938535bc65FDA drug label
  10. 10.Morgan JR, Schackman BR, Weinstein ZM, Walley AY, Linas BP. Overdose following initiation of naltrexone and buprenorphine medication treatment for opioid use disorder in a United States commercially insured cohort. Drug Alcohol Depend. 2019;200:34-39. doi:10.1016/j.drugalcdep.2019.02.031Research study · Our summary of this study
  11. 11.Wakeman SE, Larochelle MR, Ameli O, et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open. 2020;3(2):e1920622. doi:10.1001/jamanetworkopen.2019.20622Research study · Our summary of this study
  12. 12.Ross RK, Nunes EV, Olfson M, et al. Comparative effectiveness of extended-release naltrexone and sublingual buprenorphine for treatment of opioid use disorder among Medicaid patients. Addiction. 2024;119(11):1975-1986. doi:10.1111/add.16630Research study · Our summary of this study
  13. 13.Morgan JR, Schackman BR, Leff JA, Linas BP, Walley AY. Injectable naltrexone, oral naltrexone, and buprenorphine utilization and discontinuation among individuals treated for opioid use disorder in a United States commercially insured population. J Subst Abuse Treat. 2018;85:90-96. doi:10.1016/j.jsat.2017.07.001Research study · Our summary of this study
  14. 14.FindTreatment.gov. Substance Abuse and Mental Health Services Administration. Accessed October 17, 2026. https://findtreatment.gov/Government source
  15. 15.SAMHSA's National Helpline. Substance Abuse and Mental Health Services Administration. Updated June 9, 2023. Accessed October 17, 2026. https://www.samhsa.gov/find-help/helplines/national-helplineGovernment source
  16. 16.988 Suicide & Crisis Lifeline. Accessed October 17, 2026. https://988lifeline.org/Nonprofit organization

Medical disclaimer

This page is for general information only and is not medical advice. It does not replace advice from your own clinician or pharmacist. Don't start, stop or change a medicine without talking to your prescriber. If you take buprenorphine or any other opioid, starting naltrexone can cause sudden, severe withdrawal. In a suspected overdose, call 911. If you have thoughts of suicide, call or text 988.16 For free, confidential treatment referrals 24 hours a day, call SAMHSA's National Helpline at 1-800-662-4357.15

Full medical disclaimer.