Medication for opioid use disorder

Suboxone, methadone or Vivitrol: which is right for you?

Three medicines are FDA-approved for opioid use disorder: buprenorphine (Suboxone and others), methadone and naltrexone (Vivitrol). All three work. They differ in how they act, where you get them, how often you go, and whether you can start while you're still using. Here's a plain comparison to help you talk it through with a prescriber.

By Ryan Coane, LCDC-I. Updated October 27, 2026. General information, not medical advice: talk with a doctor or other prescriber about which medicine fits you.

Help right now: if someone is very sleepy, can't be woken, or is breathing slowly or not at all, call 911 and give naloxone (Narcan) if you have it. In a mental health or substance use crisis, call or text 988, any time. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open 24/7 for treatment referrals.

The short version

Buprenorphine (Suboxone, generic films and tablets, Zubsolv, or a weekly or monthly shot) is prescribed in regular clinics and by telehealth and picked up at a pharmacy. It's the easiest to start quickly.
Methadone is given only at certified opioid treatment programs (OTPs), usually daily at first. It's the strongest of the three and keeps many people in treatment the longest.
Naltrexone (Vivitrol, a monthly shot) blocks opioids instead of activating them. It isn't an opioid, but you have to be off all opioids for about 7 to 14 days before the first shot.
Methadone and buprenorphine are the two linked in the research to fewer overdose deaths. The best medicine is the one you'll keep taking; you can switch if the first one isn't right.

Side by side

Question	Buprenorphine (Suboxone)	Methadone	Naltrexone (Vivitrol)
How it works	A partial opioid: eases withdrawal and cravings with a weaker effect, and blocks other opioids	A full, long-acting opioid: steadies the brain so cravings and withdrawal stop	Not an opioid: blocks opioid receptors so opioids have little effect
Where you get it	Any clinician who can prescribe controlled medicines, in person or by telehealth; filled at a pharmacy. Shots are given at a clinic.	Only at a certified opioid treatment program (a "methadone clinic")	Any prescriber; the shot is given at a clinic or doctor's office
How often	A film or tablet daily, or a shot weekly or monthly	Daily at the clinic at first; take-home doses can start early for stable patients	A shot every four weeks
Can you start while still using?	You need to be in early withdrawal first, or follow your prescriber's low-dose start, to avoid precipitated withdrawal	Yes: no withdrawal needed; the clinic starts low and raises the dose slowly	No: you need to be off opioids for about 7 days (short-acting) to 14 days (long-acting) first
Coverage	Medicaid must cover it; Medicare and most private plans do too; prior authorization is common for some forms	Medicaid must cover it at certified clinics (federal law since 2020); Medicare covers OTP care; many private plans	Medicaid must cover it; Medicare and most private plans do too

Since October 1, 2020, federal law (SUPPORT Act section 1006(b), made permanent in 2024) has required every state Medicaid program to cover all FDA-approved medicines for opioid use disorder, including methadone. Each of the seven states we cover says in its Medicaid state plan that it covers methadone at opioid treatment programs. Not every clinic takes Medicaid, so ask. Coverage details vary by state and plan. See Does Medicaid cover Suboxone and MAT? for each of our seven states.

Buprenorphine (Suboxone)

Buprenorphine is a partial opioid. NIDA explains that it activates the brain's opioid receptors, but less than methadone does, and it can block other opioids from attaching. That means less of a high and a lower risk of overdose from the medicine itself.

Forms: films or tablets that dissolve under the tongue (brand Suboxone and Zubsolv, plus cheaper generics), and long-acting shots (Sublocade monthly; Brixadi weekly or monthly) given at a clinic.
Starting: because it pushes other opioids off the receptors, taking it too soon can set off sudden, strong withdrawal. Your prescriber will tell you when to take the first dose.
Good fit if: you want to start fast, by telehealth or with your own doctor, and pick up your medicine at a pharmacy.

Step-by-step: How to start Suboxone this week.

Methadone

Methadone is a full opioid that works slowly and lasts a long time, so one dose a day keeps withdrawal and cravings away without the highs and lows. SAMHSA says that for opioid use disorder it can only be dispensed through a certified opioid treatment program. A regular pharmacy can't fill a methadone prescription for addiction.

Daily visits at first. Since 2024, federal rules let clinics give take-home doses from the first week to patients who are doing well, and more over time. States can be stricter.
Easier entry. The 2024 rules dropped the old requirement of a one-year history of addiction, and getting medicine no longer depends on attending counseling. Clinics can screen new methadone patients by video.
Safety. The dose goes up slowly over the first weeks, because the first weeks are when the risk is highest. Don't mix it with alcohol or sedatives.
Good fit if: you've tried buprenorphine and still had cravings, or you want the daily structure and support of a clinic.

Find one in SAMHSA's opioid treatment program directory.

Naltrexone (Vivitrol)

Naltrexone is an opioid blocker. It isn't an opioid, it isn't addictive, and it won't cause withdrawal when you stop. For opioid use disorder it's given as Vivitrol, a shot every four weeks.

The hard part is starting. If opioids are still in your body, naltrexone causes sudden withdrawal, so the label calls for at least 7 to 10 days off opioids first. SAMHSA says 10 to 14 days after long-acting opioids like methadone. Many people start it at the end of a detox stay.
Watch your tolerance. If you stop the shots or miss one, your tolerance is low, and an amount of opioids you used to take can kill you.
Good fit if: you've already stopped opioids, you don't want an opioid medicine, or your job or a court program won't allow one.

What the evidence says about overdose

A 2017 review in the BMJ of 19 studies following more than 138,000 people found overdose death rates were about five times higher out of methadone treatment than in it (12.7 vs 2.6 deaths per 1,000 people a year), and about three times higher out of buprenorphine treatment than in it (4.6 vs 1.4).
The same review found that the first four weeks of methadone, and the first weeks after leaving either medicine, are the riskiest times.
The National Academies of Sciences concluded in 2019 that methadone, buprenorphine and extended-release naltrexone "are effective and save lives," that staying on medicine long term is linked to better outcomes, and that stopping often leads to relapse and overdose.
NIDA notes that methadone and buprenorphine can be equally effective at reducing opioid use, that methadone may keep some people in treatment longer, and that naltrexone can work as well as buprenorphine for people who keep taking it.

How people choose

The National Academies put it simply: the right medicine "varies by individual and may change over time." Questions to talk through with a prescriber:

How fast do I need to start? Buprenorphine and methadone can start in days. Naltrexone needs a week or more off opioids.
Can I get to a clinic every day? If not, buprenorphine from a pharmacy or a monthly shot may fit better than methadone, at least at first.
What have I tried before? If buprenorphine didn't hold your cravings, methadone may. If you want to be off all opioids, naltrexone may.
Am I pregnant? SAMHSA calls buprenorphine and methadone the treatments of choice in pregnancy and breastfeeding. Don't stop opioids suddenly on your own; get care quickly.
What will my plan cover? See Medicaid coverage by state, or Does insurance cover rehab?

You can switch medicines later. Moving between them takes planning (for example, waiting before naltrexone), so do it with your prescriber.

Medicines for alcohol, briefly

NIAAA lists three approved medicines for alcohol use disorder. All three are non-addictive and can be prescribed by a primary care doctor:

Naltrexone, as a daily pill or the monthly Vivitrol shot, reduces the urge to drink. You can't take it while you use or take opioids.
Acamprosate, a pill, eases the restless, unpleasant feelings some people have after they stop drinking.
Disulfiram, a pill, makes you sick if you drink, which some people use as a backstop.

Stopping heavy drinking suddenly can be dangerous. Read alcohol detox: do you need it? before you quit.

Myths, answered

"It's just trading one drug for another." Taken as prescribed, methadone and buprenorphine stop cravings and withdrawal without the intense high, which NIDA says makes them less addictive than the drugs they replace. They do cause physical dependence, like many long-term medicines, but dependence isn't addiction: addiction is losing control and using despite harm. People on a steady dose work, drive, raise kids and live their lives.

"You should get off it as soon as you can." The evidence points the other way. Long-term treatment is linked to better outcomes, and the weeks after stopping are a time of high overdose risk. How long to stay on is a decision for you and your prescriber, with no set end date.

"Medicine doesn't work without counseling." Counseling helps many people, but the National Academies found some people do well with medicine and medical care alone, and that a lack of counseling isn't a reason to withhold medicine. Federal OTP rules no longer make medicine depend on attending counseling.

"Detox is enough." Detox treats withdrawal, not the disease. Without medicine afterward, tolerance drops and a return to use is more dangerous. If you go through detox, ask about starting one of these medicines before you leave.

"Methadone or Suboxone means you're not really in recovery." Many recovery groups and programs welcome people on medicine. If one doesn't, find one that does.

Find medication treatment near you

Programs offering medication for addiction, with phone numbers, on Cima Find Care:

Texas: Houston, Dallas, San Antonio, Austin, El Paso
Louisiana: New Orleans, Baton Rouge
Oklahoma: Oklahoma City, Tulsa
Arkansas: Little Rock
Missouri: St. Louis, Kansas City
Kansas: Wichita
Mississippi: Jackson

Ask each program which medicines it offers: not every program offers all three, and only opioid treatment programs give methadone.

Questions people ask

Which is better, Suboxone or methadone?

Neither is better for everyone. Both lower the risk of overdose death. Methadone may keep some people in treatment longer; buprenorphine is easier to get and can be picked up at a pharmacy. Many people try one and switch if it isn't working.

Can I get methadone from my regular doctor?

Not for opioid use disorder. Federal rules allow methadone for addiction only through certified opioid treatment programs. Your doctor can prescribe buprenorphine or naltrexone.

Is Vivitrol the same as Narcan?

No. Both block opioids, but Narcan (naloxone) is a short-acting rescue spray for an overdose. Vivitrol (naltrexone) is a monthly shot that blocks opioids for weeks to help prevent a return to use.

Can I take these medicines while pregnant?

SAMHSA calls buprenorphine and methadone the treatments of choice for opioid use disorder during pregnancy and breastfeeding. Talk with a prescriber and an obstetric provider right away, and don't stop opioids suddenly on your own.

How long will I be on medication?

There's no set limit. Research links longer treatment to better outcomes. If you want to taper, plan it with your prescriber and keep naloxone at home.

Sources

FDA, Information about Medications for Opioid Use Disorder (MOUD): approved buprenorphine, methadone and naltrexone products: fda.gov
NIDA, Medications to Treat Opioid Use Disorder Research Report: how the medications work and how effective they are: how they work, how effective they are
SAMHSA, Methadone (dispensed only through certified OTPs; pregnancy): samhsa.gov
SAMHSA, Buprenorphine (treatments of choice in pregnancy): samhsa.gov
SAMHSA, Naltrexone (opioid-free period, reduced tolerance after stopping, alcohol use disorder): samhsa.gov
Vivitrol prescribing information (FDA-approved label): opioid-free period of at least 7 to 10 days: labeling.alkermes.com
SAMHSA, 42 CFR Part 8 final rule (2024), table of changes: take-homes, telehealth screening, counseling, one-year history: samhsa.gov; and the rule, 89 FR 7528: federalregister.gov
Sordo L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis. BMJ 2017;357:j1550: pmc.ncbi.nlm.nih.gov
National Academies of Sciences, Engineering, and Medicine, Medications for Opioid Use Disorder Save Lives (2019), committee conclusions: nationalacademies.org
CMS, State Health Official Letter #20-005 (SUPPORT Act section 1006(b): Medicaid must cover all FDA-approved drugs for opioid use disorder, including methadone): medicaid.gov; CMS SMD Letter #24-004 (made permanent): medicaid.gov
KFF, Medicaid Behavioral Health Services: Methadone for MAT (2022): kff.org; state-by-state details and sources: Does Medicaid cover Suboxone and MAT?
Medicare.gov, Opioid use disorder treatment services (Part B coverage at OTPs): medicare.gov
NIAAA, Treatment for Alcohol Problems: Finding and Getting Help (naltrexone, acamprosate, disulfiram): niaaa.nih.gov
SAMHSA, Opioid Treatment Program Directory: samhsa.gov