Over 16 million people worldwide have opioid use disorders (OUDs). Drugs like heroin and fentanyl are responsible for 120,000 deaths worldwide annually.[1] Medications can alter these statistics and reduce the rates of death and overdose. Up to 90% of people who use MAT remain sober for 2 years.[8]
2 of these medications are Vivitrol and Suboxone (buprenorphine/naloxone). Vivitrol and Suboxone allow people to resist relapse urges and build sober lives. In Medication for Addiction Treatment (MAT) programs, doctors combine these drugs with therapy to help their patients get and stay sober.
Your doctor can help you find the medication that's right for you. Here's what you should know about Vivitrol and Suboxone as you decide.
What Are Vivitrol & Suboxone?
Suboxone and Vivitrol are two of the most prescribed brand-name medicines in MAT, but they are very different medications and prevent opioid use by two different mechanisms.
Vivitrol
The U.S. Food and Drug Administration (FDA) approved Vivitrol in April 2006 for the treatment of OUD [6]
Vivitrol is an injectable form of naltrexone, an opioid antagonist. Doctors use naltrexone to help patients overcome alcohol use disorder and opioid use disorder, as the antagonist nature of this prescription blocks the euphoric effects of both drugs. [2]
One shot releases a consistent amount of medication into your body for one month.
If a person using Vivitrol relapses to opioids or alcohol, they will not feel the same high or pleasure. Experts say this can break a drug's psychological hold. If you use a substance and don't feel the euphoric effects of that drug, you may not be as tempted to use again.[3]
Suboxone
The FDA approved Suboxone in October 2002 for the treatment of OUD [7]
Suboxone contains two ingredients:
- Buprenorphine, a partial opioid agonist that is the active ingredient in Suboxone. Buprenorphine binds to receptors in the brain to ease cravings and withdrawal symptoms[4]
- Naloxone, a fast-acting opioid antagonist is an in-active ingredient that only becomes active if the medication is injected intravenously, preventing overdose and serving as a safety mechanism if the individual attempts to misuse the medication. [5]
Suboxone comes in tablets and films, and it’s typically taken anywhere from one to three times per day.
What Are the Advantages of Suboxone over Vivitrol and vice versa?
Though both Suboxone and Vivitrol are important forms of MAT, they are very different medications.
Here are a few similarities between the two:
- Both medicines are prescribed to treat opioid use disorder.
- Both block some effects of opioid drugs in the event of a relapse.
- Neither stops an acute opioid overdose.
Advantages of Suboxone Over Naltrexone Include:
- Suboxone is a partial opioid agonist which means it has some opioid activity. In this way, it actually prevents cravings for opioids and prevents the withdrawal symptoms from opioids. Naltrexone does not do this. Therefore overall Suboxone is considered a more efficacious medication for OUD than Naltrexone, particularly in early recovery while patients are still experiencing acute withdrawal symptoms.
Advantages of Naltrexone over Suboxone Include:
- Naltrexone is completely non-addictive. Some people do not like the idea of being on any medication with “addiction” or “dependency” potential. For those people, Naltrexone may be a better choice.
- Naltrexone is dosed by injection once a month which may be more realistic or convenient for some patients, as compared to Buprenorphine which is dosed one, two or even three times a day.
- Even though the risk of sedation, dizziness and respiratory depression is extremely low with Suboxone, it is non-zero. Naltrexone does not have these risks, which is another reason some patients may prefer it.
Which Is Better for MAT?
For people with OUD, both Suboxone and Vivitrol can be effective. However, Suboxone success rates tend to be a little higher. In a study comparing Suboxone to Vivitrol, researchers found Suboxone to be a more effective substance misuse treatment.[9]
Suboxone’s success is due to the following:
- Less opioid use: People taking Suboxone had an average of 10 opioid-free days compared to 4 among those taking Vivitrol.
- Abstinence: In 144 days, people taking Suboxone reported an average of 81 abstinent days, while those taking Vivitrol reported 39 abstinent days.
- Relapse: People taking Suboxone abstained longer before relapse — 14 weeks compared to Vivitrol's 8 weeks.
However, for patients who cannot tolerate Suboxone, naltrexone can be a very good alternative. Some people may take Suboxone until they are quite stable off opioids and then choose to either continue with Suboxone on a long-term basis or change to Vivitrol.
Can You Take Both Drugs at the Same Time?
Unfortunately, Suboxone and Vivitrol cannot be taken together. Vivitrol binds more strongly to opioid receptors in the brain than Suboxone does. Taking Vivitrol after taking Suboxone will therefore render the Suboxone ineffective or even cause withdrawal symptoms.
Usually, a patient and their doctor will decide to take one or the other at a time as the mainstay of their treatment for OUD. Talk to your doctor about which medications might be right for you.
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