Getting Vivitrol starts with a prescription from a healthcare provider, but there are several steps between deciding you want the medication and receiving your first injection. Vivitrol is a once-monthly shot of naltrexone, used to treat both opioid use disorder and alcohol dependence. Unlike methadone or buprenorphine, it doesn’t require visiting a specialized clinic, and any licensed healthcare provider can prescribe it. Here’s what the process actually looks like.
Step 1: Find a Prescribing Provider
Any doctor, nurse practitioner, or physician assistant with prescribing authority can write a Vivitrol prescription. There’s no special certification or waiver required, which makes it more accessible than some other addiction medications. You can start by asking your primary care doctor, contacting an addiction medicine specialist, or searching for providers through SAMHSA’s treatment locator at findtreatment.gov.
Many addiction treatment centers, outpatient clinics, and even some correctional facilities offer Vivitrol as part of their programs. If your current provider isn’t familiar with it, they can still prescribe it after reviewing the clinical guidelines. The manufacturer also runs a provider locator through the Vivitrol website.
Step 2: Meet the Opioid-Free Requirement
This is the most important medical prerequisite and the step that trips people up. If you’re being treated for opioid use disorder, you need to be completely opioid-free for a minimum of 7 to 10 days before your first injection. This includes heroin, fentanyl, prescription painkillers, and opioid-based medications. If you still have opioids in your system when you receive Vivitrol, the medication can trigger sudden, severe withdrawal that may require hospitalization.
The timeline is even longer if you’re transitioning from buprenorphine (Suboxone) or methadone. Because these medications leave the body more slowly, you may be vulnerable to precipitated withdrawal for up to two weeks after your last dose. Your provider will likely confirm you’re opioid-free through a urine test or a naloxone challenge test before giving the injection.
For alcohol dependence, the requirement is simpler: you should not be actively drinking at the time of your first injection. There’s no set number of alcohol-free days required, but your provider will want you to be in a stable enough condition to begin treatment safely.
Step 3: Get the Injection
Vivitrol is not a self-administered medication. A healthcare professional gives it as a deep intramuscular injection into the upper outer area of the buttock. The provider alternates sides with each monthly visit. Needle length varies based on body composition, with a longer needle used for patients with more tissue at the injection site.
Each injection lasts about four weeks, so you’ll return once a month for your next dose. The medication is shipped directly to your provider’s office, not dispensed at a pharmacy. Your provider orders it, and it arrives ready to prepare and inject during your appointment.
How Vivitrol Works
Vivitrol blocks opioid receptors in the brain for roughly 30 days per injection. If you use opioids while on Vivitrol, you won’t feel the euphoric effects, which removes the reinforcement that drives continued use. For alcohol dependence, the mechanism is slightly different: blocking opioid receptors reduces the pleasurable effects of drinking, which helps lower cravings over time.
A pilot study from NYU Langone Health looked at relapse rates among people released from jail and found that 88% of those without Vivitrol relapsed within one month, compared to 38% of those who received the injection. The medication doesn’t eliminate the challenge of recovery, but it provides a significant buffer during the period when relapse risk is highest.
Paying for Vivitrol
Vivitrol is expensive without insurance. The wholesale cost runs over $1,000 per injection, which makes coverage essential for most people.
Medicare covers naltrexone (the active ingredient in Vivitrol) under Part B when administered in a doctor’s office or through an Opioid Treatment Program, and under Part A for inpatient hospital settings. Part D drug plans may also cover it. If you have both Medicare and Medicaid, you pay nothing for covered services through your state Medicaid program. Most state Medicaid programs cover Vivitrol as well, though prior authorization requirements vary by state.
Private insurance plans generally cover Vivitrol, especially since the Mental Health Parity and Addiction Equity Act requires insurers to cover addiction treatment comparably to other medical conditions. Call your insurance company before your first appointment to confirm coverage and find out whether prior authorization is needed.
If you’re uninsured or facing high out-of-pocket costs, the manufacturer offers two assistance programs. The Vivitrol Co-Pay Savings Program can reduce your copay, and a broader program called Vivitrol2gether provides financial assistance resources alongside patient support services. You can reach both programs by calling 800-848-4876.
What to Watch for After the Injection
Most people tolerate Vivitrol well, but injection site reactions are the most notable risk. Common reactions include mild pain, swelling, or hardness at the injection site that resolves on its own. In rare cases, severe reactions can occur, including tissue death at the injection site that requires surgical treatment.
Contact your provider right away if you notice any of these symptoms at the injection site:
- Intense pain that worsens rather than improves
- Blisters or a dark scab forming over the area
- Hardness or a firm lump under the skin
- A large area of swelling or an open wound
These symptoms can appear days to weeks after the injection, so keep an eye on the site between appointments.
What Makes Vivitrol Different From Other Options
The main advantage of Vivitrol is the monthly dosing schedule. Because a healthcare provider administers it once every four weeks, there’s no daily pill to remember and no opportunity to skip doses during difficult moments. This makes it especially useful for people who struggle with medication adherence or who want a treatment that doesn’t require daily decision-making.
The tradeoff is the opioid-free period required before starting. Medications like buprenorphine can be started while someone is still in mild withdrawal, which makes the transition easier for many people. With Vivitrol, those 7 to 14 opioid-free days can be a real barrier, and medically supervised detox is often the safest way to get through them. If you’re currently using opioids daily, talk with your provider about whether an inpatient or residential detox program could bridge the gap before your first injection.
Vivitrol also carries one important safety consideration: if you stop treatment and then use opioids, your tolerance will be significantly lower than it was before. This creates a heightened overdose risk. Your provider should discuss a safety plan with you before starting and before discontinuing treatment.