Suboxone, Methadone and Vivitrol | AspenRidge Recovery

Suboxone, Methadone and Vivitrol: Let’s Review and Compare 3 Opioid Replacement Therapies

Suboxone, methadone and Vivitrol are popular medications often used to treat opioid addictions, and are often used in opioid replacement therapies (ORT). An addiction occurs when a person develops a psychological or physical dependence. Once this happens, the body goes through withdrawal whenever the drug is not in the system. If you’re looking to get sober, most rehab centers will recommend using one of those drugs in your medical detox treatment plan. Here’s a side-by-side comparison on all three of these drugs. Get a better idea of the characteristics and features of each medication. This will help you make a more informed decision that will benefit your recovery.

What Is Opioid Replacement Therapy (ORT)?

Opioid Replacement Therapy (ORT) uses weaker opioids as a substitute for stronger drugs. This means that Suboxone, methadone and Vivitrol are essentially weaker drugs with the same effects as stronger drugs, like oxycodone. ORT reduces the intensity of any withdrawal symptoms you may experience. You’re less likely to experience life-threatening withdrawal symptoms. This treatment also curbs cravings. Because of all these factors, patients are less likely to relapse. ORT is one of the most effective treatments available, which is why it is extremely popular. 40% to 65% of patients who have gone through ORT are less likely to use other opioids again.

What Are Some of the Main Differences Between Suboxone, Methadone and Vivitrol?

Suboxone, methadone and Vivitrol all hope to achieve the same thing; however, they work in different ways. The differences are minor, but have a profound overall impact. Here’s a quick look at the chemical differences between each type of medication.


Suboxone is made from buprenorphine and naloxone. Both of these drugs work in harmony to treat opioid addictions. Buprenorphine is a partial opioid agonist. This means that it stimulates the same areas in the brain as opioids do. In particular, it creates a sense of euphoria and satisfaction. Although it does the same task, buprenorphine does not have the same signal strength. It causes a much weaker reaction. This reaction prevents withdrawal symptoms. Naloxone is an opioid antagonist. It’s mixed in with the buprenorphine to block receptors in the brain that respond to the opioids. This helps get rid of any lingering effects that may remain. In a way, naloxone helps reverse the effects of opioid usage.


Unlike Suboxone, methadone is a full opioid agonist. The brand name for this drug is Dolophine, and it consists of only one chemical compound. This medication is mostly used to treat opioids like heroin. In comparison to illicit street drugs, methadone has a slow onset of action. This gives it a smaller addictive potential than heroin. It also makes the withdrawal symptoms of methadone less intense. This makes it a lot easier for patients to taper off of the drug. Since methadone is still fairly strong, it is usually administered during inpatient detoxification. Most professionals find methadone to be a riskier option for patients who choose outpatient detoxification, as the dosage of the methadone administered must be exact.


Vivitrol is one of the newest options available for ORT. It’s also known as naltrexone. While it’s been used since the 1980s, this chemical was repackaged and altered in the late 2000s for treating alcohol dependence. Vivitrol is an opioid antagonist. This means that it blocks receptors in the brain, so that they cannot be stimulated by opioids. This prevents patients from feeling ‘high’ or euphoric when they take prescription opioids or illicit street drugs.

A Side-by-Side Comparison of Side Effects

Since Suboxone, methadone and Vivitrol all work because they function similarly to opioids, they do come with some side effects. These side effects are much less intense in comparison to both opioids and opiates. This is why they are a popular treatment remedy. Take a look at some of the short-term and long-term side effects of each drug below.

Suboxone Methadone Vivitrol
Short-term · Confusion · Constipation during use · Diarrhea during withdrawals · Euphoria · Insomnia · Irritability · Nausea · Reduced stress · Respiratory depression · Sleepiness · Anxiety and restlessness · Constipation · Diarrhea · Dry mouth · Euphoria · Drowsiness · Insomnia · Itchy skin · Loss of libido · Nausea and vomiting · Profuse sweating · Weakness or fatigue · Anxiety · Change in energy levels · Constipation · Depression · Diarrhea · Dizziness · Euphoria · Headaches · Loss of appetite · Muscle or joint pain · Nausea or vomiting · Restlessness · Sleep problems
Long-term · Anxiety · Depression · Disorientation and confusion · Financial strain · Gastrointestinal issues · Isolation · Trouble with relationships · Cardiac problems · Cognitive function impairment · Hallucinations · Menstrual problems in women · Respiratory problems · Seizures · Stomach pain and cramps · Swelling of the face, eyes, and other areas · Allergic pneumonia · Blurry vision · Extreme confusion · Infections or skin damage · Hallucinations · Liver damage · Severe vomiting

The type of side effects associated with each drug should be carefully explored. Doctors should determine which drug is most suitable for each patient, based on their biological makeup. At times, some doctors may even switch patients to a different medication if the current one causes too many side effects.

Risk of Dependence

Due to the differing chemical structure of each drug, they have varying addiction potentials. Out of all three medications, methadone has the highest risk of dependence. Suboxone contains buprenorphine. This drug has a “ceiling effect“, which basically means that its effects will plateau after a certain dosage. Due to this plateau, Suboxone has a low risk of dependence.  It is impossible for patients to develop any type of tolerance on the drug. Even if they were to take more and more of the drug, they are not likely to get high from it. The same can be said for Vivitrol. Much like Suboxone, it has a fairly low risk of dependence. This is because this drug is usually administered only once a month. On top of that, a medical professional will supervise the administration of the drug. Due to the way that Vivitrol is given to patients, it is also quite difficult to get addicted to it. Methadone, on the other hand, has a higher addiction potential than the rest of the drugs. In comparison to the other two, methadone is a stronger drug. It does not have a “ceiling effect”, which is why it is often used to treat heroin addictions. This means that it is possible to build tolerance to methadone. A higher dosage results in a greater high.

Short-Term and Long-Term Success of Each Medication

While Suboxone, methadone and Vivitrol all play the same role in ORT, they have varying success rates. For optimal success, pair ORT with counselling and various types of therapies. The length of stay in addiction therapy will also have a profound impact. In general, patients have a higher chance at recovery if they opt for a longer stay at the rehab.


With that said, Suboxone treatments are much more effective if they are used for at least 55 days. Unfortunately, once completing the Suboxone treatments, 40% to 60% of patients relapsed. A higher relapse rate is associated with a shorter length of treatment. The success rate for Suboxone will also depend on how well the patients tapered off of the drug. Those who wean off of Suboxone too quickly have a higher risk of relapsing. On the other hand, those who wean off Suboxone gradually have a higher success rate.


Vivitrol is administered once a month via an injection. It is only administered once all alcohol and opioid molecules have left the body. Due to this reason, a naloxone challenge test must be performed before Vivitrol is prescribed. Those who develop symptoms of opioid withdrawals after the test should not start treatment. This medication is just as effective as Suboxone. Different study groups have seen different success rates. Study groups in UCLA have seen success rates of about 1 in 9. These individuals successfully recover from their addiction, and never relapse. It’s important to note that not all patients will respond to Vivitrol. In fact, studies show that an average ofonly 40% of patients respond to this medication. As a result, your doctor may need to switch you over to a different medication if you’re not getting any results. 


Methadone is the standard care for opiate addictions. It has a success rate between 60% to 90%. The longer that patients use this treatment, the greater their success rate. While methadone has one of the highest success rates out of all the medications used in ORT, it needs to be administered carefully. As mentioned above, it has the highest risk of dependence. It’s also easy for patients to overdose on this medication. As a result, it’s imperative that patients gradually taper off of this drug. This means that a longer addiction treatment length is necessary when using methadone.

Withdrawals and the Process of Weaning Off of Each Drug

Patients who wean off of the medication gradually are less likely to experience physical symptoms. However, withdrawals are quite common still, and can last anywhere from hours to days. Here’s a look at what to expect.


Withdrawals from Suboxone are due to the buprenorphine in the medication. Withdrawal symptoms basically feel like a bad flu. The withdrawal symptoms can peak within 24 to 72 hours, and can last anywhere from 1 to 4 weeks. By the end of the 1st week, patients usually experience some minor aches and pains. These aches and pains will continue to subside until the 4th week. Common withdrawal symptoms include:

  • Anxiety
  • Insomnia
  • Irritability
  • Nausea
  • Pain
  • Profuse sweating
  • Restlessness

Other symptoms are similar to the flu. Those who are withdrawing from Suboxone may feel down under the weather.


The withdrawal timeline for methadone is similar to Suboxone. Physical symptoms may begin to kick in within 24 hours, and will peak in 2 to 10 days. Symptoms usually begin to fade by the 11th day, and will be gone completely by the 22nd day. Common withdrawal symptoms include:

  • Anxiety
  • Chills
  • Cravings
  • Depression
  • Diarrhea
  • Fever
  • Hallucinations
  • Insomnia
  • Irritability
  • Muscles aches and pain
  • Nausea and vomiting
  • Paranoia
  • Profuse sweating
  • Rapid heartbeat
  • Stomach cramps

Those addicted to many substances will go through a lengthier withdrawal timeline. In addition, those who attempt to quit cold turkey will experience more severe withdrawal symptoms.


It takes anywhere from 5 days to 2 weeks to get over Vivitrol withdrawal symptoms; however, the symptoms are quite mild. The length of time will depend on the dosage that was injected. Some of the main withdrawal symptoms include:

  • Anxiety
  • Abdominal pain
  • Insomnia
  • Shakiness

Basically, Vivitrol withdrawal symptoms are non-existent or so mild that they shouldn’t count. It is almost impossible to experience withdrawals from Vivitrol.

How to Taper Off of ORT Medications like a Champ

Since all three medications work in similar ways, the taper method is also similar in most cases. The taper schedule will be personalized to the needs of each patient. While some patients may be able to wean off of the drugs within a shorter time frame, others need more time. It’s important to pay attention to the body, and how it’s reacting to the taper.


It takes anywhere from 2 to 6 months to completely wean off of Suboxone use. The taper schedule will vary from patient to patient based on their body. With that said, once a dosage of 2 mg is reached, most doctors will follow the same schedule. They will reduce dosage by 0.5 mg every 2 weeks. Then, they will prescribe Suboxone every other day once a dosage of 0.5 mg is reached. Patients should not experience any physical withdrawal symptoms at this rate.


Decrease methadone dosage by 5 mg every 3 to 14 days. At this rate, patients should experience very little physical and psychological withdrawal symptoms. Once the dosage is lowered to about 20 mg, the decrease in dosage should be even more gradual.


The taper schedule for Vivitrol is a lot simpler. In most cases, doctors will simply stop administering any injections. Some doctors may administer a lower dosage each month before stopping. It all depends on the patient, and how they are reacting to the drug.

Tips and Tricks for a Successful Taper

Tapering off of these medications can be difficult. Those who don’t wean off of the drugs in a gradual manner will have a greater risk of a relapse. Other tips for successfully weaning off of the drug include:

  • Adjusting the tapering speed based on the body’s reaction; let your doctor know how you’re feeling every day
  • Resisting the urge to take a larger dosage even if you’re not feeling great when weaning off of the drug
  • Taking the medication only once every 24 hours or as prescribed by the doctor
  • Using the least amount of medication possible to feel good enough to get through the entire day

When weaning off of the drug, take this opportunity to focus on other therapies and counselling. If you’re an artist, focus on your art. If you love to cook, focus on that. It’s important that you don’t obsess over the medication and the tapering schedule.

A Look at the Safeness of Each Medication

While each ORT medication can be used for months, and even years, the goal is to slowly wean off of them. Patients should try to live life without having to take any medications whatsoever. With that said, not all of these medications are suitable for long-term use. Long-term use of Suboxone can lead to severe side effects. As a result, most physicians only recommend using it for several months at most. Methadone, on the other hand, can be used for years; however, it is easy to build tolerance to this drug. Long-term use needs to be carefully monitored and supervised to prevent addiction. Supervision is also necessary to prevent misuse or abuse. Those who misuse methadone may get addicted to the drug. Vivitrol can also be used for long periods of time with ease. This drug is considered to be fairly safe. As a result, patients won’t get addicted to it nor will they experience many intense side effects from long-term use. Unlike with Suboxone and methadone, Vivitrol treatments can only be started once all opioids are cleared from the system. Otherwise, the drug is not safe, and can cause harsh side effects.

Compare and Contrast Suboxone, Methadone and Vivitrol to Make an Informed Decision

If you’re addicted to an opioid, ORT may be the way to go. It will reduce any withdrawal symptoms you may experience. It also makes it much easier to wean off of the opioids. With that said, the type of ORT that will be most effective for each patient will differ. The type of medication that the doctors will choose to use will depend on the amount of drugs taken, the length of the drug use and more. To get a better idea of what is most recommended for your situation, get a free phone assessment today. This will give you a better idea of what to expect on the road to sobriety. Our staff will walk you through the different medications and treatments we offer. We’ll help you figure out what will work best for you, and what you should try. We’ll also discuss the risks and benefits of each medication used in ORT, so you can make an informed decision.

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