Timeline For Switching From Methadone To Vivitrol

Changing medication-assisted treatment (MAT) medications should be approved and monitored by a trained professional, especially when switching from methadone to Vivitrol. There are three medications approved by the U.S. Food & Drug Administration to treat opioid use disorder (OUD), which are naltrexone (Vivitrol, ReVia), methadone, and buprenorphine. Naltrexone is the only non-narcotic MAT approved to treat OUD.

This may be a desirable option for some, however, it requires that a person is opioid-free for a number of days before starting a medication like Vivitrol. Once Vivitrol injections have begun, the length of treatment varies. On average, Vivitrol injection treatments typically continue for 12 months.

Learn more about using Vivitrol to overcome addiction

How To Switch From Methadone To Vivitrol

When the decision is made to switch to Vivitrol from methadone, a tapering process to reduce the dosage of daily methadone may be suggested by your healthcare provider. The length of time will vary between individuals and depending on how much methadone a person takes each day. A person has to be free of methadone for 10 to 14 days before they can begin Vivitrol injections. Addiction treatment professionals may consider a low dose of naltrexone in pill form during the first couple days without methadone, but this is under complete supervision and may not be an option in all areas.

Steps to switch from methadone to Vivitrol include:

• slowly reducing the amount of methadone (tapering)
• stopping methadone completely
• remaining opioid-free (including methadone) for 10 to 14 days
• working with a healthcare provider to manage methadone withdrawal

In some situations, medically supervised detox may be recommended. Managing withdrawal symptoms can help prevent relapse or other complications during the time between stopping methadone and starting Vivitrol.

How Much Time It Takes To Switch From Methadone To Vivitrol

Transitioning from methadone to Vivitrol is a carefully managed process that typically takes several weeks to complete safely. The timeline varies for each person based on factors like current methadone dosage, how long they’ve been taking it, body weight, metabolism, and overall health. The most critical part of this switch is timing, as you cannot start Vivitrol while any opioids, including methadone, remain in your system. Taking Vivitrol too soon triggers precipitated withdrawal, which is a sudden and severe form of withdrawal that occurs when Vivitrol blocks opioid receptors while methadone is still present in the body.

Precipitated withdrawal symptoms include:

• extreme and uncontrollable vomiting
• high fever and chills
• severe muscle and body aches
• rapid or irregular heartbeat
• intense, debilitating diarrhea
• potential seizures
• profuse sweating
• severe anxiety, agitation, and psychological distress

Because of these serious risks, doctors require patients to be completely opioid-free for at least 7-14 days before administering the first Vivitrol injection. Your healthcare provider will create a personalized tapering schedule to gradually reduce your methadone dose over time, then conduct urine drug tests to confirm all opioids have cleared your system before starting Vivitrol.

Possible Complications When Switching From Methadone To Vivitrol

The biggest complications that can arise when switching from methadone to Vivitrol are withdrawal symptoms and the return of opioid cravings.

Adequate medical supervision can help a person manage cravings and withdrawal symptoms that may occur while waiting to start Vivitrol injections.

Factors That Can Affect The Timeline For Switching From Methadone To Vivitrol

While the general timeline for switching from methadone to Vivitrol typically takes several weeks, the actual duration can vary significantly from person to person. Multiple factors influence how quickly and safely someone can make this transition, and healthcare providers carefully consider each of these elements when creating an individualized treatment plan.

Factors that can affect the switching timeline include:

• Previous Substance Abuse History: People with longer histories of opioid use or multiple past relapses may need a slower, more cautious taper to ensure stability throughout the process.
• Length of Time Taking Methadone: Those who have been on methadone maintenance for years typically require more time to taper safely compared to people who’ve only been taking it for months.
• Current Methadone Dosage: Higher daily doses require longer tapering periods to gradually reduce the amount without causing severe withdrawal symptoms.
• Available Withdrawal Management Services: Access to medical supervision, medications to ease withdrawal symptoms, and supportive care can make the transition smoother and potentially faster.
• Relapse Risk Assessment: Individuals at higher risk of relapse may need additional time in treatment, counseling, and support before making the switch to ensure they’re stable enough to handle the transition.
• Environment Where Tapering Occurs: Whether someone is tapering in an inpatient facility with 24/7 support versus at home while managing daily responsibilities significantly impacts the timeline and safety of the process.
• Co-Occurring Mental Health Conditions: Depression, anxiety, PTSD, or other mental health issues may require additional treatment time and support during the transition.
• Physical Health Status: Overall health, liver function, and other medical conditions can affect how the body processes methadone and how quickly it can be safely eliminated.

Your healthcare provider will evaluate all of these factors together to determine the safest and most appropriate timeline for your specific situation. Some people may be able to complete the switch in a few weeks, while others may need several months to taper off methadone safely before starting Vivitrol.

How Are Vivitrol And Methadone Different?

Vivitrol is an injectable non-narcotic, while methadone is a synthetic opioid oral medication. Vivitrol has to be injected monthly by a healthcare provider or pharmacist, methadone is usually self-administered daily after a pattern of non-abuse has been established. Vivitrol is not shown to be addictive, but methadone can be addictive.

Insurance companies vary in their coverage of both Vivitrol and methadone, but Vivitrol tends to be significantly more expensive than methadone.

Which MAT Medication Is Better?

There’s no single “best” medication-assisted treatment option for opioid use disorder because each medication works differently and offers unique benefits depending on a person’s individual circumstances. Methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol) all serve different purposes and are suited to different stages of recovery and personal situations. What works well for one person may not be the right choice for another.

Healthcare providers evaluate multiple factors when recommending a MAT medication, including the severity of addiction, history of relapse, living situation, work schedule, ability to attend daily clinic visits, personal preferences, and any co-occurring health conditions. The decision is made between the individual and their treatment team to find the medication that offers the best chance of long-term recovery.

Written by the Addiction Resource Editorial Staff