Quick Answer: Naltrexone and Suboxone both treat opioid use disorder, but they work differently. Suboxone helps reduce opioid cravings and withdrawal symptoms, while naltrexone blocks opioid effects and generally requires completing withdrawal before treatment begins. The right choice depends on your current opioid use, medical history, and treatment needs.

Maybe you’re getting ready to start treatment, or maybe you’ve been on one medication for a while and wonder whether the other would suit you better. Either way, weighing naltrexone vs. Suboxone shows you’re taking your recovery seriously. Knowing how each works, when you can start each, and what switching involves can make that conversation with your provider feel much less overwhelming. 

What’s the Difference Between Naltrexone and Suboxone?

The main difference between naltrexone and Suboxone is how they interact with opioid receptors in the brain. Naltrexone blocks opioid effects, while Suboxone contains medication that partially activates those receptors to help control withdrawal symptoms and cravings.

Naltrexone is an opioid antagonist, meaning it blocks opioid receptors without activating them. It contains no opioid and is available as an oral tablet or as Vivitrol, an extended-release injection generally administered once a month. For opioid use disorder, injectable naltrexone is often emphasized because consistent daily use of oral naltrexone can be difficult to maintain.

Suboxone contains buprenorphine, a partial opioid agonist, and naloxone. Buprenorphine reduces cravings and withdrawal symptoms without producing the same effects as full opioid agonists when taken as prescribed. Naloxone is included primarily to discourage misuse by injection. Suboxone is generally taken daily as a film placed under the tongue or inside the cheek.

Extended-release buprenorphine options like Sublocade offer monthly injections, so less frequent dosing doesn’t necessarily require switching to naltrexone. Unlike Suboxone, naltrexone also treats alcohol use disorder, and despite their similar names, naltrexone and naloxone are different medications. 

Can You Start Naltrexone or Suboxone During Opioid Withdrawal?

Suboxone can be started during opioid withdrawal under appropriate medical supervision because buprenorphine helps relieve withdrawal symptoms and cravings. However, starting it too soon can trigger sudden withdrawal, especially after fentanyl, which can linger in the body longer than many people expect. That’s why clinicians check where you are in withdrawal before the first dose.

Naltrexone requires a different approach because it blocks opioid receptors, which can trigger severe withdrawal if you start taking it while you’re still physically dependent on opioids. That’s why treatment generally begins after withdrawal has resolved and you’ve been opioid-free for at least 7 to 10 days, sometimes longer.

These differences when weighing naltrexone vs. Suboxone matter when someone is still using opioids or has recently stopped. At Wise Path Recovery Centers, detox and stabilization can help patients manage withdrawal under medical supervision while preparing for an appropriate ongoing treatment plan.

Is Naltrexone Better Than Suboxone for Opioid Addiction?

When comparing naltrexone vs. Suboxone, neither medication is universally better, but how easily someone can start treatment matters. A 2018 clinical study found that more people successfully started Suboxone than extended-release naltrexone, largely because naltrexone requires completing opioid withdrawal first.

Among those who successfully started either medication, relapse outcomes were similar. This highlights why medically supervised detox and ongoing support can be important when preparing for naltrexone treatment. However, the study took place before fentanyl became widespread in the illicit opioid supply, so its findings may not fully reflect today’s treatment challenges.

What Are the Side Effects of Naltrexone vs. Suboxone?

Both medications can cause side effects, although the symptoms and risks differ depending on how they’re taken and how they work.

• Naltrexone: Common side effects include nausea, headaches, and fatigue, especially when you first start treatment. Vivitrol injections may also cause soreness or swelling at the injection site. Our guide to naltrexone side effects explains which symptoms may improve over time and which need medical attention.
• Suboxone: Possible side effects include headaches, nausea, vomiting, constipation, sweating, and insomnia. The oral film can also cause tongue pain, mouth numbness, or redness.

Suboxone also carries a risk of dangerous sedation and slowed breathing when combined with alcohol, benzodiazepines, or other sedating medications. You can learn more about the risks of mixing benzodiazepines and opioids.

Keeping Narcan available is an important overdose safety measure, regardless of which treatment you’re receiving. Overdose risks can increase if someone returns to opioid use after losing tolerance or attempts to overcome naltrexone’s blocking effects by taking larger amounts of opioids.

Can You Switch From Suboxone to Naltrexone?

Yes, you can switch from Suboxone to naltrexone, but it requires careful planning with a qualified prescriber. Because buprenorphine can produce physical dependence, starting naltrexone before that dependence has resolved may trigger severe withdrawal.

According to the American Society of Addiction Medicine (ASAM), clinicians generally allow 7 to 14 days between the final buprenorphine dose and naltrexone initiation. The appropriate interval and monitoring depend on the patient’s condition, withdrawal status, and treatment history.

That gap between medications can be a vulnerable time, since cravings often return once buprenorphine is no longer working in the background. Planning the switch with your care team and having extra support during those weeks helps protect the progress you’ve already made. 

There’s also no set time limit on how long someone can stay on buprenorphine. If Suboxone is helping you remain stable, there’s no need to switch simply because another medication is available. Your clinician can help weigh the potential benefits of changing treatment against the risks of interrupting care.

How Do You Choose Between Naltrexone and Suboxone?

Choosing a medication for opioid use disorder depends on more than whether you prefer an opioid-blocking medication or one that helps manage withdrawal. The best choice is one you can start safely, that fits your medical needs, and that remains accessible as treatment continues.

Some factors to discuss when weighing naltrexone vs. Suboxone with your healthcare provider include:

• Your current opioid use: Whether you’re physically dependent, experiencing withdrawal, or have already completed detoxification.
• Medication options: Whether a daily film, oral tablet, or longer-acting injection is appropriate, including extended-release buprenorphine options.
• Your medical history: Liver health, other medications, pregnancy considerations, and any anticipated need for opioid pain management.
• Ongoing treatment access: Your ability to attend appointments, continue medication, and receive recovery support.

Methadone is another evidence-based treatment option that may be appropriate when other medications don’t fit someone’s needs. Your clinician can help determine which approaches are worth considering, rather than limiting the decision to these two medications.

Cost and coverage may also affect access. Wise Path can help you verify your insurance benefits before beginning treatment so you can better understand which services may be covered.

Explore Your Treatment Options With Wise Path

There’s no wrong answer in choosing between these medications, only the one that fits where you are right now. Whether you’re just starting out, thinking about switching, or unsure where to begin, our team in West Virginia can help you weigh your options without pressure. 

Through our medication-assisted treatment program, we offer Suboxone, Sublocade, and Vivitrol when they’re clinically appropriate, always alongside counseling and people who genuinely want to see you do well. 

If you’re considering medication treatment or want to understand the next steps toward care, reach out to Wise Path Recovery Centers or call 866-860-9772 to discuss your needs and available options.

FAQs About Naltrexone vs. Suboxone