For people struggling with opioid use, medication can be one of the most important tools in recovery. Research consistently shows that medications for opioid use disorder reduce cravings, lower the risk of relapse, and significantly reduce the risk of fatal overdose.
Yet many people still have questions about which medication is right, how they differ, and how they fit into broader addiction treatment. Here is a clear comparison of three common options: Suboxone, Sublocade, and Vivitrol.
Why Medication Matters
Opioids change the brain’s reward and stress systems. When someone stops using, withdrawal and cravings can be intense, and relapse becomes very likely. After a period without opioids, tolerance drops, so returning to use, especially with fentanyl in the drug supply, carries a high risk of overdose. Medication helps stabilize the brain and protect against that risk while people build the skills and support needed for long-term recovery.
Suboxone (Buprenorphine and Naloxone)
How It Works
Buprenorphine is a partial opioid agonist. It attaches to the same receptors as other opioids but activates them only partway, which eases withdrawal and cravings without producing the strong high of full opioids. It also has a “ceiling effect,” meaning higher amounts do not keep increasing its effects, which lowers overdose risk. Naloxone is added to discourage misuse.
What to Know
- Taken daily as a film placed under the tongue or inside the cheek
- Can be prescribed in an outpatient office setting
- Usually started when someone is already in mild to moderate withdrawal, with timing guided by a provider
- Offers flexibility for adjusting the dose over time
Sublocade (Extended-Release Buprenorphine)
How It Works
Sublocade contains the same medication as Suboxone, buprenorphine, but it is delivered as a monthly injection given by a healthcare provider. It forms a depot under the skin that releases medication steadily over the month.
What to Know
- Removes the need to take a daily dose
- Provides more consistent medication levels
- Reduces the risk of missed doses, loss, or diversion
- Typically started after a person has been stabilized on buprenorphine for a short period
- Must be administered in a healthcare setting
For many people, the convenience of a monthly injection makes it easier to stay consistent during stressful periods.
At Thrivur Health, medication-assisted treatment includes FDA-approved options such as Suboxone, Sublocade, and Vivitrol, always paired with therapy as part of outpatient care in the Denver area.
Vivitrol (Extended-Release Naltrexone)
How It Works
Vivitrol works differently from buprenorphine. Naltrexone is an opioid antagonist, meaning it blocks opioid receptors completely. If someone uses opioids while on Vivitrol, they will not feel the usual effects. It is also approved for alcohol use disorder.
What to Know
- Given as a monthly injection
- Not an opioid and has no potential for misuse
- Requires being fully free of opioids before starting, typically for about 7 to 10 days, to avoid sudden withdrawal
- After stopping, tolerance is low, which increases overdose risk if opioid use resumes
Comparing the Options
- Suboxone: daily partial agonist, flexible dosing, office-based
- Sublocade: monthly partial agonist injection, steady levels, fewer missed doses
- Vivitrol: monthly blocker, non-opioid, requires full detox first, also used for alcohol
How Providers Help Choose
The right medication depends on several factors:
- History and severity of opioid use
- Whether someone is currently using opioids or has completed detox
- Preference for daily versus monthly dosing
- Other health conditions and medications
- Whether alcohol use is also a concern
- Practical factors such as schedule and transportation
Some people start with one medication and switch to another as their needs change.
Medication Works Best With Therapy
Medication addresses the physical side of addiction, but recovery also involves emotional, behavioral, and social change. Therapy helps people understand triggers, manage stress, and rebuild relationships. Approaches such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), group therapy, and family therapy all play important roles. Programs that combine medication with counseling tend to produce stronger outcomes than either alone.
How Long Do People Stay on Medication?
There is no fixed timeline. Some people take medication for several months, while others benefit from staying on it for years. Research suggests that stopping too early increases the risk of relapse, so decisions about tapering are best made gradually and together with a provider, once recovery feels well established and other supports are in place.
Clearing Up a Common Myth
Some people worry that taking buprenorphine is “replacing one drug with another.” Addiction involves compulsive use despite harm. Taking a prescribed medication at a stable dose to stay healthy and functional is treatment, much like using medication to manage diabetes or high blood pressure.
Staying Safe
Anyone at risk of opioid overdose, and anyone who lives with someone at risk, should keep naloxone (Narcan) on hand. It is available without a prescription at most pharmacies.
Finding the Right Fit
There is no single best medication for everyone. The right choice is the one that helps you stay stable, safe, and engaged in recovery. A conversation with an experienced provider can help you weigh the options.
If you suspect an overdose, give naloxone if available and call 911 immediately. If you or someone you love is in crisis, call or text 988, or contact Colorado Crisis Services at 1-844-493-8255 (or text TALK to 38255).
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