How to Get a Vivitrol Prescription
Getting Vivitrol is more involved than getting most prescriptions. It is not a script the patient picks up at a pharmacy. It is a clinical encounter that ends with an injection in the prescriber's office. The workflow has several stages and timing matters at each one.
Step 1: Decide whether Vivitrol is the right medication
Vivitrol is for patients who are opioid-free (or willing to be) and want a non-opioid medication for opioid use disorder, alcohol use disorder, or both. If you are still actively using opioids and not in a position to detox, Suboxone or methadone is the right starting point. If you are detoxed and want a monthly medication that does not include an opioid, Vivitrol fits.
See Suboxone vs Vivitrol and AUD medications overview if you are still figuring out the right medication.
Step 2: Find a provider
Any licensed prescriber can write the order and any clinical office can administer the injection. In practice, three categories of providers handle most Vivitrol prescriptions:
- Addiction medicine specialists. Most fluent in Vivitrol management. Typically the right starting point if you have one nearby.
- Outpatient SUD treatment programs. Many offer Vivitrol as one option in a structured program.
- Primary care doctors and psychiatrists. Increasingly comfortable prescribing Vivitrol, especially for AUD. Less common for OUD.
Use our state-by-state directory to find SAMHSA-listed Vivitrol providers in your area.
Step 3: Initial appointment
The first visit covers diagnosis, medical history, current substance use, prior treatment, medical comorbidities, and a discussion of Vivitrol mechanism and expectations. The prescriber will assess whether Vivitrol is appropriate and, if so, plan the induction window.
Lab work typically ordered: liver function tests (LFTs) at minimum. Some prescribers add urine drug screen, CBC, and metabolic panel. Pregnancy test for women of childbearing age. Hepatitis panel sometimes added.
Step 4: Insurance verification and prior authorization
The prescriber's office submits the prior authorization with documentation of diagnosis, treatment history, and medical necessity. This typically takes 24 to 72 hours for commercial insurance, often same-day for most state Medicaid programs.
During this period, the patient is either continuing whatever they were doing (if AUD without OUD) or starting the opioid-free window (if OUD).
Step 5: The opioid-free window (OUD only)
For opioid use disorder, the patient must be opioid-free for 7 to 10 days before the first injection. This is a hard requirement, not a guideline.
- Short-acting opioids (heroin, oxycodone, fentanyl): 7 to 10 days
- Methadone: 14 to 21 days
- Buprenorphine (Suboxone): 7 to 14 days
- Sublocade: 4 to 6 weeks
Where this window happens matters. Patients in residential treatment, post-incarceration, or with strong social support do well. Patients trying to do it alone in an active-use environment often do not. See Vivitrol after detox for the full breakdown.
Step 6: The naloxone challenge
Before the first Vivitrol injection, most prescribers do a naloxone challenge to confirm the patient is opioid-free. Small dose of naloxone, observation for 30 to 60 minutes. If withdrawal symptoms appear, Vivitrol is postponed and the patient comes back later. If nothing happens, Vivitrol can be administered the same visit.
Step 7: The first injection
A nurse or medical assistant draws up 380mg of Vivitrol and injects it into the gluteal muscle. The injection takes about 5 minutes. Most patients are observed for 30 to 60 minutes after the shot to monitor for any precipitated withdrawal that the naloxone challenge missed. Then they go home.
Side effects in the first 48 hours: injection site soreness, sometimes mild nausea or headache. Most resolve within 1 to 3 days.
Step 8: Monthly follow-up
Vivitrol is a monthly injection, every 28 days. Most prescribers schedule the next shot at the time of the current one. Some clinics offer reminder programs, app-based scheduling, or text alerts to reduce missed appointments.
Missing a shot is a real problem. After 28 days the medication starts to wear off, and by 35 to 45 days the receptors are fully back online. Patients who relapse on Vivitrol typically relapse during a missed-appointment gap.
Step 9: Ongoing care
Vivitrol works best as part of a treatment plan that includes counseling, peer support, and ongoing engagement. The medication blocks the reward of opioid or alcohol use. It does not change the underlying patterns that drive substance use. Most successful Vivitrol patients pair the medication with one or more of: individual therapy, intensive outpatient program, mutual help groups, recovery housing, or family-based recovery support.
What can go wrong
- Failed induction: patient relapses during the opioid-free window, or experiences precipitated withdrawal because the window was not long enough. Most common reason for treatment failure.
- Insurance denial: prior auth denied, often resolved with peer-to-peer review.
- Missed appointments: the most common cause of relapse during ongoing treatment. Plan for transportation, scheduling reminders, and what to do if the next appointment falls during travel.
- Pain management surprises: any opioid pain medication will not work while on Vivitrol. Patients having surgery or dental work need to plan with their surgeon and have non-opioid options.