Suboxone vs Sublocade vs Vivitrol
Three proven medications, three different strategies — how to choose the right one
If you are comparing Suboxone, Sublocade, and Vivitrol, you are already asking the right question. All three are FDA-approved, evidence-based treatments for opioid use disorder — but they work in genuinely different ways, and the right choice depends on where you are in recovery, your daily life, and your goals.
As a board-certified psychiatrist running an outpatient detox and MAT practice, Dr. Agresti prescribes all three. Here is the honest comparison he walks patients through.
Side-by-Side Comparison
| Suboxone | Sublocade | Vivitrol | |
|---|---|---|---|
| Active medication | Buprenorphine + naloxone | Buprenorphine (extended-release) | Naltrexone (extended-release) |
| How it works | Partial opioid agonist — prevents withdrawal and cravings with a ceiling effect | Same medication as Suboxone, delivered as a steady month-long depot | Opioid blocker — no opioid activity at all; blocks the effect of any opioid used |
| Form & schedule | Daily film or tablet under the tongue | Monthly injection at the office | Monthly injection at the office |
| Starting requirement | Begin in mild withdrawal (12–24+ hrs after last use) | Must be stable on Suboxone first (typically 7+ days) | Requires 7–14 days fully opioid-free after detox |
| Craving control | Strong | Strong, with no daily peaks and troughs | Moderate — blocks reward rather than replacing it |
| Controlled substance | Yes (Schedule III) | Yes (Schedule III) | No |
| Best fit | Most patients starting MAT; flexible and adjustable | Patients stable on Suboxone who want to stop thinking about daily dosing | Highly motivated patients fully through detox; also treats alcohol use disorder |
How to Think About the Choice
Start with Suboxone if…
You are still using opioids or in early withdrawal. Suboxone is the most flexible entry point: the dose can be adjusted week to week, induction can begin at home under physician guidance, and it controls cravings and withdrawal from day one. It is where most successful MAT journeys begin.
Move to Sublocade if…
You are stable on Suboxone and tired of the daily ritual — or daily dosing is a privacy, travel, or adherence problem. Sublocade delivers the same medication as a steady monthly depot injection: no peaks, no troughs, no films to carry or explain.
Choose Vivitrol if…
You are fully detoxed and want zero opioid in your treatment — a common preference for licensed professionals, or after completing opioid detox. Vivitrol blocks the effect of any opioid used, removing the "what if" — and it is also FDA-approved for alcohol use disorder, which matters when both are in the picture.
Not sure which fits your situation? Dr. Agresti evaluates and prescribes all three — same-day consultations are often available.
Book a Confidential Consultation
Why Choose One Doctor for the Whole Journey
The medication is only half the treatment. Dr. Agresti is both a psychiatrist and a psychotherapist — the same doctor who manages your induction and monthly injections also treats the anxiety, depression, or trauma underneath the addiction, in extended, unhurried sessions. Every visit is with him directly, in Palm Beach or by telehealth anywhere in Florida.
Frequently Asked Questions
There is no universally better option — they fit different situations. Suboxone is the most flexible starting point for most patients. Sublocade suits patients already stable on buprenorphine who want a once-monthly injection. Vivitrol requires being fully opioid-free first but contains no opioid at all, which some patients and professions prefer. Dr. Agresti matches the medication to your situation in the initial evaluation.
Yes. A common path is Suboxone first, then Sublocade once stable. Switching to Vivitrol requires a carefully managed 7–14 day opioid-free window, which Dr. Agresti supervises as an outpatient. Switching is a clinical decision, not a failure.
Usually not. Suboxone can be started at home under physician guidance, and Dr. Agresti runs outpatient detox and MAT induction from his Palm Beach office and by telehealth across Florida. Vivitrol requires completing detox first, which can also be done as an outpatient in most cases.
Both injectables are expensive at list price, but manufacturer copay-assistance programs and PPO plans frequently cover a large portion. The practice provides superbills and prior-authorization documentation; the medications themselves are typically billed through your pharmacy benefit.