Comparing buprenorphine, methadone, and naltrexone

All three are FDA-approved medications for opioid use disorder. Which fits best depends on your situation — tap what matters most to you below.

"Isn't this just trading one addiction for another?" No. Taken as prescribed, these medications don't produce a high once you're stabilized, don't impair driving or work, and are associated with roughly halving the risk of overdose death compared to no medication. Physical dependence (needing the medication to avoid withdrawal) is not the same thing as addiction (compulsive use despite harm) — the same is true of many long-term medications for other chronic conditions.
What matters most to you right now?
Buprenorphine
Suboxone, Subutex, Sublocade, Brixadi
Dosing schedule
Daily film/tablet, or monthly (Sublocade) / weekly-monthly (Brixadi) injection
Starting requirements
Usually need to be in mild-to-moderate withdrawal first, to avoid precipitated withdrawal
Travel
Most flexible — many prescribers can do telehealth visits; daily film is easy to carry; injection forms remove daily dosing entirely
Where you get it
Primary care, telehealth, or addiction medicine — no daily clinic visit required
Pregnancy
Considered a standard-of-care option; used widely and studied in pregnancy
Missed dose
Missing a day is usually manageable due to its long half-life; talk to your provider if it happens repeatedly
Methadone
Dispensed through Opioid Treatment Programs (OTPs)
Dosing schedule
Daily liquid dose, typically at an OTP clinic (take-home doses possible over time with stability)
Starting requirements
Can often start without waiting for withdrawal to begin, under clinic supervision
Travel
Requires coordinating "guest dosing" at another clinic in advance, or carrying approved take-home doses — more planning needed
Where you get it
Federally licensed Opioid Treatment Program only — daily visits at first
Pregnancy
Long-standing standard-of-care option in pregnancy, closely monitored
Missed dose
Missing multiple days can lower your tolerance — clinics usually require reassessment before restarting the same dose
Naltrexone
Vivitrol (monthly injection), oral tablets
Dosing schedule
Monthly injection, or daily tablet (less commonly used due to adherence)
Starting requirements
Requires being fully opioid-free for about 7–10 days first — the hardest part for many people
Travel
Very travel-friendly once started — monthly injection means nothing to carry or schedule daily
Where you get it
Any prescriber; no daily or specialized clinic required
Pregnancy
Less studied in pregnancy than the other two; typically discussed carefully with an OB and addiction specialist together
Missed dose
A missed monthly injection means opioid tolerance may return — using opioids afterward at a previous dose can be dangerous
None of these is "stronger" or "weaker" than the others in a moral sense — the right one depends on your body, your schedule, and what's actually accessible where you live. A prescriber can help you weigh this against your specific situation. Generate questions to bring to that conversation →