How to Get Prescribed Naltrexone
Naltrexone is a prescription medication used to treat alcohol use disorder and opioid use disorder. If you are wondering whether it is right for you and how to actually get a prescription, the process starts with a clinical evaluation from a licensed prescriber, most often a psychiatrist or addiction medicine specialist.
What Is Naltrexone and How Does It Work?
Naltrexone is an opioid antagonist, meaning it blocks opioid receptors in the brain without activating them. That mechanism is what makes it effective for two very different conditions. For people with opioid use disorder, it removes the rewarding effect of opioids, which reduces the drive to use. For people with alcohol use disorder, it disrupts the reinforcing effects of alcohol by blocking endorphin release triggered by drinking.
It is not a controlled substance. It has no potential for abuse or physical dependence. That distinction matters because it means naltrexone can be prescribed by any licensed physician, psychiatrist, or nurse practitioner without the special DEA waiver that was historically required for buprenorphine.
According to the Substance Abuse and Mental Health Services Administration, naltrexone is one of three FDA-approved medications for alcohol use disorder and is also approved for opioid use disorder under the brand name Vivitrol when administered as a monthly injectable.
Naltrexone Forms: Oral vs. Injectable
There are two forms currently in clinical use:
Oral naltrexone (ReVia, Depade) is a daily tablet, typically 50 mg. It is low-cost, widely available in generic form, and easy to adjust. The challenge is adherence. Patients who are ambivalent about treatment may simply stop taking it.
Extended-release injectable naltrexone (Vivitrol) is administered once a month by a clinician. Because adherence is built into the delivery method, outcomes data for Vivitrol in opioid use disorder are generally stronger than for oral naltrexone in real-world settings. The tradeoff is cost and the requirement to come in monthly for the injection.
Your prescriber will discuss which form makes more sense based on your history, living situation, and goals. Neither form is inherently better. The right one depends on what you will actually use consistently.
Who Can Be Prescribed Naltrexone
Naltrexone is appropriate for adults diagnosed with alcohol use disorder or opioid use disorder who meet certain clinical criteria. Before prescribing, your clinician will review several factors:
For opioid use disorder: You must be fully opioid-free before starting naltrexone, typically for 7 to 10 days for short-acting opioids and 10 to 14 days for methadone or other long-acting opioids. Starting naltrexone while opioids are still in your system will trigger precipitated withdrawal, which is severe and rapid-onset. A urine drug screen and sometimes a naloxone challenge test are used to confirm opioid-free status before the first dose.
For alcohol use disorder: Abstinence before starting is not required in the same way. Many clinicians initiate naltrexone while a patient is still drinking, because the medication itself helps reduce craving and reinforcement. However, active liver disease is a contraindication. A baseline liver function panel is standard before prescribing.
Naltrexone is not appropriate for patients currently using opioids for pain management, patients with acute hepatitis or liver failure, or patients with known hypersensitivity to the drug.
The Prescribing Process: What to Expect
Getting prescribed naltrexone follows a straightforward clinical path. Here is what typically happens:
Step 1: Initial psychiatric or medical evaluation. Your first appointment with a psychiatrist will run approximately 45 to 60 minutes. You will discuss your history with substance use, any prior treatment attempts, your current medical status, and what you are hoping to achieve. The clinician is not there to judge your history. That appointment is diagnostic and relational. Its purpose is to understand your full picture before recommending any medication.
Step 2: Lab work. A liver function panel is required before prescribing. For opioid use disorder, a urine drug screen is also standard. These can often be ordered at the first visit and completed before your follow-up.
Step 3: Prescription or injection. Once labs are reviewed and clinical criteria are met, naltrexone can be prescribed at or shortly after your first appointment. Oral naltrexone can be called in to a pharmacy the same day. Injectable Vivitrol requires an in-clinic visit for administration.
Medication alone is rarely the whole picture. Most prescribers will also discuss behavioral support, whether that is individual therapy, group programs, or structured outpatient treatment. For people with alcohol or opioid use disorder, combining medication with behavioral treatment produces better outcomes than either approach alone.
Does Naltrexone Require a Psychiatrist Specifically
No. Primary care physicians, internists, addiction medicine specialists, and psychiatric nurse practitioners can all prescribe naltrexone. A psychiatrist is often the right choice when co-occurring mental health conditions are part of the picture, which is common. Depression and anxiety frequently co-occur with alcohol use disorder. Trauma is highly prevalent in people with opioid use disorder. A psychiatrist can evaluate and treat both the substance use and the underlying psychiatric conditions simultaneously, which a primary care physician may not be positioned to do.
How Long Does Naltrexone Treatment Last
There is no fixed duration. Clinical guidelines from the American Society of Addiction Medicine recommend at least three to six months of treatment for opioid use disorder, with many patients continuing for a year or longer, depending on their progress and circumstances. For alcohol use disorder, duration is similarly individualized. Some patients use naltrexone for several months during a period of high risk. Others stay on it long-term as part of ongoing recovery maintenance.
Stopping naltrexone does not produce physical withdrawal. It is not physiologically addictive. However, stopping abruptly without a clinical plan can increase relapse risk, so any decision to discontinue should happen in conversation with your prescriber.
What If Naltrexone Does Not Work
It does not work equally well for everyone. Response rates vary, and some patients see minimal benefit from naltrexone while responding well to other medications. For alcohol use disorder, acamprosate (Campral) and disulfiram (Antabuse) are alternatives with different mechanisms. For opioid use disorder, buprenorphine/naloxone (Suboxone) and methadone are widely used alternatives, each with distinct clinical profiles and regulatory requirements.
Psychiatric treatment is iterative by nature. If the first medication does not produce the response you need, the next step is adjustment, not abandonment. Your prescriber will reassess dosing, timing, the form of naltrexone, and whether a different medication is a better fit.
Insurance Coverage and Cost
Oral naltrexone in generic form is inexpensive and widely covered by commercial insurance and Medicare. Injectable Vivitrol is significantly more expensive, often $1,000 to $1,500 per injection without insurance. Most major commercial plans cover Vivitrol when medically indicated, but prior authorization is often required. Aetna, Blue Shield, UHC, Cigna, Anthem, Medicare, and Medicare Advantage all cover naltrexone-related treatment to varying degrees. Confirming your specific coverage before your first appointment prevents billing surprises. Calling the member services number on your insurance card before your visit is the most reliable way to verify benefits.
Frequently Asked Questions
Do I need to be sober before starting naltrexone?
It depends on what you are being treated for. For opioid use disorder, being fully opioid-free is medically required before starting naltrexone. Starting while opioids are still in your system will trigger precipitated withdrawal, which is rapid and severe. For most short-acting opioids, a 7 to 10-day abstinence window is required. For alcohol use disorder, abstinence before starting is not required. Many clinicians initiate naltrexone while a patient is still actively drinking, as the medication works by reducing the rewarding effects of alcohol rather than requiring abstinence first.
Is naltrexone a controlled substance?
No. Naltrexone is not a controlled substance under federal law. It has no abuse potential and does not cause physical dependence. This means it can be prescribed by any licensed physician, psychiatrist, or nurse practitioner without a DEA waiver. It can be filled at any standard pharmacy. This distinguishes it from buprenorphine, which is a Schedule III controlled substance requiring specific prescriber certification to prescribe for addiction treatment.
What is the difference between oral naltrexone and Vivitrol?
Oral naltrexone (sold under the brand names ReVia and Depade) is a daily tablet, typically 50 mg. It is inexpensive in generic form and flexible to adjust. The main challenge is daily adherence, which is difficult for many patients in early recovery. Vivitrol is an extended-release injectable formulation administered once per month in a clinical setting. Because adherence is guaranteed for a full month, outcomes data in real-world settings tend to favor Vivitrol for opioid use disorder. The tradeoff is cost and the need for monthly in-person injections. The right choice depends on your specific circumstances, and your prescriber will help you weigh them.
Will my employer or family find out I am taking naltrexone?
No. Your psychiatric and medical records are protected under HIPAA. Employers do not have access to your prescription records or treatment history without your written consent. Your prescriber cannot share information about your diagnosis or medications with family members, your employer, or any third party without your explicit authorization. The only exceptions to confidentiality under HIPAA involve imminent safety concerns or specific legal obligations, and those situations are rare and narrow. Treatment for addiction and psychiatric conditions receives the same legal protection as any other medical care.
Can naltrexone be prescribed via telehealth?
Yes. Naltrexone can be prescribed through a telehealth appointment. Because it is not a controlled substance, no federal restrictions limit prescribing to in-person visits. A clinician can conduct the initial evaluation remotely, order labs at a local facility, review results, and send the prescription to your pharmacy electronically. For injectable Vivitrol, the evaluation can occur via telehealth, but the injection itself requires an in-person visit at a clinical site. Telehealth prescribing for naltrexone is available to any California resident, not just patients in the Los Angeles area.
How long before naltrexone starts working?
Oral naltrexone reaches effective blood levels within one to two hours of the first dose. For alcohol use disorder, many patients notice reduced craving and blunted reward from drinking within the first week. For opioid use disorder, the opioid-blocking effect is active from the first dose. Injectable Vivitrol reaches peak plasma concentration over several days following the injection and maintains effective levels for the full 30-day cycle. The full clinical benefit, meaning sustained reduction in use and improved functioning, typically becomes clearer over the first four to eight weeks of consistent treatment.
What are the most common side effects of naltrexone?
The most commonly reported side effects of oral naltrexone include nausea, headache, fatigue, decreased appetite, and sleep disturbance. Nausea is the most frequent complaint and tends to be worse in the first few days. Taking naltrexone with food often reduces this. Injectable Vivitrol shares most of the same systemic side effects and also carries a risk of injection site reactions, including pain, bruising, and, in rare cases, more serious tissue reactions. Naltrexone can cause liver enzyme elevations at high doses, which is why baseline liver function testing is standard before prescribing. Your prescriber will monitor liver function periodically during treatment.
Do I need a psychiatrist, or can my primary care doctor prescribe naltrexone?
Primary care physicians can and do prescribe naltrexone. If substance use is your only concern and you have no co-occurring mental health conditions, a primary care provider may be well-positioned to manage your treatment. A psychiatrist becomes the right choice when depression, anxiety, trauma, or another psychiatric condition is also present, which is common in people with alcohol or opioid use disorder. A psychiatrist can evaluate, diagnose, and treat both conditions simultaneously, which often produces better outcomes than treating them separately. If you are uncertain which type of provider is most appropriate, a psychiatric evaluation is a useful starting point.
PsychBright Health offers psychiatric evaluations and naltrexone prescribing for adults with alcohol and opioid use disorder, with telehealth appointments available to any California resident and same-week availability within 5 business days. If you are ready to explore whether naltrexone is appropriate for you, request an appointment online or call (213) 584-2331.