Why the timing is different
Naltrexone blocks opioid receptors. Given while an opioid is still active, it sets off sudden withdrawal, which the Vivitrol label says can be severe enough to need hospital care. SAMHSA's treatment guide TIP 63 says starting naltrexone requires at least 7 days without short-acting opioids and 10 to 14 days without long-acting ones, and that prescribers may require longer for people coming off buprenorphine or methadone. SAMHSA TIP 63, Medications for Opioid Use Disorder (2021).
The Vivitrol label recommends at least 7 to 10 days without any opioid before the first injection, and says people switching from buprenorphine or methadone may be vulnerable to precipitated withdrawal for as long as two weeks. When a doctor judges a faster switch necessary, the label says to monitor the patient closely in a medical setting where precipitated withdrawal can be managed. Vivitrol prescribing information, DailyMed.
Sedation programs make that switch quickly. The programs that describe their procedure give an opioid blocker, such as naloxone or naltrexone, while the patient is sedated, so that the withdrawal it sets off passes during sedation, and then start naltrexone. Advanced Rapid Detox, for example, says its Vivitrol injection can be given right after the procedure instead of after the usual 7 to 14 days.
Sublocade and other monthly injections
Monthly buprenorphine injections stay in the body far longer than daily Suboxone. The Sublocade label says that once levels have built up over 4 to 6 months, buprenorphine may be detectable in blood and urine for 12 months or longer after the last injection, and that people who stop should be watched for withdrawal for several months. Sublocade prescribing information, DailyMed. We found no program website that says how it handles patients on Sublocade or Brixadi, so ask before booking.
What each program's website says
Has separate pages for Suboxone and methadone. Says methadone patients do not need to lower their dose before coming, and that patients keep taking their medication until midnight before the procedure. Says its Vivitrol injection can be given right after the procedure. The methadone page gives 4 days; the Suboxone page gives 3 days in its title and 4 days in the text.
Sources: Suboxone page, Methadone page
Has pages for Suboxone, buprenorphine and methadone, and a guide on rapid detox from Suboxone or methadone. The guide says some patients may be advised to taper under medical guidance before the detox date, and gives a typical stay of 3 to 5 days. A cost article on its site says long-acting opioids can add $2,000 to $5,000 to the base price of sedation detox, without saying whether that applies to its own price.
Sources: Suboxone and methadone guide, Methadone page, Cost article
Lists methadone and buprenorphine (Suboxone) among the dependencies patients may be evaluated for. We found no statement on its site about preparing for the procedure if you take either.
Source: Procedure page
Says it treats methadone, Suboxone and Subutex, and that patients on any of the three must switch to a short-acting opioid before the procedure.
Source: Home page
Lists methadone and buprenorphine among the opioids ANR treats. Its Suboxone and methadone pages say many patients arrive while on their medication and that the team adjusts and stabilizes the dose before the procedure as needed. Its methadone page describes a hospital stay of about 36 hours, followed by 3 days of in-person follow-up.
Sources: Opioids treated, Suboxone page, Methadone page
What reviewers mention
In the reviews summarized on this site, reviewers of Advanced Rapid Detox and Rapid Drug Detox Center describe coming off Suboxone, and reviews of All Opiates Detox mention coming off methadone.
Questions to ask if you take Suboxone, Sublocade or methadone
- Do I need to switch, taper or keep my current dose before admission, and who supervises it? The programs differ on this.
- When should I take my last dose before the procedure?
- Does my dose change the length of stay or the price?
- If I am on Sublocade or Brixadi, how long after my last injection can I be treated?
- When do I get the first naltrexone, and in what form?
More in questions to ask before you pay a deposit and what each program says it costs. For 7-OH and kratom, see which programs treat them.
Tolerance to opioids drops after any detox. SAMHSA's TIP 63 notes that patients who complete medically supervised withdrawal are at risk of opioid overdose. ANR Clinic's pages ask patients not to change or stop medication on their own before treatment, and Advanced Rapid Detox asks patients to keep taking theirs until midnight before the procedure.