When discharging a client on Vivitrol, if their UDS is positive for benzodiazepines and opioids, should you start Vivitrol?

• A. Yes, proceed with Vivitrol
• B. Yes, but only if LFTs are normal
• C. No, because UDS is positive for benzos and opioids
• D. No, because Vivitrol cannot be used in patients with any history of opioid use

Answer: (C)

Starting Vivitrol requires that the patient be opioid-free. Naltrexone blocks opioid receptors, so if opioids are still present in the body, administering it will precipitate withdrawal and derail treatment.

If the urine drug screen shows opioids, you should not start Vivitrol at discharge. You need to complete opioid detox and confirm a negative opioid screen (and usually after an appropriate observation period) before considering initiation. The presence of benzodiazepines on its own isn’t a formal contraindication, but concurrent opioid use signals ongoing dependence and increases risk if Vivitrol is started now.

So the safest course is to withhold starting Vivitrol until there is clear opioid abstinence demonstrated by a negative UDS for opioids, preventing precipitated withdrawal and improving the chance of successful treatment.