How to Help Your Patients Find Naltrexone in Stock: A Provider's Guide

The naltrexone tablet shortage is creating a practical burden on clinical practices. Patients are calling your office when they can't find their medication. Front desk and care coordination staff are fielding calls from frustrated patients. And in the worst cases, patients are going days or weeks without their medication — risking the recovery they've worked hard to maintain.

This guide is for clinical teams: physicians, nurse practitioners, physician assistants, care coordinators, and medical assistants who are helping patients navigate the shortage. It provides concrete, actionable steps your practice can take to minimize disruptions to your patients' naltrexone treatment.

Why Patients Are Having Trouble Filling Naltrexone

Multiple generic manufacturers have either discontinued naltrexone 50 mg tablets or are producing at reduced capacity. The shortage is driven by DEA quotas on thebaine (the precursor compound), surging demand for addiction treatment medications, and low profit margins that discourage manufacturers from investing in expanded production.

The practical result: pharmacy-to-pharmacy availability is highly variable. A pharmacy that had naltrexone last week may not have it this week. Patients who call one chain pharmacy and hear "out of stock" often assume it's unavailable everywhere — which is not true.

Practice-Level Strategies to Protect Your Patients

1. Prescribe 90-Day Supplies When Possible

For stable patients, 90-day prescriptions reduce the frequency of potential supply disruptions. Check which of your payers allow 90-day fills for naltrexone. Many commercial plans and Medicare Part D plans allow 90-day fills, especially through mail-order pharmacies. Medicaid rules vary by state.

2. Educate Patients to Request Early Refills

Many patients wait until they have 1-3 days of medication left before trying to fill their prescription. During a shortage, that's not enough lead time. Counsel your naltrexone patients to:

Request refills when they have 10-14 days of medication remaining

Not rely on a single pharmacy — know which nearby pharmacies are backup options

Call your office before running out rather than after — so the care team can help find alternatives

3. Build a Local Pharmacy Resource List

Have your care coordination team identify which pharmacies in your service area currently and reliably stock naltrexone. This may require a round of calls once a month. Include:

Independent pharmacies (often more agile in sourcing from multiple wholesalers)

Grocery chain pharmacies (Kroger, Publix, HEB, Safeway, etc.)

Warehouse club pharmacies (Costco, Sam's Club)

Mail-order pharmacies for patients on stable long-term treatment

4. Use medfinder to Locate Stock Efficiently

Rather than having your staff spend time calling pharmacies, refer patients to medfinder.com/providers. medfinder calls pharmacies in the patient's area, checks whether naltrexone is in stock, and texts the patient the results — freeing your staff from this time-consuming task.

5. Prepare a Prior Authorization Strategy for Vivitrol

Vivitrol (naltrexone ER injectable 380 mg) is not in shortage and is a clinically appropriate option for suitable patients. However, many commercial plans require prior authorization for Vivitrol. Consider pre-authorizing Vivitrol for patients on oral naltrexone who:

Have experienced prior supply disruptions

Have adherence challenges with daily oral dosing

Are highly motivated OUD patients who would benefit from monthly rather than daily treatment

The Alkermes Vivitrol2gether savings program ensures that 9 out of 10 commercially insured patients pay under $5 per injection — removing the cost concern for most eligible patients.

6. Know When and How to Switch Medications

If naltrexone becomes genuinely unavailable for a specific patient, have a clear protocol for transitioning:

AUD patients: Acamprosate (Campral) 333 mg TID is a first-line alternative, especially for patients with liver disease. Disulfiram (Antabuse) is appropriate for highly motivated patients with a strong support structure. Both require a new prescription.

OUD patients: Buprenorphine/naloxone (Suboxone) is now prescribable by any DEA-licensed Schedule III prescriber without special waiver (since the 2022 MAT Act). Patients transitioning from naltrexone to buprenorphine should have documented opioid abstinence within the preceding 7-14 days, but can start buprenorphine once naltrexone has cleared their system. Transition planning should account for timing to avoid precipitated withdrawal.

7. Communicate the Relapse Risk Clearly

Every patient on naltrexone for OUD should be counseled about the risk of fatal opioid overdose if they relapse after discontinuing the medication. Reduced opioid tolerance following naltrexone use is a documented FDA warning. Ensure patients understand:

Opioid doses they previously tolerated may now cause overdose

They should have naloxone (Narcan) accessible at home

They should contact you immediately if they are forced to stop naltrexone due to the shortage

Resources for Patients

Refer patients to medfinder.com to find which pharmacies near them have naltrexone in stock. This can save significant time for both your staff and your patients during the shortage.

Also see our companion post: Naltrexone Shortage: What Providers and Prescribers Need to Know in 2026 for a deeper clinical overview.