The rates of opioid use in youth are rising. Long-acting injectable naltrexone (Vivitrol), a medication that blocks the effects of opioid drugs, has been shown to be effective for treatment of opioid dependence in adults. Vivitrol is an important option for individuals not wanting agonist treatment (e.g. buprenorphine, methadone). Vivitrol may be particularly appealing to youth who have difficulty reaching their opioid use goals with daily oral medications as it is a monthly injection and therefore eliminates the problem of daily medication non-adherence. Vivitrol may also be appealing to families as it reduces conflicts around issues of adherence and thus supports positive parenting. Whereas Vivitrol has been used clinically in minors, it has not been studied in a prospective outpatient trial. Starting naltrexone, however, can be challenging in opioid-dependent individuals because detoxification is required prior to treatment with this medication.There are no standard outpatient detoxification protocols for opioid-dependent youth. Therefore, more studies are needed to support broader and approved use of Vivitrol in this population.