Buprenorphine as Adjunct to Outpatient Induction Onto Vivitrol

Inclusion Criteria: 1. Age 18-60. 2. Meets DSM-5 criteria for current opioid use disorder (moderate-severe) of at least six months duration, supported by urine toxicology OR COWS score \> or =6 OR Naloxone Challenge. 3. Voluntarily seeking treatment for opioid dependence. 4. In otherwise good health based on complete medical history and physical examination within normal ranges (AST or ALT \< 3 times normal). ) 5. Able to give written informed consent. Exclusion Criteria: 1. Methadone maintenance treatment or regular use of illicit methadone (\> 30 mg per week). 2. Maintenance on, or regular use of buprenorphine or other long-acting narcotic agonists. 3. Pregnancy, lactation, or failure in a sexually active woman to use adequate contraceptive methods. 4. Active medical illness which might make participation hazardous, such as untreated hypertension, acute hepatitis with AST or ALT \> 3 times normal, AIDS (CD4 count under 200 currently or medically ill with an opportunistic infection), unstable diabetes. 5. Active psychiatric disorder which might interfere with participation or make participation hazardous, including DSM-5 Schizophrenia or any psychotic disorder, severe Major Depressive Disorder, or suicide risk or 1 or more suicide attempts within the past year. 6. Physiologically dependent on alcohol or sedative- hypnotics with impending withdrawal. Other substance use diagnoses are not exclusionary. 7. History of allergic or adverse reaction to buprenorphine, naltrexone, naloxone, clonidine, or clonazepam. 8. Chronic organic mental disorder (e.g. AIDS (CD4 count under 200 currently or medically ill with an opportunistic infection) dementia). 9. History of accidental drug overdose in the last 3 years as defined as an episode of opioid-induced unconsciousness or incapacitation, whether or not medical treatment was sought or received. 10. Painful medical condition that requires ongoing opioid analgesia or anticipated surgery necessitating opioid medications.