Pharmacotherapies for opiate dependence first involve detoxification from physical dependence on opiates and then maintenance of that abstinent state. There are now three agents of distinct pharmacological classes available to achieve both phases: the opiate agonist methadone, the partial opioid agonist buprenorphine, and the opioid antagonist naltrexone. This chapter reviews the role of naltrexone in current opiate detoxification strategies and its use in long-term maintenance of sobriety from opiates.