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Methadone Vs Suboxone: Which Is Better For Treating Opioid Addiction?

Dr. Richard Foster, LICDC-CS

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 8, 2019

Methadone and suboxone are two different medications used for the treatment of heroin and opioid addiction. While these drugs accomplish the same goal, they do have slight differences that can influence an individual’s recovery. Knowing the differences between these two medications can help you make the right choice for your recovery needs.

The Opiate And Heroin Epidemic

In this day and age, the global abuse of opioids such as heroin, morphine, and prescription pain relievers are on the rise. The devastation from these addictions is seeping into the health, social environment, and economics all over the world. Between 26.4 and 36 million people are estimated to abuse opioids on a worldwide scale.

According to the National Institute on Drug Abuse, in the United States, an estimated 2.1 million individuals suffer from substance use disorders relating to prescription opioid pain relievers, with a further 467,000 estimated to be addicted to heroin. The increasing number of accidental overdose deaths from prescription pain relievers has skyrocketed in the United States since 1999.

A growing connection between the non-medical use of opioid pain relievers and heroin abuse is evident within the United States as well. Prescriptions for opioid pain relievers has gone through the roof in the last 25 years. By 2002, opioid analgesic poisoning was listed as a cause of death in numbers greater than heroin or cocaine. The all too common transition, for those who used prescription opioids, especially in younger people, is to switch to heroin. In many cases, heroin has become a more accessible and cheaper drug of choice, two things that are thought to contribute to its growing abuse and addiction.

Is There Help?

Numerous treatment options exist across the U.S. that provide addicted individuals with access to evidence-based treatment options. Oftentimes, these programs will employ medication-assisted treatment, which, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), “is the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose.”

This versatile treatment allows a person to overcome their addiction, by detoxing through the aid of medications that may alleviate or reduce the symptoms of withdrawal. This occurs by a person gradually being weaned off the drug of abuse, while being supported by the prescribed medication that, in the words of SAMHSA, “normalize body functions without the negative effects of the abused drug.” In some cases a person may require medications as part of a maintenance program to support them in their recovery.

Here, we discuss two types of medication used to treat opioid addiction, buprenorphine and methadone.

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What Is Buprenorphine?

Buprenorphine is an opioid partial agonist. This means, like opioids, it produces effects such as euphoria or respiratory depression, as noted by SAMHSA. However, unlike heroin or methadone, the effects of buprenorphine are weaker. Even after increased doses, buprenorphine levels off, giving it a contained effect, lowering the risk of misuse, dependency, and other side effects.

This drug is used to help deal with withdrawal symptoms when people cut out opioid drugs. Some of these withdrawal symptoms can be: depression, anxiety, cravings, nausea, diarrhea, muscle and joint pain, vomiting, muscle spasm, runny eyes and nose, sweating and problems sleeping.

Due to its long-lasting results, many patients do not have to take it on a daily basis. Because buprenorphine controls cravings and withdrawal symptoms without producing a high like a full opioid, it is used to help patients make better life choices, while balancing the brain’s neurochemistry. For those in recovery, having to only get a monthly prescription can save time, energy, and mental stress, and in some cases makes treatment more obtainable.

What is Suboxone? How Is It Different From Subutex?

While Suboxone contains two different medicines, buprenorphine and naloxone, Subutex only contains buprenorphine. Giving naloxone and buprenorphine in combination, as in Suboxone, can, in most cases, make it much easier to use the medicine in its correct way. The naloxone helps deter abuse by creating a safeguard against misuse and diversion. Taken properly and as prescribed, the naloxone helps to temper the withdrawal symptoms, however, if taken illicitly, by injection, it actually does the opposite, inducing opioid withdrawal symptoms.

Subutex, which doesn’t contain this added drug, may be better accepted by patients in their first few days of treatment for induction, thus it is often used as an introduction to buprenorphine. In this period of time, the patient would receive treatment under the doctor’s or addiction treatment facility’s supervision.

What Is Methadone?

Methadone dives into the parts of the nervous system in the brain, which responds to pain. It helps with the symptoms of opiate withdrawal and helps to deal with the euphoric effects that opiate drugs have on the body. With an average pain relief that lasts four to eight hours, methadone helps deal with the pain from opioid withdrawal, and also blocks the effects of certain opioid drugs, examples including morphine, heroin, oxycodone, and others.

The treatment with methadone should be a minimum of a twelve-month period. Methadone is a full agonist, which means it produces a full opioid effect, and most importantly, that it can be addictive. For these reasons, it must be used as prescribed to avoid addiction and dangerous side effects.

The dosage of this medication is fashioned for each individual patient. Due to this, is not to be exchanged or given to others. If mixed with other medications it can cause increased risk and side effects, including heart problems. Even when the effects of it fade away, it can remain in the body for a longer period of time. It can also cause respiratory depression, thus it requires monitoring, especially within the beginning of your treatment, or at any time your dose is altered.

Methadone is to be prescribed only as part of a treatment plan, which includes counseling and active participation in social support programs. After a time of consistency, patients may be allowed to take methadone home between their program visits. Methadone can only be dispensed, by law, through an opioid treatment program (OTP).

Methadone Vs Buprenorphine (Suboxone/Subutex)

Because of the ceiling effect, buprenorphine causes less respiratory depression than methadone and also has a lower risk of overdose. A cross-sectional study was done, and the mortality associated with buprenorphine was less than that with methadone usage. When used with other respiratory depressants, however, buprenorphine can create sedation, coma, or even death. If patients aren’t educated about the pharmacology of buprenorphine and use additional opioids, they are at a greater risk when the effects of buprenorphine fade.

While given in different doses, buprenorphine was much less effective than methadone in keeping patients active within treatment, however, for the patients who remained, it was equal in effect to suppressing heroin usage. With low doses of methadone, patients were more likely to be retained in treatment, compared to low or medium doses of buprenorphine.

Studies found that buprenorphine was still equal to methadone in dealing with the severity of opioid withdrawal, but the symptoms would be settled faster, and there was evidence toward a quicker completion of treatment with methadone. Also, according to SAMHSA, buprenorphine may not be the best treatment choice for individuals “with high levels of physical dependency.” However, in many instances, depending on the specifics of a person’s needs, buprenorphine is an evidence-based treatment option that has great success.

Methadone can be more useful to patients who need help with structure, while buprenorphine is less stressful on the daily schedule of the patient. For some people, this may be one of the biggest concerns—methadone treatment requires daily visits to a clinic, while buprenorphine allows a person the option of receiving a prescription on a monthly basis. Additionally, a person may have an easier time finding access to buprenorphine, as it can be prescribed, and may be offered by a doctor, rehab facility, hospital, or other treatment settings.

Risk Of Addiction

Lastly, and perhaps most importantly, we have to consider the possibility of misuse and addiction. Though buprenorphine does have a limited opioid effect, and a potential for misuse, it is not nearly as great as the risk of addiction that occurs with methadone. Due to the full opioid effects of the latter drug, there are also greater health risks and dangers associated with this form of treatment.

It is important to note that a person can switch from methadone to buprenorphine, however, as noted by SAMHSA, they may not be pleased with the results because of the medication’s significantly different properties. Inversely, a patient may be able to switch from buprenorphine to methadone.

It is important to remember that every person is different, and due to their unique physiology and other health and medical needs, treatment options will vary person-to-person. For this reason, a decision about medication-assisted treatment, including switching from one type of medication to another, should only be made under the guidance and supervision of a highly trained addictions specialist.

Let Us Help You Find Treatment Options

Don’t let an opioid addiction take over your life. Our staff is standing by to answer any questions you might have about drug abuse, addiction, or treatment. We understand that there is a lot of information to consider, and that’s why we’re here. Contact us at today to learn more about Suboxone and methadone.

Substance Abuse and Mental Health Services Administration - Buprenorphine

Substance Abuse and Mental Health Services Administration - Methadone

MedlinePlus - Methadone

National Institute on Drug Abuse - America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

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