Methadone and buprenorphine/naloxone (Suboxone) are evidence-based treatments for opioid use disorder-- an addiction to opioids (such as fentanyl, heroin, oxycodone, percocet, and vicodin).
Methadone has been in use for over 50 years to treat opioid use disorder, but is only available in specialized Opioid Treatment Centers (aka “methadone clinics”) whereas buprenorphine/naloxone (Suboxone) is a more modern medication that is more easily available in outpatient clinics, such as your primary care or psychiatrist’s office.
When taken as prescribed, both are considered safe and effective, helping patients achieve and sustain long-term recovery and reclaim active and meaningful lives.
Both should be considered part of a comprehensive treatment program that may include behavioral therapy and other other supplemental treatments (such as 12-step meetings like AA/NA, Smart Recovery, getting a sponsor, spirituality, and self-care).
We've compiled all you need to know about Methadone and buprenorphine/naloxone (Suboxone) to determine which medication might be right for you or a loved one.
Buprenorphine/naloxone (Suboxone) and Methadone are both characterized as opioids though work in different ways.
Imagine your brain is covered in opioid receptors. For a person without an opioid addiction, these receptors are used to being empty most of the time (there are NO opioids on the brain’s receptors). For a person with an addiction, these receptors are used to being completely filled-- with fentanyl, heroin, oxycodone, percocets, vicodin or other opioids. If a person runs out of opioids, the receptors that are used to being occupied instead go empty and the person feels awful withdrawal symptoms (like having the flu! Sweating, nose running, body aches, chills).
Buprenorphine/naloxone (Suboxone) and methadone bind to these opioid receptors so people do not feel withdrawal symptoms. At the same time, they stimulate the opioid receptors so a person does not have cravings. And, they block the opioid receptors from other opioids (like fentanyl and percocet) preventing relapse and overdose.
Thus, when taken appropriately, both medications should make a person feel NORMAL —not high, not in withdrawal, not having cravings— just normal, allowing a person to wake up and go about their day: go to work, take care of their kids, reconnect with friends, take care of their health, pay their bills, etc.
Both have common side effects associated with all opioids. These include: constipation, nausea/vomiting, sweating, itching, and sexual problems, like premature ejaculation, erectile dysfunction and decreased libido.
While both work to relieve cravings and withdrawals and prevent overdose, Methadone and buprenorphine/naloxone (Suboxone) work differently:
Methadone is a full-agonist opioid. This means that when it binds to the opioid receptor, it FULLY STIMULATES it, just like fentanyl or oxycodone would. The more a person takes, the more the opioid receptor is stimulated. This means that higher and higher doses can cause a “high” or euphoria. And, since we all have opioid receptors in our lungs as well, taking too much can cause respiratory (lung) depression and overdose and death.
Methadone clinics work to find the right dose that makes someone feel normal (blocking all the opioid receptors to minimize cravings and withdrawal) without giving too much to produce a euphoria or overdose.
As you can imagine, because methadone poses the risk of overdose, it is HIGHLY regulated and must be directly dispensed from a specialty clinic.
Buprenorphine/naloxone (Suboxone), on the other hand, is a partial-agonist opioid. It contains buprenorphine (the active opioid component) and naltrexone (which is not absorbed by the body but prevents misuse of the medication). When buprenorphine/naloxone (Suboxone) binds to the opioid receptor, it PARTIALLY STIMULATES it, enough so the person does not feel cravings or withdrawal symptoms. But, it also has a CEILING effect, meaning that taking more and more does NOT produce a “high” or euphoria AND it is very difficult for a person to overdose on Suboxone. So, it is considered VERY safe.
Buprenorphine/naloxone (Suboxone) is available as a tablet or film and dissolves under the tongue. We like to tell our patients to remember the “Rule of 15”- no smoking, eating, or drinking for 15 minutes before taking; let it dissolve under your tongue for at least 15 minutes; no smoking, eating or drinking for 15 minutes after taking it. It is usually well tolerated.
Methadone is taken orally as a liquid, powder, or in diskettes formulations.
For more information on buprenorphine/naloxone (Suboxone) & Methadone visit the SAMSHA (Substance Abuse and Mental Health Services Administration) website:
At Bicycle Health, we prescribe buprenorphine/naloxone (Suboxone) to our patients through telemedicine appointments. Our team of providers, health coaches, and staff is here to help you get started to achieve and sustain long-term recovery.
Bicycle Health’s Chief Medical Officer, Dr. Brian Clear, explains “For patients experiencing problems from opioid use, our goal is to provide same-day access to assessment and the best available treatment. For most patients, this means providing buprenorphine which is the same well-established treatment any specialty office-based practice would provide. What makes us different is that we offer it in the most timely and accessible way possible. Patients appreciate that and benefit from it tremendously.”
To learn more about the success rates and safety of Bicycle Health’s telemedicine buprenorphine/naloxone (Suboxone) treatment, call us at (844) 943-2514 or schedule an appointment here.
Header image by Josh Estey under a Creative Commons Attribution 2.0 Generic license.