Methadone and buprenorphine/naloxone (Suboxone) are evidence-based treatments for opioid use disorder. Opioid use disorder is the clinical term for addiction to opioids (which includes drugs like fentanyl, heroin, oxycodone, Percocet, and Vicodin).
ethadone has been in use for over 50 years to treat opioid use disorder, but it is only available for patients with opioid use disorder when it’s prescribed in specialized Opioid Treatment Centers (aka “methadone clinics”). Buprenorphine/naloxone (Suboxone) is a more modern medication that is more easily available in outpatient clinics, like primary care centers or psychiatry offices.
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 as components 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 a better fit for you or a loved one.
How do Suboxone and Methadone Work?
Suboxone and methadone are both important medications in the treatment of opioid use disorder.
They are both long-lasting medicines that bind to opioid receptors in the brain, easing cravings and withdrawal symptoms, and preventing relapse. This allows the person taking these medications to feel more physically and emotionally stable. It also helps people benefit from services offered in addiction rehabilitation programs such as counseling.
However, there are important differences between these two medications. These might influence which your doctor may recommend as best for your individual treatment.
Suboxone is a brand name for a medicine that contains combination of buprenorphine and naloxone. Methadone is the generic name for the medication, methadone, itself. Methadone and buprenorphine are comparable in their chemical action, in that they both bind to opioid receptors and activate them. The pharmacological effect of naloxone is quite different, though.
By itself, naloxone is an opioid antagonist that quickly binds to opioid receptors in the brain to kick opioids off. It is prescribed as a single-component medication to reverse the effects of opioids, for example when someone takes too much, and prevents opioid overdoses long enough for the person to get complete medical treatment. This can be lifesaving, as opioid overdoses are often fatal. When combined with buprenorphine in Suboxone, however, naloxone prevents tampering with or misuse of the medication by stopping buprenorphine from activating the opioid receptor if it is administered in any way other than the way it is prescribed: as a sublingual drug.
Similarities Between Suboxone and Methadone
These are similarities between methadone and buprenorphine:
- Both medications are in the opioid family.
- Both bind to opioid receptors in the brain.
- Both have analgesic functions, so they ease pain.
- Both are safe to take for months or years with counseling and supervision.
- Both remain in the body for several hours, with metabolites lasting longer than 30 hours.
- Both drugs work well to ease withdrawal symptoms in people overcoming opioid use disorder.
Differences Between Suboxone and Methadone
There are also many important differences between buprenorphine and methadone, making buprenorphine the preference for many physicians treating people with OUD.
The biggest difference is methadone is a full opioid agonist, while buprenorphine is a partial opioid agonist. Although they both bind to opioid receptors in the brain for a long time, buprenorphine is less abusable. The full agonist effect of methadone gives it a higher risk of causing overdose and death than buprenorphine. Buprenorphine has a ceiling effect, such that as the dose goes up, at a certain point, dose increases do not have stronger agonist effects on the opioid receptor. This renders it much safer from the overdose perspective.
This full opioid agonist has been used to treat addiction to heroin, opium, and other opioids in the United States since the 1950s. Methadone is approved by the U.S. Food and Drug Administration (FDA) for OUD treatment and for long-lasting pain relief for certain chronic pain conditions.
Although it is a Medication for Addiction Treatment (MAT), methadone is an opioid, like heroin or oxycodone, so the drug can also be habit-forming. It is tightly regulated by the Drug Enforcement Administration (DEA).
Since it is a potent opioid, methadone is only dispensed by programs certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). People prescribed methadone for OUD must go to a clinic and take their dose under a clinician’s supervision until they have reached a stable point in treatment and can safely take medication home.
Methadone was one of the first medical treatments for OUD, but it is also sometimes a drug of abuse. Although it is still occasionally prescribed, it is no longer the preferred MAT for opioid addiction.
This approach to MAT for opioid addiction was approved by the FDA in 2002. While buprenorphine binds to opioid receptors in the brain for a long time, like methadone, it is a partial opioid agonist rather than a full opioid agonist. This means it can alleviate pain and withdrawal symptoms, but it has a much lower risk of causing overdose. Its activity at the opioid receptor is weaker, and therefore it causes less intoxication and euphoria, too.
Since it is considered a safer medication for most people, buprenorphine can be prescribed by physicians in an outpatient setting, which has greatly improved access to MAT and rehabilitation for American adults. It is also increasingly being used as a treatment for chronic pain. Although coming off of buprenorphine suddenly can cause someone to experience opioid withdrawal symptoms, it tends not to trigger the same kinds of compulsive behaviors that stronger opioids do, mainly because it is not as euphoria-inducing.
Your physician will likely prescribe Suboxone first and monitor your experience of withdrawal symptoms. Most people experience relief within a day of their first doses of buprenorphine, but if Suboxone cannot manage this experience, you may be prescribed methadone treatment instead.
Suboxone vs Methadone: How do I take it?
Methadone and Suboxone are taken in different ways.
There are several ways you can take methadone, including as a liquid solution and a tablet. For MAT, a clinician will dispense the dose to you and watch you take it, usually once a day.
One dose typically lasts 12 to 24 hours, released slowly through your digestive system. Since methadone is taken orally, it needs up to an hour to take full effect in the bloodstream.
While there are pill/tablet versions of Suboxone, the most common prescription version is a sublingual film strip. You may also receive a buccal film strip, which is dissolved in the cheek.
Suboxone dissolves through the mucous membranes in your mouth to rapidly enter the bloodstream. This typically takes less than 15 minutes.
It is recommended that you do not eat, drink, or smoke cigarettes for 15 minutes before and after you take your dose of Suboxone, as this can interfere with buprenorphine’s release into your brain. However, if you need to rinse your mouth with water to help the strip dissolve or to alleviate some bad taste after it dissolves, this is safe.
Only take these medications as prescribed by your physician. It is important to keep both medications away from others.
Comparing Suboxone and Methadone
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.