Suboxone vs Methadone: The Differences, Similarities, and Which Could Be Best For You

September 28, 2020

Methadone and 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 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 Suboxone to determine which medication might be right for you or a loved one.

How do Suboxone and Methadone work?

Buprenorphine/naloxone (Suboxone) and Methadone are both characterized as opioids though work in different ways.

Brain with a receptor

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).

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. 

So what’s the difference between Methadone and Suboxone? 

While both work to relieve cravings and withdrawals and prevent overdose, Methadone and 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.

Suboxone (Buprenorphine-naloxone), 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 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.

Suboxone vs Methadone: How do I take it? 

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 Suboxone & Methadone visit the SAMSHA (Substance Abuse and Mental Health Services Administration)  website: 

Comparing Suboxone and Methadone

Suboxone Methadone
How it works in the brain Partial opioid agonist Full opioid agonist
How it helps with addiction to opioid Prevents cravings, withdrawals, and overdose Prevents cravings, withdrawals, and overdose
Safety profile Has ceiling effect; VERY difficult to overdose
Interacts with few other medications
No ceiling effect, risk of overdose if too much is taken
Interacts with several other medications
Must monitor heart rhythm with regular testing
Typical dose & formulation Suboxone (8 mg buprenorphine- 2 mg naloxone); most patients stabilize at 12-16 mg buprenorphine/ day (1.5-2 Suboxone tabs or films/day); can take up to 24 mg/day
taken sublingually: dissolves under tongue in ~15 minutes
60-120 mg/ day
taken orally: in liquid, powder and diskettes formulations
Time to reach maintenance (stable) dose Usually 1-2 days Doses start at 20 mg day, can increase dose every 2-5 days, takes ~ 2 weeks to reach maintenance dose
Where medication is obtained & taken Patients get a prescription from a DEA-waivered physician in ANY treatment setting (like other prescriptions) and can take the medicine in their home Patients must travel to a specialty clinics (Opioid Treatment Programs- aka “methadone clinics”) which are highly regulated by federal & state accreditation and take the medicine under supervision
Amount of Structure Usually requires weekly appointments, patients doing well may be spaced-out to bi-weekly or monthly appointments Usually requires daily visits; after months-years in recovery, patients meeting specific federal criteria can earn “take homes” and not have to come in as often
Does it help with pain? Yes, Suboxone is considered as strong as “taking a Vicodin” for pain relief. But that is not what it is being used for. Patients taking Suboxone to treat addiction may need additional non-opioid pain medications. Yes, methadone is a strong pain reliever. But that is not what it is being used for. Patients taking methadone to treat addiction may need additional non-opioid pain medications.
Safe in pregnancy Yes- considered first line treatment Yes- considered first line treatment
Other pearls Suboxone also binds to other receptors that boost your mood! So it works as a mild antidepressant.
How has COVID-19 changed things Patients can start Suboxone without an in-person visit While each program is different (and must seek state approval), patients are getting more “take homes” but they still CANNOT start methadone without an in-person visit

At Bicycle Health, we prescribe 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 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.

About the Author

Randi Sokol, MD, MPH, MMedEd

Randi Sokol, MD, MPH, MMedEd, is an Assistant Professor at the Tufts Family Medicine Residency Program and Instructor at Harvard Medical School. She is Board Certified in both Family Medicine and Addiction Medicine. She earned her B.A. at the University of Pennsylvania, her Medical Degree and Masters in Public Health from Tulane University, completed Family Medicine Residency at UC-Davis, and earned a Masters in Medical Education through the University of Dundee.

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