Subutex vs. Methadone: What Are the Differences?

Subutex was taken off the market in 2011, but newer formulations of its active ingredient, “Buprenorphine”, are still used today.

Buprenorphine is a partial opioid agonist. Methadone is a full opioid agonist. When used as prescribed, both Buprenorphine and methadone can help combat opioid dependence as part of a wider treatment plan. Each medication has its own advantages and disadvantages.

What Is Buprenorphine?

Buprenorphine (also called Suboxone) is an FDA approved treatment for opioid use disorder (OUD). [1] Buprenorphine is a partial opioid agonist. It works by binding to opioid receptors in the brain that would otherwise be bound to other opioids that are being misused such as oxycodone or heroin/fentanyl. It binds to these receptors and prevents withdrawal symptoms and cravings for other opioids. This is the way in which it acts as a treatment for OUD. 

What Is Methadone?

Methadone is an opioid analgesic, a type of full opioid agonist. Like Suboxone, it is approved by the FDA for treatment of OUD. Similar to Suboxone, it also binds to opioid receptors in the brain and replaces the drug that the patient was misusing, preventing withdrawal symptoms and cravings. 

Key Differences Between Buprenorphine & Methadone

Buprenorphine and methadone share many similarities, but partial opioid agonists and full opioid agonists are also different in some key ways. These are some of these differences:

Dosing

While the induction and stabilization process can differ depending on a patient’s needs, patients are generally eventually stabilized at a dose of 2 mg to 24 mg of Buprenorphine. [3] The average dosage is 16 mg per day, but this may vary greatly between individuals.

Methadone treatments begin very carefully, with an initial daily dose that is generally between 20 mg and 30 mg. Dosing is then increased about 5 mg to 10 mg every few days to weeks. The average effective dose of methadone is between 60 mg and 120 mg a day, however some individuals may need even more than this, particularly in the new age of Fentanyl. [4]

Side Effects

Methadone and Buprenorphine are both opioids, and therefore they share a lot of common side effects. Because Suboxone is only a partial opioid agonists, some of its side effects may be more mild overall. Common side effects associated with buprenorphine and methadone include the following:

• Constipation
• Difficulty paying attention
• Dizziness
• Drowsiness
• Dry mouth
• Nausea
• Tooth decay
• Tremors
• Difficulty urinating
• Mood changes
• Stomach pain

In general, most patients do not feel significant side effects with these medications, especially once their body gets used to the new medications. In fact, most patients just report feeling “normal”, and without the cravings or withdrawal symptoms that they were experiencing when using opioids. That being said, if you do experience side effects with these medications that are severe or persistent, speak with your doctor, who can always adjust your dose. 

Pros & Cons of Buprenorphine 

One of the biggest benefits of buprenorphine is what is called a “ceiling effect,” where the effects of the drug largely caps out and doesn’t increase after a certain level of use.[5] This reduces its potential for misuse and the level of respiratory depression the drug can cause. A 2012 study concluded that buprenorphine was likely safer as an MAT than methadone for this reason. [5]

Another advantage to buprenorphine is that, unlike Methadone, it can be prescribed in an office based setting. Methadone unfortunately is only available through specially licensed Methadone clinics in the United States. 

Pros & Cons of Methadone

As a full opioid agonist, doctors have to be careful with Methadone. It has a high misuse potential if not used carefully and as prescribed. Because of its dangers, methadone is very closely regulated, which can complicate its prescription and availability. One of the more inconvenient and controversial aspects of methadone is that you can only get it from specially approved sites, called Methadone clinics, which a person will have to visit daily to get their doses.[6] Many argue that this is an unnecessary barrier to treatment, especially when similar rules aren’t applied to other prescription medications that also have misuse potential. However, currently this is the only mechanism by which Methadone is available in the US. 

Deciding Which Is Best for You

Neither methadone or buprenorphine is “better” in general. The question is which one is right for you. If you need more help deciding, your primary care doctor or other doctors specializing in addiction treatment can talk to you more thoroughly about your needs and which option seems like the best fit.