Suboxone and methadone are both evidence-based medications used in treatment for OUD. They share some similar properties as well as distinct differences.
Suboxone is generally easier to access and less harsh on the body than methadone. It is usually considered the gold standard for opioid use disorder treatment. However, there are some scenarios where an individual may benefit more from methadone over Suboxone.
Key Facts About Suboxone & Methadone
Some key facts to consider about Suboxone and methadone include the following:
- Either medication can significantly increase a person’s chances of remaining in treatment, with one study showing buprenorphine, the main component of Suboxone, increasing retention by 82%.
- Remaining in treatment is linked to a reduced risk of death from overdose, lowered risk of acquiring HIV and HCV, lower chance of being involved in crime, and a higher chance of employment.
- While both medications have controversial regulations making patient access more difficult, Suboxone is generally easier for professionals to prescribe and for patients to get.
While a variety of laws impact access to addiction treatment medications, the Drug Addiction Treatment Act of 2000 (DATA 2000) is one of the most relevant.
How Do These Medications Work?
Both of these medications act on the opioid receptors in the brain. These receptors are a key part of the brain’s reward system, and the way opioids interact with them is what causes the high opioids produce and what potentially causes drug dependence in users. Repeated opioid use causes the brain to adapt to that drug use and will cause a person to experience difficult withdrawal symptoms if they try to quit use.
Suboxone is a partial agonist opioid. It attaches to opioid receptors in the brain imperfectly, blocking them without producing the same type of euphoric high that the opioids people typically misuse can. It does produce some level of euphoria, but its misuse and addiction potential are limited.
Methadone is a full agonist opioid, the same class of drug as the opioids people generally misuse if addicted to opioids. It has a similar level of misuse and addiction potential as these drugs if not used as prescribed.
Despite this, it is still an evidence-based treatment. It attaches to opioid receptors in the brain and can suppress a person’s withdrawal symptoms and drug cravings without causing a debilitating high when used as prescribed.
Similarities Between Suboxone & Methadone
These medications both have a similar mechanism of action, although Suboxone is only a partial agonist and methadone is a full agonist. It may seem paradoxical to use opioids to treat opioid use disorder, but it’s important to understand these treatments are carefully controlled, whereas drug misuse isn’t. Both medications can greatly suppress drug cravings and withdrawal symptoms, allowing a person to regain control over their drug use.
Both medications have also been associated with some debate, as current regulations can sometimes limit patient access to these medications despite evidence showing they can reduce a person’s risk of drug overdose and improve their chance of addiction recovery.
Because they are opioids, they are technically narcotics, a class of drugs that has historically had significant stigma and fear surrounding it. While some of this fear is justified, it has proven problematic for people in recovery and the professionals who want to help them.
Differences Between Suboxone & Methadone
Methadone has more misuse and addiction potential than Suboxone. While the buprenorphine in Suboxone is considered to have a “ceiling effect,” where taking more of the drug after a certain point does not produce a meaningfully more intense high, methadone doesn’t have this property. If misused, methadone will cause the type of high typically associated with more commonly misused opioids.
Access to methadone is also more limited. Because it is a full agonist, methadone has been the subject of some regulatory fears. It is actually one of the most tightly regulated medications still accepted as having legitimate, proven medical value.
Patients can generally only receive methadone at special administration sites, where they will take the medication on site. This can be inconvenient for many patients in recovery, and it is arguably one of its most significant downsides at this time.
Medication Side Effects
Suboxone can cause a number of side effects, including these:
- Back pain
- Blurred vision
- Difficulty falling asleep or staying asleep
- Mouth numbness or redness
- Stomach pain
- Tongue pain
Methadone can also cause similar side effects, including these:
- Difficulty falling asleep or staying asleep
- Problems urinating
- Dry mouth
- Mood changes
- Sore tongue
- Stomach pain
- Vision problems
- Weight gain
In either case, these side effects generally shouldn’t be too severe or long lasting. If they don’t go away, or they begin to seriously impact your quality of life, make sure to talk with a doctor.
As long as a prescriber avoids giving a patient too low a dose for these medications to be effective, both drugs have been shown to be equally effective at reducing opioid misuse, with a review showing this using both the results of drug testing and self-reported heroin use. This wasn’t true of a placebo.
The medications both significantly improve patient outcomes in relevant addiction recovery programs. They are considered quality, evidence-based treatments by most experts.
Suboxone vs. Methadone: How Do I Take It?
Both these medications are taken orally, although there are medications similar to Suboxone that are taken via different routes. Suboxone and methadone are generally taken once a day, although the specific doses you take and how often you take it should be left up to your doctor.
You should never break from your prescribed dosing regimen without first talking to your doctor.
Comparing Costs & Insurance Coverage
A 2009 study found that buprenorphine treatments tended to not be more expensive than methadone treatments despite buprenorphine costing more overall. That same study also recommended buprenorphine over methadone for more adherent patients (meaning patients not at significant risk of intentionally breaking from their prescribed treatment).
This study examined treatments dispensed by the U.S. Veterans Health Administration (VHA), and noted “[a]n analysis that controlled for age and diagnosis found that the mean cost of care for the 6 months after treatment initiation was $11,597 for buprenorphine and $14,921 for methadone[.]” Of note is that the cost is from 2005, and the cost of treatment is generally not paid in full by the patient (since their insurance will likely cover much of their costs).
The National Institute on Drug Abuse seems to support these findings, although the actual costs quoted are significantly lower. They note the cost of methadone treatment (assuming daily visits) to be about $126 per week or $6,552 per year. Buprenorphine for a stable patient, including medication and twice-weekly visits is quoted at $115 per week or $5,980 per year. According to their article, these figures were last checked in December 2021.
Do These Drugs Produce Withdrawal Symptoms?
Both buprenorphine and methadone can cause physical dependence with repeated use. Once the brain has adapted to their use, you will experience withdrawal if you suddenly stop taking your medication. This is why it is important to talk with a doctor if you want to stop taking your medication, so they can help you avoid severe withdrawal.
Both medications have similar withdrawal symptoms due to their similar mechanism of action. Suboxone withdrawal is associated with hot or cold flushes, agitation, watery eyes, runny nose, perspiration, chills, muscle aches, diarrhea, vomiting, and other intestinal issues.
Methadone withdrawal is similar, although it will generally be more severe. It is associated with edginess, watery eyes, yawning, perspiration, back pain, runny nose, chills, muscle aches, expanded pupils (black circles in the middle of the eyes), petulance, anxiety, joint pain, stomach spasms, weakness, problems falling asleep or remaining asleep, decreased appetite, vomiting, nausea, or diarrhea.
Withdrawal from methadone is literally withdrawal from the same type of drugs people addicted to opioids tend to misuse. Still, it will usually be less severe, as prescribed methadone use won’t generally be as heavy as a person’s intentional drug misuse.
Both Suboxone and methadone should not be taken with a number of different drugs. You should always talk to a doctor before mixing either prescription medication with additional drug use, whether that drug use is for medical or recreational purposes.
Always be honest about the drugs you’re taking when talking to a doctor. This information is important, so they can make an informed decision about what to prescribe you. Both methadone and Suboxone can interact unsafely with some medications as well as modify the effectiveness of others.
Notably, neither drug should be taken with any medication that can cause respiratory depression — at least without a doctor’s permission and talking to them about the risks involved. This includes alcohol, which, despite its wide availability and legal nature, can actually be fairly dangerous to mix with many different prescription medications.
Benzodiazepines are another type of drug that can be dangerous if combined with either Suboxone or methadone. The same is true of other opioids, including taking more methadone than prescribed.
Some herbal supplements can also be potentially dangerous, including St. John’s wort and tryptophan. Neither of these should be taken with Suboxone or methadone without first talking to a doctor.
Health Issues That May Make These Drugs Unsafe
Similar to the above, one major concern when a healthcare provider is considering prescribing either methadone or Suboxone is whether the patient has any health conditions that may affect their breathing or is taking any medications that increase the pressure in their brain.
Some health conditions that may affect one’s ability to safely take these medications include the following:
- Chronic obstructive pulmonary disease
- Head injury
- Brain tumor
- Any disease that causes malnourishment or weakness
Older adults are also considered to be at greater risk of developing problems when taking methadone or Suboxone.
How Do I Know Which Option Is Best for Me?
While it’s important to be involved in any medical decision regarding your personal health, the best way to determine whether methadone or Suboxone is right for you, and which is best, is to talk with an addiction treatment professional. These professionals are trained in addiction treatment and have expertise to guide your choice. They can help work with you to identify the medication that will best suit your needs.
Overall, Suboxone and similar buprenorphine-based medications are considered the gold standard in treating opioid use disorder. Suboxone is the primary choice in Medication for Addiction Treatment to address opioid use disorder.
While this is true for most patients, different patients have different needs. Some people may have already tried Suboxone and not had the desired results. They may still benefit from methadone. Talk to your doctor about the best choice for you.
Suboxone vs. Methadone FAQs
Is Suboxone better than methadone?
While Suboxone is considered the primary medication choice in treatment for opioid use disorder, calling it “better” is an oversimplification. Methadone has a place in Medication for Addiction Treatment and can provide many of the same benefits as Suboxone.
In most cases, Suboxone will be the default choice, but talk to your doctor if it isn’t working for you.
Is methadone the same drug as Suboxone?
Methadone and Suboxone are two different drugs, even if they share some similarities. Methadone is a long-acting full opioid agonist. Suboxone is a partial opioid agonist.
Is it hard to switch from methadone to Suboxone?
Transferring from a methadone to a Suboxone treatment regimen is usually possible and fairly straightforward, although it becomes harder if an individual is on a methadone dose above 50 mg. Even then, it’s still possible to switch, but experts recommend doing these higher-level dose transfers in an inpatient setting with greater supervision.
Will Suboxone work for me?
If you have opioid use disorder, Suboxone will generally work for you as part of a complete MAT program. You should participate in counseling and therapy in addition to taking Suboxone.
Header image by Josh Estey under a Creative Commons Attribution 2.0 Generic license.
Reviewed By Peter Manza, PhD
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More
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