Methadone and Suboxone should not be mixed.
Methadone is a full opioid agonist, meaning it strongly turns on opioid receptors in the brain. Suboxone is a partial opioid agonist, which means it partially turns on those same receptors.
However, Suboxone binds more strongly to receptors in the brain than methadone. This means that if Suboxone and methadone are mixed, Suboxone will kick methadone off the opioid receptors in the brain. This will cause precipitated withdrawal.
In rare cases, combining Suboxone and methadone can lead to heart rhythm issues, which could be potentially fatal.
Precipitated withdrawal occurs when withdrawal symptoms are triggered by medications. Since Suboxone (buprenorphine/naloxone) bumps methadone and other full opioid agonists from the brain’s receptors, it triggers withdrawal.
Because Suboxone produces a reduced opioid response, the body is abruptly thrown into withdrawal when methadone is bumped off the receptors. Studies show that taking Suboxone, particularly at high levels, can precipitate withdrawal in those on methadone.
Symptoms of precipitated withdrawal include the following:
Both Suboxone and methadone can effectively be used to manage opioid use disorder (OUD). Suboxone is preferred by most physicians and addiction treatment specialists due to its lower misuse potential.
Suboxone is also often preferred by most patients because of its greater accessibility and ease of use compared to methadone. Since methadone isn’t available via take-home prescription, patients must visit a methadone clinic daily to get their dose. Suboxone, in contrast, can be taken at home.
Buprenorphine, the primary ingredient in Suboxone, is viewed as likely safer for patients than methadone. Most patients will be prescribed Suboxone versus methadone, but the choice will be made on an individual basis depending on each patient’s individual factors, including the severity of OUD, overall health, and life circumstances.
If you have been taking methadone to manage OUD and want to switch to Suboxone, talk to your doctor about how best to proceed. They will likely recommend that you wait at least 24-48 hours after last taking methadone before you take Suboxone.[5,6]
Do not attempt to switch from methadone to Suboxone without medical supervision. Your treatment team will be able to help you avoid precipitated withdrawal and make the process more comfortable. They may employ various techniques to ensure you stay safe and supported during the transition.