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What’s the difference between Suboxone and methadone?

Methadone and buprenorphine are both long-acting opioids that relieve withdrawal symptoms, cravings, and dramatically reduce overdose risk. Methadone has been in use for over 50 years to treat opioid use disorder, whereas buprenorphine is a more modern medication.

Buprenorphine acts like a partial opioid in the brain, which is different from methadone, oxycodone, heroin, and fentanyl. Because buprenorphine is a partial opioid, it has a ceiling effect—this means that after a certain dose, there is no additional opioid effect, which ultimately decreases the risk for overdose. Buprenorphine treatment is often combined with naloxone; together, this combination is known as Suboxone. Buprenorphine/naloxone (Suboxone) has many advantages:

  • Buprenorphine/naloxone (Suboxone) is widely considered to be safer than methadone and has a lower risk for sedation and overdose when taken as prescribed (unlike Suboxone, methadone often makes patients feel sleepy or groggy during the first few weeks of treatment);
  • The recommended effective dose of buprenorphine/naloxone (Suboxone) is well-known and can be safely reached within 1-2 days for most patients, whereas effective methadone dosing varies unpredictably from person-to-person and may take weeks to achieve; and 

Buprenorphine/naloxone (Suboxone) can be prescribed by licensed and trained medical providers in any treatment setting, whereas methadone is strictly regulated by the government and can only be provided through federally licensed outpatient treatment programs.

Rebekah L. Rollston, MD, MPH

Dr. Rollston is a Family Medicine Physician at Cambridge Health Alliance, Affiliate Editor-in-Chief of the Harvard Primary Care Blog, and Founder of Doctors For A Healthy US, LLC. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine and her Master of Public Health from The George Washington University. Her professional interests focus on social influencers of health & health disparities, addiction medicine, sexual & reproductive health, homelessness & supportive housing, and rural health.

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