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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

Rebekah L. Rollston, MD, MPH, is a board-certified Family Medicine Physician and Head of Research at Bicycle Health. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston completed her residency at Tufts University and Cambridge Health Alliance, a Harvard-affiliated community healthcare system in Greater Boston, with emphases in addiction medicine and sexual & reproductive health. Her professional interests focus on social determinants of health & health equity, addiction medicine, gender-based violence, sexual & reproductive health, rural health, homelessness & supportive housing, and immigrant health. Dr. Rollston has published on these topics in The Lancet, Journal of Health Care for the Poor and Underserved, American Journal of Health Promotion, Journal of Appalachian Health, and Medical Care.

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Rebekah L. Rollston, MD, MPH

Rebekah L. Rollston, MD, MPH, is a board-certified Family Medicine Physician and Head of Research at Bicycle Health. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine (in the Rural Primary Care Track) and her Master of Public Health (MPH) from The George Washington University Milken Institute School of Public Health. Dr. Rollston completed her residency at Tufts University and Cambridge Health Alliance, a Harvard-affiliated community healthcare system in Greater Boston, with emphases in addiction medicine and sexual & reproductive health. Her professional interests focus on social determinants of health & health equity, addiction medicine, gender-based violence, sexual & reproductive health, rural health, homelessness & supportive housing, and immigrant health. Dr. Rollston has published on these topics in The Lancet, Journal of Health Care for the Poor and Underserved, American Journal of Health Promotion, Journal of Appalachian Health, and Medical Care.

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