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The Difference Between Methadone and Suboxone

An overview: Methadone and Suboxone are the two leading medications used in the treatment of opioid addiction. Methadone has been utilized in opioid treatment in the United States since the late 1960’s. Suboxone was introduced in 2002. Methadone and suboxone are in widespread use around the world due to their proven benefit in the treatment of opioid addiction. Both medications are FDA-approved, and are endorsed by the American Medical Association and SAMHSA (Substance Abuse and Mental Health Services Administration).

Methadone and Suboxone aid the recovery process by binding to the brain’s opiate receptor sites such that a patient’s painful opioid withdrawal symptoms are alleviated. When withdrawal sickness is eliminated, a patient is able to focus their attention and effort on the recovery process and the restoration of work, family life, and other responsibilities.

A particularly troublesome aspect of opioid addiction is the intense physical dependency and withdrawal syndrome which emerge over time. As dependency grows, many opioid users find that they need increasing amounts of the drug to avoid withdrawal sickness. Opioid withdrawal symptoms include diarrhea, nausea, vomiting, sweating, fever, chills, tremor, racing heart, hypertension, anxiety, depression, agitation, etc.

The physical sickness and mental anguish of opioid withdrawal drive users to desperate measures. Users often move to injection drug use of street heroin (since it is cheaper and readily available) or other narcotics, thus placing themselves at increased risk of death by overdose.

Methadone and Suboxone specifically address debilitating withdrawal sickness, and they provide a degree of stability and physical/emotional relief that are valuable to a recovering addict. These medications “assist” the treatment process by keeping people in recovery longer, and they remove the daily dilemma of securing illicit drugs to prevent opioid withdrawal.

A Comparison of Methadone and Suboxone

  • Methadone is a full opioid agonist which means it is somewhat stronger than Suboxone. Suboxone is a partial opioid agonist and consequently is considered somewhat safer than methadone. Both medications are prescribed by a physician. In addiction treatment, Methadone is provided in a clinic setting and administered by a nurse (usually taken orally on site by the patient). Suboxone is often prescribed in a doctor’s office and may be taken at home.
  • Methadone is often given in liquid form and is swallowed. Suboxone is a thin film that is placed under the tongue where it dissolves.
  • A patient receiving methadone in a treatment program can earn take home medication privileges after a period of time stable on the medication.
  • Both medications present with few to no side effects, and are considered safe to take.
  • Suboxone is a combination of two drugs: buprenorphine and naloxone. Buprenorphine is the partial opioid agonist (active ingredient) that binds to opioid receptor sites and provides relief from withdrawal. Naloxone is an additive that deters the injection use of suboxone.
  • Recipients of methadone or suboxone are required to receive regular counseling in addition to their daily medication. This counseling is to help the individual develop improved coping skills and the ability to reduce or prevent relapse.

The Limits of Suboxone

Suboxone has received much attention in recent years in association with the growing U.S. opioid epidemic. Consequently, many more people have become curious about the medication as a possible alternative to methadone.

While suboxone does offer the convenience of immediate take home availability, opioid users with an extensive drug use history may find that suboxone is not sufficiently strong enough to eliminate their daily opioid withdrawal. As a partial opioid agonist, suboxone’s effect may not fully remove intense withdrawal symptoms. This varies from person to person, but is likely to be more true for opioid users who have developed a high tolerance or who have used over a period of years.

Suboxone has a ceiling effect whereby taking additional suboxone produces no more additional relief. When it is determined that suboxone is not strong enough to eliminate a person’s withdrawal, then methadone can be utilized effectively since it is a full opioid agonist. Methadone does not have a ceiling effect. For nearly all opioid addicted individuals, there is a particular dosage level of methadone that will safely and completely remove their withdrawal symptoms.

It will be important in the years ahead that legislators & policy makers promote medication-assisted treatment wherever possible while being careful to not oversell Suboxone as a panacea for all opioid addictions. Suboxone and Methadone are both life-saving advancements in medicine, and each provides unique advantages. However, methadone will remain the primary medication of choice for moderate to severe opioid addictions. Its history of effectiveness has stood the test of time, and its ability to fully alleviate opioid withdrawal and opioid cravings is very compelling.


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