Methadone and Suboxone are both medications that are used to treat opioid addiction.
The National Institute on Drug Abuse (NIDA) reports that both methadone and Suboxone are effective medications for opioid use disorders.
Uses of Methadone & Suboxone
The medications work in similar ways, but they have some differences that should be considered in a treatment plan for opioid addiction.
Methadone is an opioid agonist, which is a drug that can mimic the effects of opioids by acting on the same receptor sites in the brain.
Suboxone is a partial opioid agonist, which is a drug that interacts with the same opioid receptors in the brain but does not have the same effect as full opioid agonists.
NIDA states that over 2.5 million people struggled with opioid use disorders in 2014, which contributed to 28,000 overdose deaths that year.
Medication-assisted treatment (MAT) using methadone or Suboxone is an effective way to reduce deaths from opioid overdoses, increase participation in treatment, and lower rates of infectious disease transmission.
The Benefits and Drawbacks of Suboxone
Suboxone contains buprenorphine and naloxone. Buprenorphine reduces withdrawal symptoms and cravings for opioids.
Naloxone works as an abuse-deterrent component, as it blocks the effects of other opioids. This component of Suboxone lies dormant unless the medication is abused.
Since buprenorphine has a ceiling effect, people will not be able to get high from taking larger amounts of the drug. If they attempt to crush it to inject it, the naloxone part of Suboxone will throw them into immediate withdrawal.
Suboxone blocks the effects of other opioids, which creates a disincentive for people to relapse while on Suboxone —they will not be able to get high. This increases treatment compliance and helps people stay off drugs of abuse.
Benefits of Suboxone
- Because Suboxone is harder to abuse, patients can take the medication home rather than having to visit a dispensary clinic every day.
- It is less addictive than methadone because it has less of a euphoric effect.
- Suboxone reduces the risk of fatal overdose because it is less likely to cause respiratory depression.
- The medication may last longer than methadone because it metabolizes more slowly in the body.
- Suboxone can be offered in a dissolvable film, which lowers the risk of abuse since it cannot be crushed and snorted.
Drawbacks to Suboxone
- It can more expensive.
- Treatment providers may not be available in all areas.
- Pregnant women cannot use Suboxone if they are currently using opioids because of the risk of miscarriage during withdrawal.
- The presence of naloxone in Suboxone means that people must go through withdrawal before starting the medication.
The Benefits and Drawbacks of Methadone
Methadone is a full opioid agonist drug. It binds with opioid receptors in the brain and prevents people from going into withdrawal. It has a half-life of about 15 to 60 hours.
Benefits of Methadone
- Methadone can be started before a person goes through withdrawal, thereby preventing most painful symptoms of withdrawal.
- Methadone has been proven effective for the treatment of opioid addiction over decades of research. It has been demonstrated to improve outcomes for opioid-addicted patients.
- Methadone is often cheaper than Suboxone.
- Methadone clinics have been established for several decades, and treatment is available in many areas of need.
- Pregnant women can undergo methadone treatment because they can be treated before entering withdrawal. Withdrawal can be dangerous for both the mother and the fetus, and it can cause miscarriage if not properly managed.
- The longer half-life of methadone means that people can take the medication just once a day during a maintenance program.
Drawbacks to Methadone
- Methadone must be dispensed from a licensed facility, which means that patients have to visit a clinic daily for their medication. In some instances, they may be able to take their medication at home when they have demonstrated continued treatment compliance.
- Methadone has a higher risk of abuse.
Why is MAT Treatment Effective for Opioid Addiction?
Opioid drugs act on the opioid receptions in the brain. This provides relief from pain and triggers a pleasurable reward response in the brain by releasing higher levels of pleasure neurotransmitters, such as dopamine. When the brain becomes accustomed to this cycle of reward and relief, it can become dependent on the opioid to avoid painful symptoms that accompany the withdrawal process.
Opioid dependency can happen when taking any opioid drug for a prolonged period of time.
Opioid abuse can cause changes in the brain that make withdrawal and abstinence very difficult for people with prolonged dependency problems. This is why MAT is considered the best option for people with significant histories of opioid abuse and dependency.
Even after detox and withdrawal have been completed, people with opioid addictions can still experience intense cravings and a prolonged substance withdrawal syndrome that can last up to a year. During that time, the risk for relapse remains high.
How MAT Can Lower the Risk of Relapse
Relapse comes with inherent dangers, and people can easily overestimate their tolerance to an opioid drug. During detox, tolerance levels drop.
When a person relapses, they may consume a higher dose than they can handle. Their body can no longer tolerate the amount of opioids they were taking before. This can cause a person to accidentally overdose. It makes incidents of relapse particularly dangerous for people with a history of addiction.
MAT can prevent relapse and increase compliance in treatment. Since people aren’t distracted by intense cravings and powerful withdrawal symptoms, they can focus on therapy. This allows them to gain a strong footing in recovery.
What are the Official Recommendations to Treat Opioid Addiction?
Researchers support a patient-centered approach to opioid addiction treatment that includes education and support to meet individual needs.
NIDA reports that many treatment facilities do not offer MAT. Only about a third of people with opioid dependence receive MAT. This shortage of services means that many people who could benefit from MAT are not receiving the care they need.
Studies support the use of MAT for opioid addiction. Doctors should evaluate the risks and benefits of all treatment options for each individual.
Overall, MAT is more effective than abstinence-based programs at keeping participants off drugs of abuse.
MAT is not sufficient on its own. It should be used as part of a comprehensive treatment program that includes therapy. Medications like methadone and Suboxone can support treatment, but therapy is required.
Which is Right for You?
Talk with your doctor about your options for MAT.
Suboxone is often recommended for those who:
- Abuse prescription painkillers
- Cannot make daily visits to clinics or addiction treatment facilities
- Have a history of abusing methadone
Methadone is often the preferred recommendation for those who:
- Abuse heroin
- Are at high risk for dropping out of treatment
- Are pregnant women
- Inject drugs
These considerations, along with other individual health factors, should be discussed thoroughly. Doctors and patients can then choose the best treatment plan to reduce the risks associated with opioid addiction and recovery.
Whether Suboxone or methadone is chosen, opioid addiction can be effectively treated with a combination of medication and therapy.