Comparing Methadone vs. Suboxone For Medication-Assisted Treatment

Methadone and Suboxone offer two main medication options for opioid addiction treatment. These medications affect the brain differently, but both reduce withdrawal symptoms, decrease cravings, and help people recover. Research proves their effectiveness when doctors combine them with counseling and support services in complete treatment programs, but which one is better for ongoing recovery?

What is Methadone?

Methadone functions as a long-acting synthetic opioid that doctors prescribe to treat opioid addiction.[1] This medication activates the same brain receptors as other opioids but produces a milder effect without the extreme highs and lows. Methadone blocks withdrawal symptoms for 24 to 36 hours, making it effective for daily dosing [2]. Physicians typically administer methadone in specialized clinics under direct supervision, particularly during early treatment phases.

The Drug Enforcement Administration classifies methadone as a Schedule II controlled substance due to its potential for misuse.[2] Despite this classification, methadone remains one of the oldest and most researched medications for opioid addiction treatment. Patients often require daily clinic visits to receive their dose, especially when they begin treatment. Some patients may qualify for take-home doses after demonstrating stability in their recovery program.

What is Suboxone?

Suboxone is a medication commonly used in the treatment of opioid addiction. It contains two active ingredients: buprenorphine and naloxone.[2] Buprenorphine is an opioid medication that works by reducing cravings and withdrawal symptoms, making it easier for individuals to stop using opioids. Naloxone is an opioid antagonist that blocks the effects of other opioids, making it more difficult to get high if Suboxone is not used as directed.

In addition to its role in medication-assisted treatment, Suboxone may also be used to help prevent opioid overdose. When taken as directed, it can help individuals avoid the potentially fatal consequences of opioid abuse. However, it is important to note that Suboxone can be addictive if not used as directed, and it is essential to use it only as part of a comprehensive treatment program that includes counseling and other forms of support.

How Are These Medications Similar?

Methadone and Suboxone are similar in several ways:

• Both medications are primarily used in the treatment of opioid addiction.
• They are both considered opioid agonists, meaning they activate the same receptors in the brain that opioids do.
• Both medications help reduce cravings and withdrawal symptoms associated with opioid addiction.
• Methadone and Suboxone are typically used as part of a comprehensive treatment plan that includes counseling and behavioral therapy.
• They are both prescription medications that should only be taken under the supervision of a healthcare professional.

How Are They Different?

Despite their similarities, there are some important differences between the two medications. For example, methadone is a full opioid agonist, while Suboxone is a partial opioid agonist. This means that Suboxone has a ceiling effect on its ability to produce euphoria, making it less likely to be abused.

Other differences include: 

• Abuse potential: Suboxone has a lower potential for abuse compared to methadone due to its ceiling effect on euphoria.
• Treatment setting: Methadone is typically dispensed in a specialized clinic, while Suboxone can be prescribed by a qualified healthcare provider in an office-based setting.
• Administration: Methadone is usually given as a liquid, while Suboxone is typically given as a sublingual film.
• Treatment initiation: Methadone can be started during the withdrawal phase of addiction, while Suboxone typically requires a waiting period after the last use of opioids.
• Use during pregnancy: Methadone is generally considered safer for use during pregnancy, while Suboxone may be associated with certain risks to the fetus.
• Medication cost: Methadone is generally less expensive than Suboxone.
• Prescription refills: Suboxone can be prescribed with refills, while methadone typically requires daily visits to the clinic for administration.

Are Both Medications Effective?

Both methadone and Suboxone are considered effective medications for the treatment of opioid addiction.[4] Research has shown that these medications can significantly reduce opioid use, improve retention in treatment, and decrease the risk of overdose.

Methadone has been used for over 50 years in the treatment of opioid addiction and has a well-established track record of effectiveness. Studies have found that methadone maintenance treatment can lead to significant reductions in opioid use, criminal activity, and HIV risk behaviors.

Suboxone, on the other hand, is a more recent addition to the treatment options for opioid addiction. However, it has also been shown to be effective in reducing opioid use and improving treatment outcomes. In addition, Suboxone may be a preferable option for some patients due to its lower abuse potential and the ability to prescribe it in an office-based setting.

What About Side Effects?

Methadone can cause a range of side effects, particularly during the initial phase of treatment. Some of the most common side effects of methadone include:[5]

• Drowsiness and fatigue
• Nausea and vomiting
• Constipation
• Dry mouth
• Sweating
• Itching
• Headache
• Mood changes
• Weight gain
• Respiratory depression

More serious side effects of methadone may include respiratory depression, cardiac arrhythmias, and drug interactions with other medications.

Suboxone can also cause side effects, although they may be less severe compared to methadone:[6]

• Nausea and vomiting
• Constipation
• Headache
• Sweating
• Insomnia
• Mood changes
• Dry mouth
• Itching
• Drug interactions with other medications

More serious side effects of Suboxone may include respiratory depression, particularly if the medication is used in combination with other central nervous system depressants. Patients should always discuss any side effects with their healthcare provider to determine the best course of action.

Can Methadone and Suboxone Be Abused?

Methadone and Suboxone are both opioids and have the potential to be abused. However, the risk may be lower with Suboxone. Methadone is a full opioid agonist and can produce a euphoric effect similar to other opioids, making it more likely to be abused. In addition, methadone can be dangerous if taken in high doses or in combination with other central nervous system depressants.

Suboxone is less likely to be abused compared to methadone due to its partial agonist properties and the presence of naloxone, which can block the effects of other opioids and deter misuse. However, Suboxone can still be abused if taken in large doses or by people who are not opioid-tolerant. Patients should take these medications only as directed by their healthcare provider and be monitored for signs of misuse or diversion.