The ongoing battle against opioid addiction has led to the development of various medications that can be used to treat opioid use disorder and reduce the intensity of withdrawal symptoms. These medications are used in tandem with comprehensive addiction treatment programs in an approach known as medication-assisted treatment (MAT). MAT has been shown to improve treatment outcomes and reduce the risk of relapse.
Two of the most commonly prescribed MAT medications are Suboxone and methadone. While both medications serve similar purposes and are effective at treating opioid addiction, they possess distinct characteristics that set them apart. Understanding the differences and similarities between Suboxone and methadone can help you decide which treatment medication is right for you.
What is Suboxone?
Suboxone is a combination medication composed of two active ingredients – buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, which means it activates opioid receptors in the brain to a lesser degree than full agonists like heroin or oxycodone. This mitigates withdrawal symptoms and cravings without producing the intense euphoria associated with stronger opioids. Naloxone, on the other hand, acts as an antagonist, blocking the effects of opioids and preventing misuse of Suboxone.
Suboxone was approved by the U.S. Food and Drug Administration (FDA) in October 2002. It was introduced as a safer, less addictive alternative to methadone.[1]
Suboxone Side Effects
Common side effects of Suboxone are:
- Nausea
- Vomiting
- Constipation
- Headache
- Insomnia
- Sweating
- Nervousness
- Dizziness
- Fatigue
- Painful tongue
- Blurred vision
- Irregular heartbeat
- Difficulty breathing
- Back pain
- Stomach pain
- Withdrawal symptoms (if not taken as directed or stopped abruptly)
- Difficulty concentrating
What is Methadone?
Methadone, a full opioid agonist, works by binding to the same receptors as other opioids, satisfying the body’s need for opioids without producing the extreme high. This gradual and prolonged effect helps reduce withdrawal symptoms and cravings, allowing individuals to stabilize their lives while minimizing the risk of overdose.
Methadone was originally approved by the FDA in 1947 for use as an analgesic and antitussive, however, its use was extended for the treatment of opioid use disorder in late 1972.[2]
Methadone Side Effects
Potential side effects of methadone include:
- Nausea
- Vomiting
- Constipation
- Drowsiness
- Dizziness
- Weakness
- Sweating
- Dry mouth
- Flushing
- Headache
- Mood changes
- Blurred vision
- Difficulty urinating
- Decreased libido
- Irregular heartbeat
- Difficulty breathing
- Confusion
- Increased risk of overdose and death (when not taken as directed)
- Withdrawal symptoms (if not taken as directed or stopped abruptly)
Exploring the Differences Between Suboxone and Methadone
While Suboxone and methadone serve similar purposes and share many of the same side effects, these are two very different medications. Key differences are found in the following areas.
Administration and Dosage
Suboxone comes in the form of a sublingual or buccal film that dissolves under the tongue and is taken once a day.[3] Due to the presence of naloxone, it has a ceiling effect, meaning its effects plateau even if higher doses are taken, reducing the risk of respiratory depression and overdose. While Suboxone can be prescribed by qualified medical practitioners, it is often offered in outpatient settings, making it more accessible for individuals seeking treatment.
Methadone, on the other hand, is available in tablet or liquid form and is usually dispensed through tightly regulated opioid treatment programs (OTPs) to ensure proper monitoring and reduce the risk of misuse.[4] Dosing is closely monitored and adjusted based on the client’s needs. Methadone is taken once daily, usually under the supervision of a medical professional.
People can start taking methadone at any point during the detox process, however, they must wait 12-24 hours after their last dose of opioids before starting Suboxone. Starting Suboxone too early may result in symptoms of precipitated withdrawal.
Safety Considerations and Abuse Potential
Due to its potential for respiratory depression and overdose, Methadone requires careful monitoring and dosage adjustment. The gradual onset of action also means that its effects might not be immediately noticeable, increasing the risk of overdose if not managed properly. Further, as a full opioid, methadone can be abused. People may crush and snort or inject their methadone to get high.
Suboxone, on the other hand, is designed to discourage misuse. If injected, naloxone can lead to intense and sudden withdrawal symptoms. This feature is advantageous for people who are concerned that they may abuse their medication. Additionally, Suboxone blocks the effects of other opioids, and you can’t get high on it.
Methadone is a Schedule II controlled substance whereas Suboxone is a Schedule III substance, indicating Suboxone has a lower potential for abuse, addiction, and dependence.
Can You Take Methadone and Suboxone at the Same Time?
No, you should never take Suboxone and methadone or any other opioid together at the same time. Mixing the two can increase the risk of opioid overdose, and the naloxone component may result in symptoms of withdrawal. If you are considering switching from one medication to the other, be sure to consult with your healthcare professional and follow their directions for dosing.
Find out if Suboxone or Methadone is Right for You
In the journey to overcome opioid addiction, both Suboxone and Methadone have proven to be effective tools. The choice between the two depends on various factors such as the individual’s history of opioid use, treatment goals, accessibility to clinics, and medical considerations. Ultimately, the decision should be made in consultation with healthcare professionals, taking into account the unique needs and circumstances of each individual seeking recovery.
At ARISE Treatment Center, our addiction experts can evaluate your needs and help you choose the right treatment program for you. To learn more about medication-assisted treatment (MAT) or to discuss all of your treatment options, please call now.
References:
- Drug Enforcement Administration (DEA): Buprenorphine, Retrieved August 2023 from https://www.deadiversion.usdoj.gov/drug_chem_info/buprenorphine.pdf
- National Library of Medicine: Federal Regulation of Methadone Treatment, Retrieved August 2023 from https://www.ncbi.nlm.nih.gov/books/NBK232111/
- Food and Drug Administration (FDA): Suboxone label, Retrieved August 2023 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf
- Food and Drug Administration (FDA): Dolophine (methadone) label, Retrieved August 2023 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/006134s038lbl.pdf