Methadone vs Suboxone for Treating OUD

Author: Susanne Reed, Ph.D.

In this article:

• What are Methadone and Suboxone?
• Differences of Methadone vs Suboxone
• Methadone vs Suboxone Benefits
• Side Effects of Methadone and Suboxone
  
• Methadone vs Suboxone and Behavioral Therapies
• Switching from Methadone to Suboxone
  
• Discontinuing Methadone or Suboxone
• Find the Right Treatment Program

Opioids like heroin, fentanyl, and prescription painkillers can be difficult to quit once you’re addicted. However, professional treatment, such as medication-assisted treatment with methadone or Suboxone, can help you treat opioid use disorder (OUD). When considering such treatment options, it’s important to remain informed on the distinctions of methadone vs Suboxone.

What Are Methadone and Suboxone?

The debate of methadone vs Suboxone in treating opioid use disorders is ongoing, with both having pros and cons.

Suboxone is a combination of two medicines, buprenorphine, which reduces cravings, and naloxone, which prevents you from feeling the effects of opioids. Methadone also reduces cravings but alleviates pain associated with withdrawal by sedating the brain and central nervous system.³

Methadone and Suboxone are long-lasting opioids, unlike prescription and illicit opioids such as heroin. This means you do not feel its effects quickly. The effects of opiates like morphine typically last four to six hours. With methadone or Suboxone, the effects are time-released and slowly reach their peak, lasting up to 48 hours in some people. This also means you do not feel the intense rush of euphoria associated with most other opioids.³

Differences of Methadone vs Suboxone

The two drugs are similar in performance but differ in many other ways. For example:⁴

• Methadone treats chronic pain and OUD, whereas Suboxone only treats OUD.
• Methadone is a Schedule II-controlled substance, and Suboxone is Schedule III.
• Methadone comes in tablet, liquid, and injectable forms. Suboxone comes as a film or tablet that dissolves under your tongue.
• Methadone treatment takes place at a certified opioid program facility but a primary physician can give suboxone prescriptions.
• Methadone is administered daily at a methadone clinic, and Suboxone is a take-home prescription.
• Methadone costs much less than Suboxone.
• Methadone can be taken for years or life, while Suboxone programs are shorter than a year.
• Methadone is a full opioid agonist medication and Suboxone is a partial opioid agonist.

All medicines can be misused. In this case, misuse occurs if someone chooses to take methadone or Suboxone in a way that does not follow prescription instructions. Misuse also means trading your medicine for illicit opioids, selling it for monetary reasons, and mixing it with other substances, such as sedatives or stimulants.

Methadone vs Suboxone Benefits

Both medicines offer benefits in treating opioid use disorders, including:⁵

• Decreasing prescription and illicit opioid misuse
• Preventing overdose
• Reducing cravings
• Making you feel calm and relaxed
• Having a high success rate
• Costing less than purchasing on the street or a prescription

Each medicine has benefits separate from the other, which can be helpful to doctors when choosing between the two. For example, Suboxone has the following advantages over methadone:⁶

• Safer to take at high doses due to the ceiling effect
• Easier to taper off
• Less euphoria than methadone produces
• Easier to access through general practitioners
• Shorter program length

The advantages of methadone over Suboxone include the following:⁶

• Price is lower than Suboxone
• People stay in treatment longer when on methadone
• Evidence of success over many decades
• Pregnant people can take it safely

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Side Effects of Methadone and Suboxone

When taking methadone or Suboxone, there is a risk for misuse and developing a substance use disorder, even with methadone or Suboxone.

Side effects that may appear in either methadone or Suboxone include:^7,8

• Dizziness
• Drowsiness
• Digestive problems
• Sweating
• Respiratory depression
• Slowed or irregular heart rate
• Headaches

Methadone and Suboxone do not share all the same side effects. If taking Suboxone, you may experience:⁸

• Fainting
• Numbness, redness, or swelling in your mouth
• Poor concentration
• Blurry vision
• Poor coordination
• Low blood pressure
• Liver problems
• Itchy skin or rashes

Methadone side effects that are not common with Suboxone include:⁸

• Seizures
• Stomach pain, ranging from mild to severe
• Sexual problems

Methadone vs Suboxone and Behavioral Therapies

Behavioral therapies are an integral part of medication-assisted treatment. The medicines make it possible for you to focus and learn recovery skills to move forward with achieving the goals you want to reach. Behavioral therapies with evidence supporting medication-assisted treatments include the following:⁹

• Cognitive-behavioral therapy (CBT) helps you change negative thought patterns so you can overcome cravings, avoid giving in to temptations, reason before reacting, and gain the skills needed to maintain abstinence.
• Contingency management (CM) uses incentives and rewards to encourage continued abstinence and remain in the medication-assisted program. CM is particularly effective with methadone treatment. Participants in the program can earn the chance to take home medicine for several days or a week if they reach goals, including passing random urine screens or attending all counseling sessions.
• Motivational Interviewing (MI) gives you the extra knowledge and encouragement needed to recognize you have a substance use disorder and desire change.
• Family therapy helps you and anyone in your circle affected by your opioid use disorder. Together, you learn tools to heal your relationships and support recovery. Family can also learn more about addiction, how the brain is affected, and how methadone or Suboxone can help your recovery.

More research is needed on whether behavioral therapies improve outcomes for those on Suboxone. There is conflicting evidence that behavioral therapies of any kind support Suboxone treatment outcomes in the studies conducted to date. Researchers in one study claim participants do not feel behavioral therapies are helping them, but at the same time, more than 60% of participants claim they are necessary and effective.¹⁰

Other studies show the more CBT sessions you attend, the better your outcomes. Once again, behavioral interventions do not show clinical significance for improving treatment outcomes, but participants see them as beneficial.¹¹ The fact that participants see them as a necessary component of treatment suggests they are helpful.

Switching from Methadone to Suboxone

Studies show people choose to switch from one medication to another to treat opioid use disorder for multiple reasons. A group switching from methadone to Suboxone stated their reasons included:¹²

• Suboxone is easier to taper off
• Methadone’s side effects are too severe
• Methadone interacts with other medicines
• Suboxone is a take-home prescription

There is a lack of reported data on why people request switching from Suboxone to methadone. However, clinical guidelines do exist for switching between methadone and Suboxone.¹²

Doctors should do the following when helping someone switch medications:¹³

• Avoid rapid transfers, especially for those on high doses of methadone or Suboxone
• Consider inpatient rehab for transfer of those on high doses of medication
• Consider tapering to a lower dose, then switch the medications
• Weigh risks and benefits of methadone vs Suboxone before transitioning to a different medicine
• Ensure co-occurring disorder stabilization before switching from between the two medications
• Increase monitoring of participants during the transition of methadone or Suboxone
• Allow participants to input their thoughts on switching from medications

Discontinuing Methadone or Suboxone

The end goal of medication-assisted treatment is to discontinue the medicine when you acquire the psychological and behavioral skills necessary to prevent relapse. That time is different for each person. For some, it can take years before discontinuing medicine. The dose and how long you have been taking medication will determine the length of the discontinuation process.

Tapering down in dose is always recommended. It is safer than sudden discontinuation, and you will experience few, if any, adverse effects. The tapering down process should resemble the tapering up process you went through when initiating methadone or Suboxone treatment. And you should never discontinue use without a doctor’s supervision, as they can create your individualized tapering schedule.

Reasons for discontinuing methadone or Suboxone rather than transitioning to a different treatment may include:¹³

• Participant requests tapering or discontinuation of the medicine.
• Participant has substantially improved, meeting goals, and is ready.
• Participant has not improved at all, meaning the treatment is not working.
• Participant is misusing their medicine.
• Side effects range from uncomfortable to dangerous.
• Risk for health problems increases due to new physical or psychological conditions.

Keep in mind that forcing someone off methadone or Suboxone will likely be counterproductive.

Find the Right Treatment Program

The Substance Abuse and Mental Health Services Administration (SAMSHA) compiled a list of must-have qualities to look for when seeking an opioid treatment program. Below are questions to ask the treatment center. Their answers will help you decide if they can meet your needs in treating OUD:¹⁴

1. Is your opioid treatment program accredited?
2. Do you have state licenses and certifications in good standing?
3. Is the medication you use FDA-approved? Is Suboxone the same as methadone?
4. Do you implement evidence-based practices?
5. Is family therapy provided?
6. Do you provide aftercare planning or case management?

Don’t be afraid to ask the basics, such as cost, insurance acceptance, the average length of the program, emergency contacts, and the success rate of former participants. You can also ask for references.

If you are ready to make your first transition from opioid misuse to treatment with methadone or Suboxone, or if you are interested in switching from methadone to Suboxone or vice versa, you can start the process today.

We can connect you with a quality treatment provider within minutes of receiving your call. Since we are here 24/7, you can call 800-994-1867Who Answers? now to speak with a treatment specialist.

We look forward to bridging the gap between you and a program that works.

Resources

1. Center for Disease Control and Prevention. (2021). U.S. Opioid Dispensing Rates Map.
2. Center for Disease Control and Prevention. (2021). Understanding the Epidemic.
3. Bell J, Strang J. (2020). Medication Treatment of Opioid Use Disorder. Biological Psychiatry, 1;87(1):82-88.
4. Dydyk AM, Jain NK, Gupta M. (2021). Opioid Use Disorder. StatPearls [Internet]. Treasure Island (F.L.): StatPearls Publishing.
5. Bart G. (2012). Maintenance Medication for Opiate Addiction: The Foundation of Recovery. Journal of Addictive Diseases, 31(3), 207-225.
6. Canadian Agency for Drugs and Technologies in Health. (2016). Appendix 5, Main Study Findings and Author’s Conclusions. Buprenorphine/Naloxone Versus Methadone for the Treatment of Opioid Dependence: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON).
7. Reckitt Benckiser Pharmaceuticals Inc. (2018).
8. Substance Abuse and Mental Health Services Administration. (2021).
9. National Academies Press. (2019). The Effectiveness of Medication-Based Treatment for Opioid Use Disorder. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Sciences Policy, Committee on Medication-Assisted Treatment for Opioid Use Disorder. Medications for Opioid Use Disorder Save Lives. Washington (D.C.).
10. Ling, W., Hillhouse, M., Ang, A., Jenkins, J., & Fahey, J. (2013). Comparison of Behavioral Treatment Conditions in Buprenorphine Maintenance. Addiction, 108(10), 1788-1798.
11. Moore BA, Barry DT, Sullivan LE, Oʼconnor PG, Cutter CJ, Schottenfeld RS, Fiellin DA. (2012). Counseling and Directly Observed Medication For Primary Care Buprenorphine Maintenance: A Pilot Study. Journal of Addiction Medicine, 6(3):205-11.
12. Lintzeris, N., Monds, L. A., Rivas, C., Leung, S., Dunlop, A., Newcombe, D., Walters, C., Galea, S., White, N., Montebello, M., Demirkol, A., Swanson, N., & Ali, R. (2018). Transferring Patients from Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines. Journal of Addiction Medicine, 12(3), 234-240.
13. S. Department of Health and Human Services. (2019). HHS Guide for Clinicians On The Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.
14. Substance Abuse and Mental Health Services Administration. Finding Quality Treatment for Substance Use Disorders.