Opioid addiction and dependence have been rising steadily since 1999 in the U.S. The American Society of Addiction Medicine provides statistics on just how serious this issue is:
- Approximately 80% of heroin users started out taking prescription opioids.
- Heroin overdose deaths quadrupled from 2000 to 2013.
- Women have been impacted by both prescription pain medication and heroin overdose. Their rates of prescription overdose increased 400% between 1999 and 2010, with heroin overdoses tripling from 2010 to 2013.
- Limited access to and the expense of treatment has led people to choose heroin over medication-assisted treatment programs.
- Adolescents are also affected, with nearly half of adolescents using prescription opioids for conditions other than pain being addicted to them.
Fortunately, there is a growing availability of medications like Suboxone and methadone that can help minimize the symptoms of withdrawal to make it easier to recover. It’s important to understand the differences between Suboxone vs. methadone to select the treatment option that will work best for you.
Suboxone vs. Methadone Explained
Methadone was first introduced in 1947 as a treatment for opioid use disorder (OUD). It was remarkably effective in terms of getting people off of prescription opioids and heroin and into recovery.
However, over time and with more research, it became clear that methadone had one specific downside: it carried with it the dangerous prospect of addiction to the very medication meant to treat it in the first place.
This sent researchers back to the lab to design a better option that was safer and had less chance of addiction. In 2002, Reckitt Benckiser released Suboxone as a replacement therapy. Suboxone had in it a system of checks and balances that treated OUD with less potential for addiction. With two medications working together, Suboxone was designed to specifically fight opioid addiction.
The Difference Between Methadone and Suboxone
The difference between methadone and Suboxone begins with a basic definition of what they are. Both are prescribed to treat addiction, but methadone is a generic drug and Suboxone is the brand name of an addiction treatment that includes both buprenorphine and naloxone.
Both of these treatments require a doctor’s prescription and supervision. Of the two, only methadone is approved by the U.S. Food & Drug administration to also treat chronic pain. For treatment of opioid use disorder, both medications can only be accessed through an approved treatment program.
Beyond that, there are some differences in:
- Primary ingredients
- Basic actions
- Dosing and administration
- Efficacy when used for maintenance
Suboxone primary ingredients are buprenorphine and naloxone. Buprenorphine works to reduce cravings and withdrawal symptoms, while naloxone moderates its release so that there is no “high” associated with this medication.
Methadone is simply methadone. There is no other active ingredient.
It is critical to understand how opioids function in the brain before discussing the actions of Suboxone and methadone.
Opioids are agonists that bind to receptors in the brain, spinal cord, and other regions in the body. They can offer profound, temporary relief of severe pain, but not without a cost. In addition to pain relief, these medications provide a euphoric feeling that can change your brain over time.
Additionally, as the body gets used to opioids it requires more to achieve both pain relief and the “high” of the medication. The effects — both pain relief and the euphoria that accompanies it — wear off faster, too.
Suboxone’s two medications are generally prescribed for the first part of opioid withdrawal to ease symptoms and reduce cravings. Buprenorphine is a partial agonist that also binds to opioid receptors, but in a more gradual way that is not as intense as opioids. The euphoric high is missing, and pain relief is longer-lasting. The naloxone in Suboxone is an antagonist. It blocks the effects on opioid receptors to protect against overdose. It eliminates the euphoria of opioids completely, an action that reduces cravings. The effects of naloxone are so powerful that it is used on its own to treat opioid overdose (as a nasal spray under the brand name Narcan).
Methadone changes the brain and nervous system response to pain, too. When administered correctly, it can reduce symptoms of opioid withdrawal and block the euphoric effects that those who are addicted have come to crave.
Dosing and administration
Dosing of Suboxone occurs once daily. For people in medication-assisted treatment (MAT) programs, taking Suboxone for pain is a safer alternative to opioid medications.
Suboxone is typically prescribed as a sublingual (under the tongue) or buccal (inside the cheek) film. Generic buprenorphine and naloxone are also available as an oral film or sublingual tablet (a tablet that dissolves under the tongue).
A basic maintenance adult dose might be once daily 16 milligrams of buprenorphine and four milligrams of naloxone as one dose. Because the half-life of methadone is longer, the risk of over-prescribing is high. The dose needs to be individualized to the patient precisely, and patients are monitored before, during, and after dosing to make sure there are no side effects.
Methadone can be prescribed as an:
- Oral tablet
- Oral solution
- Oral concentrate
- Injectable solution
- Oral dispersible (dissolved in water and then taken)
Adults taking methadone for opioid addiction generally start with 20 to 30 milligrams in a single dose per day. Your doctor will adjust this amount as needed, but generally it will not exceed more than 40 milligrams. It is critical to follow your doctor’s dosage.
Suboxone vs. methadone for maintenance
Both Suboxone and methadone can be taken in the first stages of treatment to minimize symptoms of withdrawal. They also both perform equally well in reducing opioid dependence when used long-term in combination with other therapies (e.g., counseling and community support).
Methadone maintenance therapy (MMT) may be slightly more effective in terms of maintaining an opioid-free profile for people with comorbid substance use disorder and chronic pain, but the risk of addiction is high. There is an additional risk of liver injury and reduced attention span with long-term use of methadone.
Although it is not approved for the treatment of pain, Suboxone has less chance of dependence and may be safer long-term. It has even been classified by the U.S. Drug Enforcement Agency as a Schedule III drug with a lower risk of dependency.
Side Effects of Suboxone vs Methadone
Both of these medications can be life-saving in terms of helping people recover from opioid use disorders. However, in addition to side effects that mimic opioid withdrawal, they each have other potential side effects to be aware of.
The list of side effects can be intimidating. It is important to note that research and doctors agree that the benefits of both Suboxone and methadone outweigh the risks of side effects for patients with opioid use disorder. Before taking either medication, talk to your doctor about any health conditions or concerns that you have.
Suboxone side effects
Suboxone comes with significant dental side effects that have recently been recognized as serious by the FDA. Buprenorphine dissolved in the mouth can lead to:
- Tooth decay
- Oral infections
- Loss of teeth
You are at risk even if you have not had a history of dental problems. These risks can be minimized somewhat by proper administration that includes rinsing your mouth with water and brushing your teeth an hour after taking Suboxone.
In addition to dental concerns, other potential side effects include:
- Back pain
- Opioid withdrawal symptoms
- Blurred vision
- Mouth numbness or burning
- Stomach pain
- Tongue pain
Serious side effects including difficulty breathing or swelling in the mouth or tongue require immediate medical attention.
Methadone side effects
There is a long list of medications that can interact with methadone. It is critical to discuss any other health conditions you have and medications you are taking before beginning methadone therapy.
Short-term side effects can include:
- Nausea or vomiting
- Slow breathing
- Itchy skin
- Profuse sweating
- Sexual problems
- Weight gain
- Sleep changes
- Changes in appetite
- Stomach pain
- Dry mouth
- Mood changes
- Vision issues
Serious side effects that require immediate medical attention include:
- Trouble breathing
- Fainting or lightheadedness
- Hives or a rash
- Swollen lips, tongue, throat, or face
- Chest pain or a rapid heartbeat
- Hallucinations or confusion
- A hoarse voice
- Trouble swallowing
- Severe drowsiness
- Changes to menstrual periods
Can You Take Methadone And Suboxone Together?
The short and precise answer is no. Combining these two medications is dangerous and puts you at greater risk for overdose.
Additionally, if you add Suboxone to an already-established methadone treatment, you have an immediate risk of withdrawal symptoms that include:
- Watery eyes
- Runny nose
- Profuse sweating
- Fever and chills
- Agitation and irritability
- Mood disorders (e.g., anxiety and depression)
- Rapid heartbeat
- Body aches
- Abdominal cramping
- Loss of appetite
- Gastrointestinal issues (e.g., nausea, vomiting, and diarrhea)
These put you back to square one in terms of working through withdrawal and can lead to a relapse. This is not a case of “if some is good, more must be better.” Combining these medications can have deadly consequences.
Switching From Methadone To Suboxone
Switching from methadone to Suboxone (and vice versa) is not common if a patient is getting good results, but it does occur. Some reasons why a person would switch medications include:
- Relapse due to non-compliance with methadone program
- Poor results from methadone
- Addiction to methadone
The switch from one medication-assisted therapy to another can only be completed under a doctor’s close supervision.
When switching from methadone to Suboxone, the methadone dose is tapered down to a certain amount before Suboxone can be taken at least 24 hours after the last methadone dose.
If a person is on a lower dose of methadone, the transition likely occurs without any increase in withdrawal symptoms or cravings. It is critical to monitor for both, as withdrawal can cause relapse.
Find Resources For Opioid Addiction And Dependence
When considering suboxone vs. methadone, only your doctor can help you decide which is best for you. Is Suboxone the same as methadone? No. And what works for one person may not help another.
Arizona Pain’s Mercy Care Center of Excellence can help. We have the tools you need to tackle chronic pain, substance use disorders, and mental health issues. The road to recovery is long and winding — we want to be with you every step of the way. Get in touch today to schedule an appointment to start getting your life back.