Understanding Opioid Addiction Treatment Medications
A common misunderstanding about MAT for opioids is that they replace one addiction for another. While it is true that methadone and buprenorphine are opioids themselves, they have been shown to markedly reduce the troublesome and damaging symptoms of addiction.
A distinction must be made between a daily medication that treats a chronic condition, like opioid use disorder and addiction. MAT medications should be thought of as similar to other chronic medications that treat conditions like asthma and high blood pressure.
For example, let’s say we have a person with opioid use disorder that takes methadone every day for treatment. They start taking more methadone than they should — they spend a whole day feeling euphoric and then crash the next day. They miss work and spend the entire day recovering. In this instance, they have used methadone to facilitate addiction.
However, the chemistry of methadone prevents this type of behavior, and it can be safely administered once daily to prevent binging behavior and cravings.
Now, this example is not entirely realistic because methadone dosing is carefully controlled. But when methadone is administered properly, symptoms of addiction, like craving and withdrawal, are markedly reduced. The reduction in symptoms helps facilitate a normal life.
The choices of MAT usually come down to Suboxone vs methadone or buprenorphine vs methadone. However, buprenorphine alone is rarely (if ever) used by itself.
Benefits of Buprenorphine
Buprenorphine can be used alone for opioid dependence, but it is usually combined with naloxone into the product Suboxone. Suboxone is formulated as a tablet or film placed under the tongue.
Buprenorphine is a partial opioid agonist, so it activates opioid receptors, but not as much as full agonists like oxycodone or heroin. Partial agonism allows for a “ceiling effect” that gives some small protection from an overdose. In other words, buprenorphine products are more difficult to overdose on than other opioids.
Suboxone also contains naloxone, which blocks opioid receptors, but is only activated when someone tries to abuse Suboxone by snorting or injecting it. Naloxone is not active when taken orally, but blocks opioid activity when taken by other routes.
Since Suboxone is taken by mouth, it reduces risky behaviors like needle-sharing that increase the risk for the spread of disease.
Benefits of Methadone
The benefits of methadone are similar to the benefits of Suboxone. It is taken by mouth, so it reduces risk-taking behavior around sharing needles. It is also taken once daily.
Methadone may be more useful for people with opioid addiction that use very high doses of illicit opioids. Methadone can be increased or decreased more safely because only one dose is handed out per day. We also have decades of experience with methadone compared with that of other MAT options.