We hear a lot about the opioid epidemic in this country, and the numbers are staggering — over 130 people die each day from an opioid overdose. Currently, over 2 million people are living with a diagnosed opioid use disorder (OUD), but this number is probably much higher amongst the undiagnosed.
So what can we do as a country to stop people from dying? How can we help people that are already affected?
One option currently deployed by the medical community is medication-assisted treatment (MAT). Different forms of MAT have been approved to treat alcohol and opioid dependence. The current leading MAT options for opioids are methadone and buprenorphine.
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.
Buprenorphine vs. Methadone Administration
Suboxone is a Schedule III medication according to the Drug Enforcement Agency (DEA), meaning it has a recognized medical use but with a moderate risk for abuse and addiction. Suboxone can be obtained from any pharmacy but requires a prescriber with special training in opioid addiction. Suboxone comes as a tablet or sublingual film.
In contrast, methadone is a Schedule II medication, so its dispensation is more tightly controlled than Suboxone. Methadone must be picked up at methadone clinics, and recipients can only receive one dose per day. Thus, they must go to the clinic every morning. Methadone comes in tablet, liquid or wafer formulation.
Side Effects & Risks of Buprenorphine vs. Methadone
Compared to Suboxone, methadone is more likely to provoke seizures and to have many drug interactions. Therefore, Suboxone may be safer for a person with a seizure disorder or a long medication list.
The side effects of methadone and Suboxone will be similar to the side effects of illicit opioids. Side effects may indicate that the dose is too high. Examples of side effects include:
- Difficulty falling asleep or staying asleep
- Dry mouth
- Mood changes
- Problems urinating
- Sore tongue
- Stomach pain
- Vision problems
- Weight gain
People on MAT should also learn to recognize the signs of withdrawal. Examples of withdrawal signs include:
- Abdominal cramping
- Dilated pupils
- Muscle aches
- Runny nose
Making the Choice Between Buprenorphine vs. Methadone Treatment
Suboxone is the best choice for people who cannot go to a methadone clinic every day to receive their dose. It also may be better for people with a history of seizures and other drug interactions.
Those who require higher opioid doses should use methadone instead of Suboxone because it has a much higher dose ceiling.
Ultimately, the choice of Suboxone or methadone will depend on the opioid use disorder treatment program and the needs of the individual. Not every treatment program uses methadone, and not every program uses Suboxone.
How We Incorporate Buprenorphine and Methadone in Our Treatment Programs
MAT is incorporated during the medical detox phase. Treatment begins with detox, continues into the treatment phase and then continues into the maintenance phase.
Since MAT keeps the symptoms of withdrawal at bay, incorporating it during detox will prevent any harm that comes from withdrawal and helps facilitate a more stable treatment. Typically, MAT recipients will continue treatment indefinitely.
If you or someone you know needs help stopping opioid use, consider contacting The Recovery Village Palm Beach at Baptist Health. We incorporate evidence-based practices like medication-assisted treatment to help ensure the best results. Call today to speak with our representatives and begin the pathway to recovery.
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Hser, Yih‐Ing, et al. “Long-Term Outcomes After Randomization to Buprenorphine/Naloxone Versus Methadone in a Multi-Site Trial.” 2016. Accessed September 15, 2019.
MedlinePlus. “Opiate and Opioid Withdrawal.” 2016. Accessed September 15, 2019.
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