Suboxone and methadone are prescription medications approved by the Food and Drug Administration (FDA) to treat opioid dependence.
Both medications are prescribed within the setting of drug rehab and are useful tools for clinicians to ease someone through medical detox. When taken as prescribed, both medications are safe and effective.
When drugs like these are used in the treatment of addiction, they are referred to as medication-assisted treatment (MAT).
Benefits of Suboxone vs. Methadone
Both medications work by agonizing (or activating) opioid receptors in brain cells. Those familiar with opioid addiction may notice that this is the same mechanism for addictive opioids. When any substance activates opioid receptors, nerve cells halt pain signals and send pleasure signals throughout the body. These feelings of pleasure are why people abuse opioids in the first place.
So it is reasonable to wonder — how does activating opioid receptors treat addiction when this is what caused the addiction?
Opioids that people become addicted to, like heroin, hydrocodone, and oxycodone, activate a lot of opioid receptors very quickly. For example, heroin only works for about five minutes, but it is so potent that people can become addicted to the feelings of pleasure almost immediately. The problem with addiction comes next — an intense crash and then cravings follow the euphoria. This is the cycle of addiction: euphoria, crash, and craving.
The problems with addiction are the negative impacts on social, financial and occupational aspects of a person’s life. The addiction cycle hijacks normal motivation, and regular life takes a backseat to the drug-seeking behavior.
Suboxone and methadone activate opioid receptors, but much less than their addictive counterparts. Think of someone pressing a gas pedal slow and steady versus flooring it all the time and then slamming on the brakes.
Understanding Suboxone Treatment
Suboxone is a combination of the drugs buprenorphine and naloxone. When formulated into Suboxone, the combination is a schedule III medication. The Drug Enforcement Agency (DEA) considers schedule III drugs medically useful, but with a moderate potential for abuse and addiction.
Buprenorphine is a partial opioid agonist, meaning it has a “ceiling effect” that gives some protection against overdose. Buprenorphine can also be dosed once per day, so the dose works around the clock to dampen cravings.
Naloxone is added to reduce Suboxone’s potential for addiction. Despite being less potent than other opioids like heroin, buprenorphine still has the potential to be abused. If someone tries to crush Suboxone for snorting or injection, naloxone will block opioid receptors (antagonize) and prevent euphoria.
Suboxone comes as a tablet or sublingual film.
Suboxone can be obtained from any pharmacy, but physicians must go through special training to prescribe it.
Understanding Methadone Treatment
Methadone maintenance treatment (MMT) has been around for decades, and rehab programs have a lot of experience with it. Unlike Suboxone, methadone does not contain any opioid antagonists like naloxone.
Methadone activates opioid receptors enough to dampen craving and withdrawal symptoms, but it lasts much longer than most opioids.
A single dose of methadone stays in the body for about five days, so it is beneficial for providing low and constant levels of opioid receptor activation. It can be dosed once daily, but the dose must be obtained each day from a methadone clinic. Methadone for opioid dependence cannot be dispensed at a normal pharmacy, and physicians cannot prescribe it without extra training.
Methadone is formulated as tablets, liquid, and wafers.
Cost of Suboxone Treatment vs. Methadone Treatment
The cost of each medication depends on many factors. If insurance pays for opioid dependence treatment, a person may pay nothing for their prescription, but not everyone has this benefit. Anyone curious about their insurance coverage should call the phone number on the back of their insurance card to speak with their benefits office.
Methadone and Suboxone both come in generic formulations, but this does not mean they will be inexpensive. Someone looking for MAT treatment should speak with their drug rehab facility. Cost-saving and low-income options may be available for some people.
Suboxone vs. Methadone Side Effects
Suboxone and methadone have similar side effects. The presence of side effects is a signal that the dose may be too high. Anyone experiencing side effects should speak with their prescriber. Common side effects for Suboxone and methadone include:
- Side Effects of Suboxone and Methadone
Difficulty falling asleep or staying asleep
Compared to Suboxone, people on methadone are more likely to have seizures. Therefore, Suboxone may be safer for a person with a seizure disorder. Methadone also causes a lot of drug interactions, especially with psychiatric medications.
MAT, like Methadone and Suboxone, are intended to both treat cravings and prevent symptoms of withdrawal. While side effects mean the dose may be too high, withdrawal symptoms can mean the dose is too low. Withdrawal symptoms to watch for include:
- Withdrawal Symptoms
Choosing Between Suboxone vs. Methadone for Addiction Treatment
Someone looking to start MAT should enter a treatment program and speak with their counselor about options. The decision to start one drug versus the other is complex, and many individual factors must be taken into account.
Suboxone is probably more convenient because it can be picked up at any pharmacy in more than one dose at a time.
Methadone is more potent than Suboxone and will be more effective for people with severe opioid use disorder.
If you or someone you know is looking for opioid dependence treatment, please call The Recovery Village Palm Beach at Baptist Health. We can give you information and put you in touch with professionals to start your journey to recovery.
DailyMed. “Methadone Package Insert.” 2018. Accessed September 15, 2019.
Dailymed. “Suboxone Package Insert.” 2018. Accessed September 15, 2019.
Harvard Health Publishing. “Treating Opiate Addiction.” 2019. Accessed September 15, 2019.
MedlinePlus. “Opiate and Opioid Withdrawal.” 2016. Accessed September 15, 2019.
MedlinePlus. “Methadone.” 2018. Accessed September 15, 2019.
SAMHSA. “Methadone.” Aug. 2019. Accessed September 15, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.