Suboxone vs. Methadone: Choosing a Medication for Opioid Addiction

What is Suboxone?

Suboxone is a brand name medication that is used to treat opioid addiction. The two ingredients in Suboxone are buprenorphine and naloxone. Buprenorphine (a partial opioid agonist) blocks the opiate receptors and reduces cravings. Naloxone helps reverse the effects of the opioids. The combination of these ingredients aids in reducing cravings for opioids and reverse the side effects of short-acting opioids such as fentanyl and heroin. Suboxone also helps with preventing withdrawal symptoms from opioid detox. Furthermore, Suboxone, unlike other opioid agonist therapy, was designed with safety in mind and prevents individuals from using illicit opioids by limiting their euphoric effect. In addition to this, Suboxone helps reduce the pain of withdrawal and, in some cases, completely eliminates opioid withdrawal symptoms.

How is Suboxone Administered?

In order for Suboxone to be administered, a doctor must prescribe it to you. Suboxone can be both administered in film or tablet form. If Suboxone is being used in film form, it will need to be placed under your tongue in order for the film to deliver the correct amount of medication. As time progresses, your doctor may alter the dose to help wean you off Suboxone altogether.

Pros and Cons of Suboxone?

As Suboxone is designed with safety in mind, those who wish to come off Suboxone can do so through tapering off with a doctor, a relatively painless process. Suboxone also significantly limits the euphoric effects of opiates, thus preventing individuals from using illicit drugs. Moreover, those on Suboxone are less likely to develop a dependency on the drug. Some other pros of Suboxone are:

  • Newer, safe, and effective medicine for opioid addiction.
  • Possible to gradually taper and weaning off of the Suboxone.
  • Long acting allowing for every other day dosing during the taper period.
  • May be continued in case of pregnancy.
  • Monthly visits for compliant patients affording much better lifestyle during treatment.
  • Well tolerated even at high doses with a low likelihood of overdose.
  • Not usually a part of employment drug screening tests.
  • Prevents illicit drug usage during treatment by eliminating euphoria.
  • Associated with less stigma of drug abuse than methadone.
  • Less potential for dependence to, and withdrawal from, the medicine.
  • Covered by most insurance carriers.
  • Great choice to transition from methadone.

            The cons of Suboxone, as compared to that of methadone, are much less substantial. These cons include higher cost than methadone as well as being required to see a specialized physician to be administered the drug. Further possible cons of Suboxone are:

  • Can be more expensive for out of pocket paying clients.
  • Unpleasant taste sometimes reported.
  • May potentially be abused and diverted.
  • It is an opioid agonist, so dependence can develop during the course of therapy and withdrawals occur if treatment is abruptly stopped.
  • Typical, albeit mild, opioid side effect profile.
  • Most strictly regulated drug by DEA, hence requiring treatment by specialized physicians only.

How is Methadone Administered?

Methadone can be administered it two forms. If methadone is used to treat pain, the medication is available in tablet form or oral solution. When used to treat opioid addiction, methadone comes in a fruit-flavoured drink. The powder dissolves and is taken orally once a day.

Pros and Cons of Methadone

Unlike Suboxone, methadone lasts for about 24 hours so it needs to be administered once daily. Due to this, patients are seen on a daily basis which offers more structure. Moreover, the long-lasting nature of methadone makes it a good option for those who require chronic pain management. Further possible pros of methadone are:

  • More than 60 years of experience in treating opioid addiction.
  • Cost is usually less and may be calculated on a sliding scale based on income.
  • It is an opioid so it is able to stop the withdrawal symptoms.
  • There is no legal limit to how many patients a methadone clinic can treat.
  • Without a ceiling effect doses can be increased as the patient becomes tolerant.

Methadone, like other opioids, can be very difficult to come off of. Although methadone is not considered to be as addictive as opioids such as heroin, coming off of methadone can result in very painful withdrawal symptoms. There is also the possibility of abuse which makes methadone much more dangerous than Suboxone. In addition to this, unlike Suboxone, individuals can still use other opiates on methadone without side effects. Studies also show that methadone may have severe effects on cognitive abilities, including working and verbal memory. More possible cons associated with methadone are:

  • High risk that is misused can lead to overdose
  • Leading cause of prescription overdose in the world when misused due to its potency
  • Slow reaction time, lower attention span, and decreased memory function Highly addictive causing strong dependence to the drug and severe withdrawals if stopped.
  • Methadone treatment follows a strict protocol which makes some patients feel that they have no control over their own treatment.
  • Shows up in urine testing for employment.
  • Daily visits to the methadone clinic may be difficult for some patients who have jobs and when traveling distance is an issue.
  • Some people find it difficult to overcome self-esteem issues in a clinical environment.
  • Poor option for clients seeking to come off or taper off the drug.
  • Not all states allow methadone treatment for opioid addiction.

How do Suboxone and Methadone Differ?

There are a few key differences between Suboxone and methadone. Arguably, the most important difference to consider when choosing between Suboxone and methadone is the higher risk of overdose presented by methadone than Suboxone. Moreover, only a specialist who has completed special training can prescribe methadone, while it is much easier to find a physician that can prescribe Suboxone. Unlike Suboxone, methadone is most commonly available through specialized treatment clinics as it must be administered daily. In contrast, Suboxone is much more accessible and does not necessitate daily visits to the clinic. Further, Suboxone takes only a few days to reach a fully effective dose, while methadone can take weeks. Side-effects of methadone are also often more pronounced than with Suboxone.

Switching from Suboxone to Methadone

It is common for someone to switch from methadone to Suboxone for various reasons. Suboxone offers a less stringent treatment schedule and is less regulated than methadone. This makes Suboxone treatment much more accessible and, often, much easier to integrate into one’s daily life. Many transition from methadone to Suboxone to increase their quality of life due to methadone being very difficult to detox from. Ultimately, most people chose to switch to Suboxone simply because it is much safer than methadone.

If you wish to switch from methadone to Suboxone, you must consult with a doctor. You cannot just stop taking methadone and directly after begin taking Suboxone. Before switching to Suboxone, your prescribing doctor will taper the dose of methadone being taken. Prior to taking your first dose of Suboxone, you will need to be in a moderate state of withdrawal. This is, often, the most difficult part of switching, however, when done correctly, it can make a real difference in the success rate of treating with the Suboxone medication. Overall, in order to transition for one medication to the other safely, you must work with your prescribing physician and support team to develop a transition plan.

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