Suboxone and Methadone are both medications used in the treatment of opioid use disorder (OUD). In this article, we will explore the nature of each one, answer the commonly asked question ‘is suboxone the same as methadone?’, and then look at their similarities, differences, and relative advantages and disadvantages.
What is Suboxone?
Suboxone is a medication used in the treatment of opioid use disorder (OUD) and the management of opioid dependence. It is a brand-name drug that is made up of two active ingredients: Buprenorphine and Naloxone.
Buprenorphine is a derivative of Thebaine, an extract of opium. It is a partial opioid agonist, which means it stimulates the same brain receptors as full opiate agonists such as heroin but does so with a “ceiling effect.” This means that it produces a lesser degree of sedation and respiratory depression than full opiate antagonists and causes no significant impairment of cognitive or motor skills. In addition, its effects reach a peak and do not continue to increase with higher doses. Buprenorphine helps to reduce opioid cravings and withdrawal symptoms and the euphoric effects of other opioids, allowing individuals to stabilize their lives and participate in addiction treatment.
Naloxone is an opioid antagonist, which means it blocks the effects of opioids. It is included in Suboxone to deter misuse. If someone attempts to inject or misuse Suboxone, the naloxone component can bring about opioid withdrawal symptoms, making the misuse less rewarding.
Suboxone is used as part of a comprehensive treatment approach known as Medication-Assisted Treatment (MAT), which combines medication with counseling and behavioral therapy to support individuals in their recovery from opioid addiction.
What is Methadone?
Methadone is a synthetic opioid medication. It is a full opioid agonist, which means that it acts on opioid receptors in the brain - the same receptors that other opioids, such as heroin, activate. Although it occupies and activates these opioid receptors, it does so more gradually and with milder effects than other opioids and doesn’t deliver the same euphoric feelings that illicit opioids do. It also produces a stable level of the drug in the brain, unlike the rapid onset and short duration of action in the brain that opioid drugs have. Methadone eliminates withdrawal symptoms and relieves drug cravings for those weaning themselves off of opioids, reducing their desire to use opioids.
Like Suboxone, Methadone allows individuals with OUD to stabilize their lives and participate in treatment programs.
Differences Between Methadone and Suboxone
Methadone and suboxone are both medications used to treat opioid use disorder (OUD), but they have some key differences in terms of their composition, how they work, and their use in addiction treatment. Here are the main differences between the two drugs:
- Composition:
- Suboxone: Suboxone is a combination medication that contains two active ingredients, buprenorphine and naloxone. Buprenorphine is a partial opioid agonist that can help reduce opioid cravings and withdrawal symptoms. Naloxone is added to deter misuse, as it can precipitate withdrawal symptoms if Suboxone is injected.
- Methadone: Methadone is a synthetic opioid medication that is a full opioid agonist. It activates the same opioid receptors in the brain as other opioids but does so more gradually and with milder effects.
- Administration:
- Suboxone: Suboxone is typically administered as a tablet or film that dissolves under the tongue.
- Methadone: Methadone is administered as a liquid, and patients usually drink it as a daily dose at a Methadone clinic under supervision.
- Setting and Supervision:
- Suboxone: Suboxone is prescribed by qualified healthcare providers, and patients may be able to take it home for self-administration once they are stable in their treatment.
- Methadone: Methadone is administered by a practitioner in a Methadone clinic or opioid treatment program (OTP), where patients must visit daily to receive their dose under supervision. After achieving a sustained period of stability through consistent progress and adherence to prescribed medication dosages, patients may be granted the option to self-administer Methadone at home in between their scheduled program visits.
- Duration of Action:
- Suboxone: Suboxone has a relatively long duration of action, typically requiring daily or every other day dosing.
- Methadone: Methadone has an even longer duration of action, which is why it can be administered once a day.
Benefits of Suboxone and Methadone
The National Institute on Drug Abuse (NIDA) explains that medications that treat opioid use disorder “increase the likelihood that a person will remain in treatment, which itself is associated with lower risk of overdose mortality, reduced risk of HIV and HCV transmission, reduced criminal justice involvement, and greater likelihood of employment.”
People with opioid use disorder who go “cold turkey” and follow detoxification with complete abstinence are very likely to relapse and return to using the drug. Using an Opioid withdrawal drug means that they can reduce the adverse effects of withdrawal and cravings without producing the euphoria that the original drug of abuse caused.
Suboxone vs Methadone Treatment
Suboxone and Methadone each have their own set of advantages and disadvantages. Here’s an overview of the advantages and disadvantages of each drug:
Advantages of Suboxone:
- Lower Abuse Potential: Suboxone contains buprenorphine, a partial opioid agonist with a “ceiling effect.” This means it has a lower abuse potential compared to full opioid agonists like Methadone. It is less likely to produce intense euphoria, making it a safer option for many individuals.
- Lower Overdose Risk: The naloxone component in Suboxone discourages misuse. If someone attempts to inject or misuse Suboxone, the naloxone can precipitate opioid withdrawal symptoms, reducing the risk of overdose.
- Take-Home Dosing: Once patients stabilize in treatment and demonstrate compliance, some may be eligible for take-home doses of Suboxone. This can offer more flexibility and convenience in their recovery. Unlike Methadone, this means that they don’t have to travel to a clinic every day to receive the drug.
Disadvantages of Suboxone:
- Misuse Potential: While the abuse potential is lower than that of full opioid agonists since it can precipitate withdrawal symptoms in high doses, individuals who are addicted to low doses of opiates may still misuse Suboxone.
- Less Effective: because high doses of the drug can cause withdrawal symptoms, Suboxone is not as effective as Methadone in treating severely opiate-addicted individuals who require larger doses of opiates to maintain treatment therapy.
Advantages of Methadone:
- Effective Craving Reduction: Methadone is a full opioid agonist, and it can be highly effective in reducing opioid cravings and withdrawal symptoms. This can help individuals stabilize their lives and engage in treatment.
Disadvantages of Methadone:
- Higher Abuse Potential: Methadone is a full opioid agonist and can produce euphoria, making it more likely to be misused compared to Suboxone.
- Daily Clinic Visits: Methadone treatment typically requires daily visits to a licensed treatment clinic for supervised dosing, which can be less convenient and also carry a stigma for some individuals. While there are take-home dosing options, these are limited and have strict guidelines.
- Potentially More Side Effects: Methadone can have more side effects, including sedation and constipation, compared to Suboxone.
Methadone vs Suboxone Side Effects
Like all medications, Suboxone and Methadone can have side effects. The severity and likelihood of side effects can vary from person to person. Below are common side effects associated with both drugs:
Common Side Effects of Suboxone:
- Nausea: Nausea is one of the most common side effects of Suboxone. It can be mild to moderate and often occurs when starting the medication or when the dose is adjusted.
- Vomiting: Some individuals may experience vomiting, particularly when first starting Suboxone.
- Constipation: Suboxone, like other opioids, can slow down gastrointestinal motility, leading to constipation.
- Headache: Headaches are a relatively common side effect.
- Sweating: Excessive sweating or changes in sweating patterns can occur.
- Insomnia: Some individuals may experience difficulty falling asleep or staying asleep.
- Anxiety or Irritability: Mood changes, such as anxiety or irritability, can occasionally occur.
- Pain at the Application Site: If Suboxone is used in its sublingual form (tablet or film), some individuals may experience discomfort or pain under the tongue.
- Mild Withdrawal Symptoms: When Suboxone is first initiated or if taken too soon after using full opioid agonists, it can precipitate mild opioid withdrawal symptoms.
Common Side Effects of Methadone:
- Sedation: Methadone can cause drowsiness or sedation, especially when first starting treatment. This effect can decrease over time as the body adjusts to the medication.
- Constipation: Methadone, like other opioids, can lead to constipation.
- Dry Mouth: Some individuals may experience a dry or cottonmouth sensation.
- Nausea and Vomiting: These side effects can occur when initiating Methadone treatment or when the dose is adjusted.
- Weight Gain: Weight gain is possible with long-term methadone use for some individuals.
- Sweating: Excessive sweating or changes in sweating patterns may occur.
- Sexual Dysfunction: Methadone can affect sexual desire and function in some individuals.
- Respiratory Depression: Methadone carries the risk of respiratory depression, especially when taken at higher doses or when misused.
Potential of Abuse for Suboxone and Methadone
Both Suboxone and Methadone have the potential for abuse, but their abuse profiles are different due to their pharmacological properties.
In terms of Suboxone, Buprenorphine is a partial opioid agonist, which means it activates opioid receptors in the brain but does so with a “ceiling effect.” This limits the intensity of the opioid effect, making it less likely to produce the intense euphoria that full opioid agonists like heroin bring about. Buprenorphine’s abuse potential is generally lower than that of full opioid agonists. Naloxone is an opioid antagonist, which means it blocks the effects of opioids. It is included in Suboxone to deter misuse. If someone attempts to inject Suboxone (a common route of opioid misuse), the naloxone component can bring about opioid withdrawal symptoms, making the misuse less rewarding.
Methadone is a full opioid agonist. In essence, it is a substitute for more harmful opioids like heroin. When abused, it causes effects in some users, such as euphoria, that are similar to those caused by the abuse of heroin and other opiates. Over time, legitimate and illegitimate users may develop a tolerance for and dependence on Methadone, paving the way for addiction, which is ironic since Methadone is designed to help treat addiction.
In short, Suboxone has a lower risk of misuse compared to Methadone.
It’s important to note that both Suboxone and Methadone are considered controlled substances due to their potential for misuse, which means that they are subject to legal and regulatory controls. As with any drug, they are safe and effective for treating opioid addiction when used as directed. They only become problematic when they are taken in ways other than those intended and/or with other drugs. The potential for abuse with these medications can vary from person to person, depending on individual factors, such as the history of substance use disorder and treatment compliance.
Can You Take Suboxone and Methadone Together?
Taking Suboxone and Methadone together is generally not recommended without careful medical supervision and a specific treatment plan.
If taken together, Methadone, a full opioid agonist, and buprenorphine, a partial opioid agonist, can compete for opioid receptors in the brain. They have what is known as a synergistic effect on each other, which is when the combined action of two or more drugs or substances is greater and more potent than the sum of their individual effects when taken separately. This interaction can lead to a risk of opioid overdose and increased side effects, such as respiratory depression, opioid toxicity, and overdose.
In addition, if a person has Methadone in their system and takes Suboxone, the Naloxone element of Suboxone will induce opiate withdrawal that can be very intense and uncomfortable.
Suboxone Vs Methadone: Which One Is better?
As we have seen, each drug carries with it advantages and disadvantages. Those experiencing Opioid Use Disorder will be guided toward the proper treatment for them by a trained professional with expertise in addiction medicine. The choice between which medication they should take will be based on several factors, such as the severity of their addiction, their medical history, their response to treatment, and the specific treatment approach recommended by healthcare providers.
Opioid Addiction Treatment at Avenues Recovery
If you are struggling with opioid addiction and require medication and treatment, contact Avenues Recovery today. Our experienced and highly trained staff are waiting to help you. We have helped thousands of people overcome their addictions and we can help you too.With our help, you will be able to turn your dream of living a life free from addiction into a reality. At Avenues you will receive the highest quality care combined with utmost empathy and professionalism. Contact us today to begin your journey towards sobriety.