Suboxone vs. Methadone – is it the same?

While the two are similar, Suboxone and methadone are not the same medication. The active ingredients in Suboxone are buprenorphine and naloxone. For methadone, the active ingredient is methadone hydrochloride. Both medications are opioids, which means they act on the body in similar ways. Both suboxone and methadone are indicated for the treatment of opioid dependence, and in some cases, chronic pain.  

Does anyone still use methadone?

Yes, methadone is still used for treating opioid addiction, and to a lesser degree, chronic pain. While it isn’t talked about as much as it once was, use is actually on the rise, likely because opioid addiction and treatment are increasing. Doctors have been prescribing methadone for decades, long before I started practicing medicine.

Most of the time, I prescribe buprenorphine-based medications because they are better for the short term. Where it can take weeks to wean off of methadone, buprenorphine can help someone overcome the initial opioid withdrawal symptoms in the short term. Medications like Suboxone and Subutex are more flexible, and therefore more practical for clinical use.

Another reason Suboxone and other buprenorphine-based medications are the better choice is that they can be prescribed by approved doctors during an outpatient visit, like you do with other prescriptions. Methadone, on the other hand, requires individuals to travel to a specialty clinic where they take the drug under supervision. Now, people in recovery can treat their opioid addiction by taking medicine at home, without the additional step of traveling to the clinic.

Is suboxone more effective than methadone?

Both medications are effective for treating opioid addiction. However, most physicians (including myself) prefer to prescribe suboxone. The combination of buprenorphine and naloxone makes suboxone a safer and more flexible medication. And, subutex and suboxone can be used both in the short-term during detox and longer-term with maintenance programs.

One study comparing the effectiveness of methadone and buprenorphine (the main ingredient in Suboxone) found that they are equally effective for treating opioid addiction.

Does Suboxone cost more than methadone?

Yes. Suboxone is a brand-name medication; methadone is a generic. As such, it costs more to access. Generic versions of Suboxone have been on the market since 2018. These are more cost-effective than the brand-name drug, yet are still pricier when compared to methadone, especially given some methadone clinics are free of charge.

Can you overdose on Suboxone and methadone?

Methadone overdose can occur and is well documented. However, that doesn’t mean that the medication is unsafe or ineffective. Most methadone overdoses happen to non-prescribed users, often when someone takes more than they are prescribed or mixes the medication with other substances.

Suboxone overdose is possible, but it’s rare. This comes down to two factors. One: it is only a partial opioid agonist. Two: it contains naloxone, which is designed to reverse opioid overdose. Because of the lower potential for abuse and overdose, suboxone is usually considered the safer medication.

Is Suboxone harder to get off than methadone?

Both are opioids, and withdrawal symptoms may occur when you discontinue taking the medication. Suboxone and methadone have a reputation for causing difficult detoxes, but the truth is that all opioids can cause these symptoms, and neither suboxone nor methadone is worse. Anyone who is discontinuing these medications should consult with their doctor to help them gradually and safely lower the dose. Following the advice of medical professionals will help reduce withdrawal symptoms and ensure a safe transition off of the medication.

Because suboxone is a partial opioid agonist while methadone is a full opioid agonist, the latter is more likely to cause dependence. Keep in mind that every person will respond to these medications in their own way, so while one is more likely than the other to be harder to stop, there are no guarantees.

Is suboxone safer than methadone?

Suboxone is considered a safer medication because it contains naloxone, an opioid blocker. Naloxone blocks the feel-effects of the opioid while the buprenorphine diminishes withdrawal symptoms. Methadone, on the other hand, does not contain an opioid blocker to counter its main ingredient.

Does suboxone interfere with methadone?

Suboxone is not prescribed alongside methadone- it’s one or the other. Taking both at the same time could cause an adverse reaction and send an opioid-dependent person into full withdrawals. If the doses are high enough. Although methadone and suboxone are entirely different medications, they are both opioids, and taking them together will significantly increase your chances of overdose. Both of these medications should only be taken as prescribed by your physician.

Sources

Substance Abuse and Mental Health Services Administration: “Trends in the use of methadone, buprenorphine, and extended-release naltrexone at substance abuse treatment facilities”
Pharmacy Times: “Generic Therapies Available for Treating Opioid Dependence”
Medline Plus: “Methadone overdose”
Harvard Health publishing: “5 myths about using Suboxone to treat opiate addiction”
National Institute on Drug abuse: “Opioid Overdose Reversal with Naloxone (Narcan, Evzio)”

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