An estimated 2.7 million people in the U.S. have opioid use disorder (OUD).[1] One of the primary ways to combat this complex, chronic disease is with Medication for Addiction Treatment (MAT) programs, which use a combination of medication and behavioral therapy.
Three primary medications are used in MAT:
Although they all work with the opioid receptors in the brain, there are important differences to know before starting treatment. You’ll work with your addiction treatment team to determine the best choice for you.
Chemists first isolated methadone in the 1940s, but it wasn't used to treat people with OUD until 14 years later.[6] Even then, researchers worried that people would misuse this drug rather than recognizing that it would save lives. That confusion persists today.
Methadone is an opioid agonist, meaning it's capable of attaching to the same receptors used by heroin and prescription painkillers. But the attachment is comparatively weak, and people with OUD don't use methadone to get high.
Misuse potential exists for people who use methadone without OUD. For this reason, it’s a Schedule II controlled medication.[7] SAMHSA
Because methadone is so tightly controlled, people new to the medication must use it while supervised. They head to a clinic and take the medication while their doctors watch. Only later can they take the drug on their own at home.
Other, more recent alternatives to methadone have proven effective and are often more convenient.
FDA-approved brand-name medications include the following:[8]
When you enroll in an MAT program for OUD, your doctor will ask questions about your health, lifestyle and addiction history. Your answers will guide your doctor in choosing the right medication for you.
The following chart can help you be an informed participant in these discussions about your medication.[7,9–14]
Methadone BuprenorphineNaltrexoneHow it worksAs a long-acting opioid agonist, methadone binds to opioid receptors and reduces cravingsAs a partial opioid agonist, buprenorphine partially binds to opioid receptors to eases cravings and withdrawal symptomsAs an opioid antagonist, naltrexone blocks other opioids from bindingGeneric version?YesYesYesSide effectsRestlessness, nausea, slow breathing, itchy skin, sweating, constipation, sexual problemsConstipation, headache, nausea, vomiting, dizziness, drowsiness, sweating, dry mouth, tooth decay, muscle aches, insomnia, fever, blurry vision, tremorsNausea, vomiting, fatigue, headache, lightheadedness, reduced appetite, muscle cramps, joint pain, cold symptoms, insomnia, toothachePricingFrom $15 (per tablet) to $366 (per injection)From $18 (per tablet) to $55 (per transdermal film)From about $2 (per tablet) to more than $1,500 (per injection)FormsTablet, oral solution, injectable liquidTablet, dissolving film, injectable liquid Tablet and injection for OUD DosagesLiquid or tablet doses typically range from 20 mg to 80 mg2 mg to 24 mg50 mg (in tablet form), or 380 mg (in injection form, given once every 4 weeks)Drug classSchedule IISchedule IIINone (not a controlled substance)ConvenienceInconvenient, especially at first when in-clinic administration is requiredDesigned for at-home use Designed for at-home use Time to work30–45 minutes (oral dose)About an hour Immediate (in injection form) or about an hour (for tablets)
Keep reading for more information about each type of medication listed within this table.
Naltrexone is a prescription medication approved by the FDA to treat both OUD and alcohol use disorder. It's available as a pill (for alcohol use disorder) or an injection (for OUD).[14]
Naltrexone is not an opioid, and it's not addictive. Instead, it blocks the euphoric action of drugs like alcohol and opioids, making a relapse both less dangerous and less rewarding.
Vivitrol is the OUD injectable form of naltrexone. The shot doesn’t block withdrawal symptoms, but it can offer protection from euphoria caused by a relapse. With repeated use, this shot could help break the connection between getting high and feeling good.
Learn more: What is Vivitrol?
Naltrexone could be a good option for you if you meet some or all of the following criteria:
Buprenorphine is a prescription medication designed to help people with OUD. Buprenorphine works as a partial opioid agonist, linking to the same receptors used by drugs like heroin and oxycodone. Its loose attachment means it doesn't deliver a high for people with OUD.
Once buprenorphine enters the brain, it latches to opioid receptors. It can treat withdrawal symptoms (like nausea or diarrhea) and reduce drug cravings. Buprenorphine has low misuse potential, so people can use the drug at home instead of in a clinic.
Multiple forms of buprenorphine exist, including the following:
Suboxone combines buprenorphine with naloxone. This medication can ease OUD symptoms while providing overdose and misuse protection.
This is a good fit for people with the following characteristics:
Learn more: What is Suboxone?
Subutex is a prescription medication containing buprenorphine in a dissolving pill format. This option can ease OUD withdrawals and cravings, but it doesn't contain overdose or misuse protections like Suboxone.
Subutex is a good fit for people with the following characteristics:
Subutex is not available in the U.S. as of 2011. You can still get it in its generic form, but Suboxone is a much more popular buprenorphine option due to its abuse-deterrent form.
Learn More: What is Subutex?
Sublocade is an injectable form of buprenorphine designed to help people with OUD. Once per month, you'll visit your doctor for an injection of this medication.
Sublocade is a good fit for people with the following characteristics:
Learn More: What is Sublocade?
Zubsolv is a prescription medication that combines buprenorphine and naloxone. It's essentially the same therapy as Suboxone, but it's provided in pill form, not strips.
Zubsolv is a good option for people who dislike the taste of Suboxone strips, but it can be much more expensive. If you can afford the extra fees, it could be a good choice for you.
Learn More: What is Zubsolv?
It's reasonable to consider switching from methadone to buprenorphine if you meet some or all of the following characteristics:
While methadone, buprenorphine and naloxone are effective therapies for people with OUD, researchers believe more can be done to ease symptoms. New medications are in development that could be good options for you in the future.
Those newer options include the buprenorphine implant Probuphine. While this formulation was proven effective, it was too expensive to produce and was pulled from the U.S. market as a result.
Learn more: What is the buprenorphine implant?
Lofexidine (also known as Lucemyra) is also sometimes mentioned as a methadone alternative. This blood pressure medication can ease opioid withdrawal symptoms, but it isn’t a long-term option for managing OUD cravings. It's not considered a good option for people who are no longer in withdrawal.
While new medications and therapies will continue to emerge, Suboxone is currently considered the best methadone alternative for most patients.
These helpful resources can assist you in learning more about your medication options, so you can be an active participant in discussions with your doctor:
At Bicycle Health, we know buprenorphine medications can be lifesavers for people with OUD. We also know that far too many people can't find doctors able to administer MAT programs. We can help.
Our telemedicine approach gives you access to the following elements:
Your healthcare information is always protected. You can preserve your privacy and your health at the same time by working with Bicycle Health.
When you work with us, you’ll have easy access to the medication you need and support at every step of your recovery journey. Find out more about our treatment model.
Learn more: How Bicycle Health Treatment Works
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
