What’s the Difference Between Suboxone & Methadone?

Suboxone and methadone are two drugs commonly used to treat opioid use disorder. Suboxone is usually the medication a doctor will have a patient try first, as it is more readily available and has fewer risks associated with it. 

What Is Methadone?

Methadone is a long-acting opioid full agonist, commonly used as a Medication for Addiction Treatment (MAT) for opioid use disorder (OUD) and approved by the FDA for that purpose.[1] It can be helpful in combating OUD symptoms, as it can reduce cravings for opioids and manage withdrawal symptoms. 

Methadone is heavily regulated, only available in the United States at specialized administration sites, so people have to visit a clinic or office daily (at least at first) to get their doses. This creates a real barrier for many patients.

Many argue that the regulations surrounding methadone unjustifiably limit access to a medication that can help with the ongoing opioid epidemic. While the drug does have some misuse potential, similarly or more dangerous drugs with accepted medical uses generally don’t have similar limitations. Many within the medical community believe prescribers should be able to prescribe methadone for OUD in the office. Unfortunately this is not an option at this time. 

What Is Suboxone?

Suboxone is a brand name medication that combines buprenorphine, an opioid partial agonist, and naloxone, an opioid antagonist.[2] It is also used as a MAT for OUD. The active ingredient is buprenorphine. Its naloxone component is present to reduce the medication’s misuse potential. If taken as prescribed, sublingually, the naloxone is not absorbed and only the buprenorphine enters the person’s body. 

Buprenorphine acts similarly to methadone, binding to opioid receptors in the brain and preventing withdrawal. However, it is an imperfect fit, which means it does not produce an intense high even if taken at higher doses, the way methadone might. 

Drugs like Suboxone that combine buprenorphine and naloxone are often considered the first-line MAT for OUD.[2] They are available for at-home use via a prescription, so they are much more convenient to obtain than methadone.

Buprenorphine/naloxone (Suboxone) can be prescribed online by licensed and trained medical providers in any treatment setting, whereas methadone is strictly regulated by the government and can only be provided through federally licensed outpatient treatment center.

Important Comparisons Between Methadone & Suboxone

Methadone vs. Suboxone for Opioid Addiction Treatment

Both Methadone and Suboxone are comparable in terms of their efficacy. Both drugs can save lives and treat OUD. [3] However some individuals may prefer one over the other for various reasons. 

Methadone access is limited in the United States, and it can be difficult for a patient to reliably receive their treatments on the recommended schedule. In contrast, some patients with severe use disorders actually prefer the accountability and routine of arriving at a methadone clinic on a daily basis. For these patients, a methadone program may be preferable to Suboxone. 

In contrast, some people may find themselves too sleepy or sedated on methadone, and may prefer Suboxone, as it tends to produce less sedation or other troublesome side effects.

These are just a few of the reasons to choose one over the other. At the end of the day, the decision about which agent to use is highly specific to the individual’s needs and preferences.

Discussing MAT With Your Doctor

If you think you may benefit from the use of an MAT, talk to your doctor or an addiction treatment professional. Both methadone and buprenorphine-based medications have been shown to help people recover from OUD. 

If your doctor doesn’t think MAT is a good option for you, ask why. There are legitimate medical reasons some patients cannot benefit from these medications, such as if you have certain health conditions. However, the vast majority of patients can safely take MAT. [4]

Unfortunately, a lot of stigma still exists around MAT for OUD, even among medical professionals. Some people mislabel MAT as just “trading one addiction for another”. This is quite untrue and contributes to ongoing counterproductive stigma against these medications. While both methadone and Suboxone are generally used on a long-term basis, they’re taken on a carefully controlled schedule and in a way much safer than the uncontrolled opioid misuse associated with OUD.[5]

If your doctor isn’t familiar with MAT or doesn’t feel comfortable prescribing it, ask for a referral to a professional that does. These days, there are more and more educated medical professionals who are comfortable prescribing MAT and treating OUD.

Sources

1. Methadone. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a682134.html. February 2022. Accessed January 2023.
2. Buprenorphine. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK459126/. May 2022. Accessed January 2023.
3. Buprenorphine vs. Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds. Journal of Neurosciences in Rural Practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271614/. January 2012. Accessed January 2023.
4. Stigma, Misunderstanding Among the Barriers to MAT Treatment. Psychiatric News. https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2019.10a2. September 2019. Accessed January 2023.
5. Variation in Intervention Stigma Among Medications for Opioid Use Disorder. SSM – Qualitative Research in Health. https://www.sciencedirect.com/science/article/pii/S2667321522001238. December 2022. Accessed January 2023.