Methadone vs. Suboxone: Which Will Work Better For You

December 22, 2009 by admin 

There’s no miracle cure for opiate addiction. Sooner or later, all opiate addicts will have to go through withdrawal.

Maintenance therapy with drugs like methadone or Suboxone is helpful because it takes away the severe effects of a heroin or prescription painkiller habit while easing the symptoms of withdrawal. But it’s important to remember that these maintenance drugs are also addictive, and both come with their own withdrawal effects upon quitting.

The use of methadone and Suboxone can be a first step toward a full recovery from opiate addiction. Some people choose to use them for years, and if the drugs are taken as intended, this can be perfectly safe. Others choose to end their maintenance therapy within weeks or months of starting treatment.

In any case, both drugs have their advantages and disadvantages, and they both affect each individual differently. So what are the main things to keep in mind when choosing between methadone and Suboxone?

Agonists, Partial Agonists and the Ceiling Effect

First, a few definitions:

  • Opiate agonists: Opiate agonists are drugs that stimulate the opioid receptors in the brain, leading to the high associated with opiate drugs. They include heroin, Vicodin, morphine, codeine and methadone.
  • Opiate antagonists: Opiate antagonists block the brain’s opioid receptors, making it impossible for opiate drugs to stimulate them. For example, drugs like Naloxone and Naltrexone make it so that, if the user were to take a drug like heroin afterwards, there would be no high.
  • Partial opiate agonist: Partial opiate agonists are drugs that have a “ceiling effect.” In other words, they can only stimulate the opioid receptors to a certain extent. Buprenorphine, the main ingredient in Suboxone, is one of these. No matter how much Suboxone you take, its effects are limited.

And what does all of this mean? For one thing, because Buprenorphine is a partial opiate agonist, it’s very safe. There’s little danger of Suboxone abuse, and it’s very difficult to overdose. That’s why Suboxone is perfect for people who choose to recover from an opiate addiction at home. Taking more than the recommended dose of Suboxone does not make the patient high, and it does not cause the type of respiratory depression that makes opiate overdose dangerous. Thus, many Suboxone patients do not need full-time monitoring.

On the other hand, in some cases Suboxone’s ceiling effect can make the drug less effective, particularly for patients who have very severe, heavy and long-term opiate habits. While Suboxone does block the effects of drugs like heroin, it only partially stimulates those opioid receptors. To get rid of withdrawal effects, people with severe addictions may need more intense receptor stimulation.

That’s where methadone comes in. Because methadone is a full opiate agonist, it doesn’t have a ceiling effect. This means that, if a patient’s withdrawal symptoms are not being fully treated, his or her doctor can up the dosage to achieve a greater effect.

Other Factors to Consider

Here are some factors to keep in mind when choosing between methadone and Suboxone to help you break your opiate addiction:

  • Half-life and frequency of dosage: Suboxone works much more slowly than methadone. While methadone typically works its way through the body in a day or so, Suboxone can take a few days. For this reason, the methadone dosage is daily, while Suboxone dosage is usually every one to four days.
  • Abuse risk: When not taken under doctor supervision, methadone comes with a high risk of abuse. While it doesn’t achieve the same immediate euphoric effects as heroin, large enough doses can produce a high. That is why methadone is increasingly being sold as a black market drug, and why prescription methadone is closely regulated. Suboxone doesn’t come with the same risk. Anyone who has had a severe, long-term opiate addiction will feel absolutely no euphoric effects from any amount of Suboxone.
  • Overdose: Among people who abuse methadone, overdose is a very serious danger. In fact, it’s estimated that more than 3,000 people die from a methadone overdose each year. However, very few of these deaths are associated with methadone maintenance programs for opiate addiction treatment. With Suboxone, it’s more difficult to overdose, but still possible, especially if the drug is injected.
  • Withdrawal: With both drugs, the recovering addict will eventually have to go through some level of withdrawal. Methadone withdrawal is considered to be as bad as, if not worse than, heroin withdrawal, which means that many methadone users either keep taking the drug indefinitely or eventually turn to drugs like Suboxone to fully transition off of all opioids. Suboxone also causes withdrawal, but it’s generally milder than the types of withdrawal associated with full agonists. With both drugs, withdrawal can last anywhere from five days to multiple weeks.
  • Monitoring: Because of methadone’s high risk of abuse and overdose, its usage is generally closely monitored. In many treatment programs, recovering addicts are given only enough of the drug to last a day or two. This means that the patient has to return to the clinic regularly, and doctor visits are frequent. With Suboxone, patients are usually given larger amounts to take home with them. Long-term Suboxone patients often receive enough of the drug for one month at a time.
  • Cost: Methadone can cost an average of $50 per week, while Suboxone generally costs substantially more.

Depending on the individual patient’s needs, both drugs can be helpful. In most categories, methadone is clearly more risky and more open to abuse. However, this doesn’t mean that Suboxone is always preferable.

When taken as instructed and under close doctor supervision, methadone is often the best choice for addicts whose drug problems are particularly severe and long-lasting. Suboxone, on the other hand, is ideal for patients whose addictions are not completely debilitating, but serious nonetheless. Both drugs should only be taken under a doctor’s supervision, and strictly according to instructions.

by McKayla Arnold


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