Suboxone® vs. Methadone

When designing a medication-assisted treatment (MAT) plan for patients, most doctors prescribe one of two medications: methadone or Suboxone®. While both are used to treat opioid use disorder (OUD), these two drugs work differently and will be suitable for different patients and occasions. 

What is Suboxone?

First released in the early 2000s, Suboxone is a prescription medication made from a combination of buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, meaning it affects the same parts of the brain as other opioids, but it only partially activates the appropriate receptors. As a result, a patient doesn’t experience any of the euphoric effects normally associated with opioid use.

Naloxone is an opioid antagonist that competes with other substances in the brain for space on the opioid receptors. The receptors have a stronger affinity for naloxone, meaning they will bind with it before binding with an opioid. However, because it’s an antagonist, the naloxone stays bound without actually activating the receptor. In other words, naloxone takes up space and essentially blocks opioids from taking root in the brain. This quality also allows naloxone to reverse the effects of an opioid overdose, such as lowered heart rate and breathing. 

Suboxone uses these two compounds in conjunction to reduce cravings and withdrawal symptoms, drastically lower the risk of overdose, and create a very low potential for misuse or addiction. 

What is methadone?

Methadone was first synthesized during World War II with the intention of being used as a painkiller. It is a long-lasting, full opioid agonist, meaning it fully activates the brain’s opioid receptors and stays in the body for longer than other opioids. It’s also used to treat chronic pain. However, methadone doesn’t create the euphoric effects associated with most other opioids. 

Methadone is commonly taken daily in tablet form and is helpful in reducing cravings and withdrawal symptoms. The dosages act quickly, and the effects can eventually last for up to 36 hours. Its side effects match those of other opioids, and, while effective for treatment, it also exhibits potential for misuse.

How are Suboxone and methadone different?

Until Suboxone’s introduction to the market, methadone was the primary drug used in OUD treatment. It’s still available today, but there are very strict rules for how it’s dispensed. Patients need to be at a clinic in person so they can be observed during treatment. They often have to adhere to a very strict daily schedule that can conflict with school, work, or family responsibilities. If you don’t have access to reliable transportation, just getting to the clinic can be difficult, especially if you’re in a community where clinics are few and far between—and there are a lot of communities in that position.

Despite methadone’s efficacy as a treatment method, it’s not without risk. Due to the risk of overdose, methadone is a Schedule II drug, compared to Suboxone, which is Schedule III due to its better safety profile. Patients who start methadone need to be seen in person daily for the first 90 days to cautiously increase their dose to the full therapeutic dosage, typically 60 – 100mg. 

The buprenorphine in Suboxone is safer because it has a “ceiling effect;” after a certain dosage, the effects of the opioid do not compound. The addition of naloxone further discourages the harmful effects of opioids deterring illicit injection of the medication. 

While both medications have their benefits, Ophelia provides Suboxone-based treatment because it’s safe and effective for a wide range of people. Most importantly, it can be prescribed by a telemedicine provider and picked up at your local pharmacy. If you or a loved one is dealing with opioid use disorder, scheduling a free consultation call is the first step to getting back on track.

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Ophelia team
Ophelia team

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