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Updated on November 29, 2021

Methadone vs Suboxone

How are Methadone and Suboxone Different?

Methadone and Suboxone are prescription opioids. Both medications are FDA-approved for medication-assisted treatment (MAT)

The main difference between the two medications is that Suboxone is only approved for treating opioid use disorder (OUD). Methadone treats both chronic pain and OUD.

Methadone and Suboxone also differ in the following ways:

  1. Methadone fully stimulates the brain (full agonist), while Suboxone does not (partial opioid agonist).1
  2. Methadone is dispensed orally in a liquid or tablet form, while Suboxone is available as a tablet or sublingual film (placed under the tongue).
  3. Methadone is more effective than Suboxone, especially in severe cases of addiction. Suboxone is less effective in managing cravings that contribute to relapses.

How Does Methadone Work?

Methadone is a long-acting opioid agonist

It prevents cravings by acting on opioid receptors in the brain. This result is reduced opioid withdrawal symptoms, which include sweating, anxiety, nausea, and diarrhea, among others.2

Methadone treatment also relieves pain by acting on pain receptors in the brain and nervous system, just like other opioid pain medications like hydrocodone and morphine.

However, Methadone activates the opioid receptors in an opioid-dependent person without producing euphoria.3

Methadone is one component of a holistic treatment approach that often involves counseling and other behavioral health treatments.

Methadone Dosage & Administration

Methadone dosage differs from person to person.4 Follow your doctor’s directions to ensure you’re taking the correct dose for your condition.

By law, Methadone can only be dispensed through a certified opioid treatment program (OTP).5

In addition, a person should receive this drug under the supervision of a mental healthcare professional.

If you’ve been taking Methadone for more than a few weeks, don’t stop taking it without consulting your doctor first. To prevent Methadone withdrawals, you’ll need to stop gradually.

Benefits of Methadone

In addition to opiate addiction treatment and chronic pain management, Methadone also has the following benefits:

  • Lowers the risk of infectious diseases such as HIV/AIDS and hepatitis spread through sharing opioid injection needles
  • Improves a person’s overall quality of life 
  • Improves social functioning
  • Allows for better participation in treatment programs by eliminating opioid withdrawals
  • Prevents relapse by controlling cravings

Side Effects & Risks of Methadone

Alongside the benefits, Methadone has the following mild and severe side effects:

Mild side effects include:

  • Irritability
  • Anxiety
  • Restlessness
  • Disturbed color perception
  • Constipation
  • Confusion 
  • Missed or irregular menstrual periods
  • Weight changes
  • Decreased sexual drive
  • Night blindness
  • Weakness
  • Itching

Severe side effects include:

  • Blurred or loss of vision
  • Nausea or vomiting
  • Bleeding gums
  • Changes in skin color
  • Convulsions
  • Extreme fatigue
  • Cough with a frothy pink sputum
  • Difficult or troubled breathing
  • Difficulty with swallowing
  • Noisy breathing or wheezing
  • Dizziness, faintness, or lightheadedness
  • Dry mouth
  • Double vision
  • Puffiness or swelling around the eyes
  • Muscle pains
  • Hives or skin rash
  • Addiction 

Note that this is not a complete list of Methadone’s side effects. However, be vigilant as you take Methadone and discuss any unusual changes with your healthcare provider.

Severe reactions, including Methadone overdose, may occur if you mix the drug with other drugs such as alcohol or narcotics.

When Methadone is used with alcohol or other depressants or sedatives, slowed breathing, unconsciousness, coma, and even death can result.

Methadone Addiction Potential 

Addiction occurs when you can't control cravings. You can’t quit even when it results in harmful consequences.

The law classifies Methadone as a Schedule II drug.7 This means that it has a high risk of abuse and can lead to addiction. In this case, non-medical use of Methadone is prohibited.

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How Does Suboxone Work?

Suboxone acts on receptors in the brain, preventing cravings.8 It is a mixture of naloxone and buprenorphine. 

Buprenorphine acts like other opioid drugs such as heroin but in moderation, hence the name partial agonist.

Naloxone, on the other hand, blocks the brain receptors from the euphoric effects of buprenorphine. This helps prevent Suboxone misuse.

When the dosage of Suboxone is decreased gradually over time, these two substances work well together. 

This allows a person to recover while free of the pain and suffering associated with opiate withdrawal.

Suboxone Dosage & Administration

Suboxone comes as a sublingual film or a tablet

Treatment should begin with supervised administration and gradually move to unsupervised administration based on a person’s needs.

The recommended starting dosage is 8 mg/2 mg Suboxone.9 Eight milligrams (mg) represents the amount of buprenorphine, and two milligrams (2 mg) represents that amount of naloxone.

The recommended maintenance dose for Suboxone is 16 mg/4 mg taken once daily.

The Suboxone film should not be cut, chewed, or swallowed as this will affect absorption and lessen the effects of the drug.

Benefits of Suboxone

In regard to treating opioid addiction, Suboxone has the following benefits:

  • Increases the chances of survival in cases of severe opioid dependence
  • Prevents unpleasant withdrawal symptoms, allowing you to focus on treatment
  • Enhances the success of other holistic approaches such as behavioral therapy and support services when used together
  • Decreases criminal activities related to drug use
  • Improves outcomes in pregnant women with OUD
  • Improves a person’s overall quality of life

Side Effects & Risks of Suboxone

Mild side effects include:

  • Drowsiness
  • Anxiety
  • Depression
  • Problems with concentration
  • Sweating
  • Headache
  • Constipation
  • Blurry vision
  • Trouble sleeping (Insomnia)

Severe side effects include:

  • Problems breathing due to respiratory depression
  • Painful tongue
  • Back pain
  • Numb or tingling mouth
  • Fast or irregular heartbeat
  • Nausea and vomiting
  • Dizziness and fainting
  • Liver damage
  • Dependence
  • Coma

The main risk associated with Suboxone is respiratory depression. This is a condition where breathing is slow or too shallow, depriving the body of oxygen.

If you experience these symptoms after taking Suboxone, seek immediate medical assistance.

Suboxone Addiction Potential 

Suboxone is classified as a Schedule III drug under the Controlled Substance Act (CSA).10 

Although these drugs are not as strong as schedule I and II, long-term usage may lead to physical and psychological dependence.

If Suboxone usage is suddenly discontinued, severe opioid withdrawal symptoms may occur. To help avoid these symptoms, if you want to quit Suboxone, do so gradually, with assistance from your doctor.

Is Methadone or Suboxone Right for You?

Medication-assisted treatment (MAT) is a mix of drugs, behavioral therapy, and support services designed to help people recover and reclaim a drug-free life.

There is enough evidence to show that both Methadone and Suboxone are effective addiction treatment drugs. They reduce the need for medical detoxification.

However, in severe cases of opioid addiction, Methadone is the most effective treatment option. It prevents cravings and other withdrawal symptoms while also managing pain.

If you or a loved one is suffering from opioid addiction, talk to an addiction specialist about methadone or suboxone. Your doctor will be able to advise on the best option for you.

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Resources

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  1. Methadone,” Substance Abuse and Mental Health Services Administration (SAMHSA), 04, Nov. 202104
  2. Opiate and opioid withdrawal,” U.S. National Library of Medicine, 02 Nov. 2021
  3. Opioid Agonists and Partial Agonists (Maintenance Medications),” National Institute on Drug Abuse (NIDA), Jun. 2018
  4. Methadone (Oral Route),” Mayo Foundation for Medical Education and Research (MFMER), 01 Nov. 2021
  5. MAT Medications, Counseling, and Related Conditions,” Substance Abuse and Mental Health Services Administration (SAMHSA), 04 Nov. 2021
  6. CDC “Infectious Diseases, Opioids and Injection Drug Use,” U.S. Department of Health & Human Services, 31 Aug. 2021
  7. Methadone,”  Drug Enforcement Administration (DEA), Apr. 2020
  8. Orman JS, Keating GM.“Buprenorphine/naloxone: a review of its use in the treatment of opioid dependence,” Springer, 17 Sep. 2012
  9. DailyMed “Suboxone,” U.S. National Library of Medicine, 17 mar. 2021
  10. Buprenorphine,” Drug Enforcement Administration, Dec 2019

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