Methadone vs. Suboxone

Methadone and Suboxone can help people safely end opioid use. The drugs are both opioids, but they differ in their active ingredients and how they work in the body.

Is Suboxone the Same as Methadone?

Suboxone (the brand name for buprenorphine/naloxone) and methadone are two popular medications used to treat opioid addictions. Both can be used as part of drug replacement therapy, in which they replace more potent opioids like heroin or morphine. Because someone with a severe opioid dependence can face severe health risks if they quit “cold turkey,” these replacement medications are used to help wean patients off gradually and safely.

While both drugs are used as part of drug detox and recovery treatment, they differ slightly in their benefits and risks. The following provides an overview of the differences between methadone and Suboxone and discusses how these medications can be used as part of a safe opioid rehab program.

Comparing Suboxone and Methadone

Treatment With Methadone

The goal of methadone treatment is to help people manage opioid addiction side effects in a controlled manner. Methadone acts on the same mu opioid brain receptors as other opioids, but it lasts longer and has a cumulative effect over time. The result is fewer cravings and diminished withdrawal symptoms.

After a maintenance period, the amount of methadone used in treatment is reduced until the person is able to manage side effects without it. However, some people may continue taking methadone indefinitely.

Advantages of Methadone

Methadone’s major advantage is its ability to satiate opioid cravings in a relatively controlled way. It is classified as a “full agonist opioid,” meaning it fully stimulates the opioid receptors in the brain. This is particularly useful for severe cases of opioid addiction that may not be as responsive to other types of drug replacement therapy. This effect also allows methadone to block the euphoric effects of other opioids, such as heroin and prescription painkillers.

Disadvantages and Risks of Methadone Treatment

Methadone is generally considered safer than many other opioids, but it is still a drug that carries a risk of dependence and abuse. While methadone helps far more people than it harms, methadone addiction and overdose are risks that must be managed. This is why methadone is typically dispensed in a highly controlled, clinical environment — it allows for supervised methadone administration and minimizes abuse risks. However, this can also make it more difficult for some people to receive treatment, as they must physically visit a clinic or medical facility for each dose.

Treatment With Suboxone

Suboxone is a comparatively new option for treating opioid addiction. It is the brand name for a medication that actually contains two separate drugs: buprenorphine and naloxone.

Buprenorphine

Like methadone, buprenorphine is an opioid that is used as part of opioid drug replacement therapy. It is classified as a “partial agonist opioid,” meaning it binds to the brain’s opioid receptors but does not fully stimulate them like methadone or other opioids can. This results in less of a drug high.

Naloxone

Naloxone, also known by the brand name Narcan, is a medication that blocks the effect of opioids. On its own, it is often used to treat opioid overdose and help mitigate its life-threatening health risks. When taken by mouth, naloxone is poorly absorbed. It is added to Suboxone to reduce the risk that a person will try to misuse the drug by injecting it, as doing so will block opioid receptors and cause withdrawal symptoms.

Advantages

Because it is only a partial agonist, the buprenorphine in Suboxone has a “ceiling effect.” This means that the opioid’s effects will level off after a certain point, even if more of the drug is consumed. This built-in limit to the opioid’s euphoric effects reduces the physiological incentive to take more. The intended result is a lower risk of dependence, abuse and side effects. Buprenorphine also blocks mu opioid receptors, which has the benefit of directly blocking the effects of other, more dangerous opioids if they are also used.

Because Suboxone is taken by mouth as an oral tablet or film, the naloxone does not have a significant effect — it is poorly absorbed by the body when taken orally. Its primary purpose is to prevent people from injecting the opioid for an increased high. When someone injects Suboxone, the naloxone is more readily processed and will effectively block the effects of the buprenorphine.

When a person’s abuse risks are deemed to be low, the person may be able to take Suboxone on their own like a typical prescription. This allows for more flexibility and ease than methadone, which usually must be dispensed in a clinical environment.

Disadvantages and Risks

Because it is a partial agonist, Suboxone may not be as effective as methadone for managing cravings and withdrawal side effects in more severe addiction cases. Additionally, although buprenorphine is considered a relatively safe option for addiction treatment, it is still an opioid that carries its own side effects and risks for dependence.

Side Effects and Withdrawal Symptoms Comparison

Methadone and Suboxone are both opioids and have similar side effects.

Side effects may increase in severity when medications are used in excess or in ways other than prescribed.

Both medications can also cause physical dependence, so it is possible for people to experience withdrawal symptoms when ending the use of either drug. However, there is little data available on withdrawal symptom differences between the drugs.

Deciding Which Course of Treatment Is Best for You

If you or someone you love is struggling with opioid use, help is available at The Recovery Village. Our trained addiction experts can help you decide which medication may best suit your needs. Alongside medication-assisted treatment, we provide a full continuum of care that addresses all aspects of addiction and helps promote lifelong recovery. Contact us today to learn more about opioid addiction treatment programs that can work well for your situation.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more