Suboxone and Methadone are used to treat patients with opioid dependency or addiction. They are both synthetic opioids.

Suboxone is partial opiate agonist (i.e. its effects are limited even when taken in large doses) but Methadone is a full opiate agonist. The implications of this are the following advantages and disadvantages:

The active ingredient in Suboxone is buprenorphine while methadone is the name of the chemical that is the active ingredient in drug of the same name.

Comparison chart

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Risk of addiction High Lower than methadone
Risk of fatal overdose High Low
Effectiveness for heavy addicts High Low to medium
Ceiling on effect No (therefore, doses are strictly monitored) Yes (effects of the drug are limited even when taken in high doses)
Price Cheaper than Suboxone; generics available Costlier than methadone
Dosage Dosage closely monitored in an outpatient treatment program; majority of patients in outpatient treatment programs require 50–100 mg/day Available in 2 mg, 4 mg, 8 mg, and 12mg sublingual dosages
Active ingredient Methadone Buprenorphine and naloxone
Forms Available in the form of tablets, dispersible tablets, oral solution (liquid) and as an injection. Sublingual film. Suboxone is no longer available in tablet form.
Manufacturer Eli Lilly and Company (among others) Reckitt Benckiser
FDA approval 1947 2002
Special populations Methadone is the standard care for pregnant women and has been shown to reduce illicit opioid use. Preferable to methadone for patients with higher risks of toxicity (e.g., the elderly, benzodiazepine users), adolescents and young adults

edit Mechanism of Action

The buprenorphine in Suboxone is a strong analgesic (painkiller) similar to other opioids such as morphine, codeine, and heroin however, it produces less euphoric effects and therefore may be easier to stop taking. Buprenorphine works in the brain as a partial opiate agonist. It replaces the opiate the user has been abusing, filling opiate receptors in the brain and keeping them from experiencing withdrawal symptoms. Naloxone is included in the formulation to keep people from injecting and abusing the medication. It is an opiate antagonist that blocks the effects of opioids such as morphine, codeine, and heroin. Naloxone stays inactive if used sublingually (under the tongue). However, if it is crushed and injected, while attempting to abuse the medication, the naloxone becomes active in the brain and causes, in an opiate-dependent person, immediate feelings of withdrawal.

Methadone is a full opioid agonist. Methadone binds with the opiate receptor where methadone mimics the endorphins, keeping the user from experiencing withdrawal symptoms.

edit Metabolism

Both Methadone and Suboxone are metabolized by the liver. Suboxone is eliminated mainly through excretion into the bile. It has a slow metabolism and very high fat solubility, making it longer lasting. The elimination half-life of buprenorphine is 20–73 hours with a mean of around 37 hours.

Methadone has a typical elimination half-life of 15 to 60 hours with a mean of around 22 hours. A longer half-life frequently allows for administration only once a day in opioid detoxification and maintenance programs. Patients who metabolize methadone rapidly, on the other hand, may require twice daily dosing to obtain sufficient symptom alleviation while avoiding excessive peaks and troughs in their blood concentrations and associated effects.

edit Dosage

Suboxone can be taken home as it is much harder to abuse, but since Methadone can be abused, patients need to travel to a clinic each day to take their medication. This requirement may be relaxed and patients may be given take-home doses as they begin to recover. Suboxone is available in 2 mg and 8 mg sublingual dosages. Methadone dosing in an outpatient treatment program is closely monitored with witnessed daily dosing. A majority of patients in outpatient treatment programs require 80–125 mg/d of methadone or more and require treatment for an indefinite period of time, since methadone maintenance is a corrective but not a curative treatment for opiate addiction. For curative treatments, consult drug rehab resources and Narcotics Anonymous.

edit Side Effects

Suboxone can cause drug dependence. It may increase the effects of other drugs that cause drowsiness, including antidepressants, alcohol, antihistamines, sedatives, other pain relievers, anxiety medicines, and muscle relaxants. Suboxone can cause serious side effects like allergic reaction (difficulty breathing; closing of the throat, swelling of the lips, tongue, or face; or hives); slow breathing; dizziness or confusion; or liver problems such as yellowing of the skin or eyes, dark colored urine, light colored stools (bowel movements), decreased appetite for several days or longer, nausea, or lower stomach pain. The other side effects include like nausea and vomiting; drowsiness; dizziness; headache; memory loss; cognitive and neural inhibition; increased perspiration; itchiness, dry mouth, miosis (constriction of the pupil), orthostatic hypotension, sexual impairment, urinary retention.

Methadone too has similar serious side effects like allergic reaction: hives, difficulty breathing, swelling of face, lips, tongue, or throat; shallow breathing; hallucinations or confusion; chest pain, dizziness, fainting, fast or pounding heartbeat; or trouble breathing, feeling light-headed, or fainting. Less serious methadone side effects may include: feeling anxious, nervous, or restless; insomnia; feeling weak or drowsy; dry mouth; nausea and vomiting; diarrhea; constipation; blurred vision; insomnia; loss of appetite; or sexual impairment. Methadone can increase the effects of alcohol, which could be dangerous.

edit Preparation/Form

Suboxone is available in the form of tablets and dissolving film (Suboxone Film). Methadone is available in the form of tablets, dispersible tablets, liquid oral solution, and as an injection.

edit Suboxone Film

In addition to the sublingual tablet, Suboxone is now marketed in the form of a sublingual film, available in both the 2 mg/0.5 mg and 8 mg/2 mg dosages. The makers of Suboxone, Reckitt Benckiser, claim that the film has some advantages over the traditional tablet in that it dissolves faster and, unlike the tablet, adheres to the oral mucosa under the tongue, preventing it from being swallowed or falling out; that patients favor its taste over the tablet; that each film strip is individually wrapped in a compact unit-dose pouch that is child-resistant and easy to carry and that it is clinically interchangeable with the Suboxone tablet and can also be dosed once daily. The film discourages misuse and abuse, as the paper-thin film is more difficult to crush and snort. Also, a 10-digit code is printed on each pouch which helps facilitate medication counts and therefore serves to deter diversion into the illegal drug market.

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