Methadone vs. Suboxone

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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Methadone

Suboxone

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

Contents: Methadone vs Suboxone

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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Comments: Methadone vs Suboxone

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Anonymous comments (12)

April 12, 2014, 1:28pm

I have been taking methadone for almost 9 yrs.Before taking methadone I was a pill popper. At first lortab(10-15 a day).Then I graduated to Oxycontin(200-300mg. a day). I felt like the rest of you, for the first yrs or so thinking methadone was the answer.I word of caution methadone is like any other drug. When you first take it,it's great. but it turns on you after a while.Your withdrawls are gone and you feel good like your life is back on track.But with any opi it takes away your empathy.You feel your thinking more cleary, but actually your mind is slowed down and that spark you had prior before taking any opioid is no longer there.There is weight gain, sugar cravings,and insomnia to name a few.I never had any these problems prior to taking methadone.My advice to anyone thinking about doing the methadone program.Stay at the lowest dose possible. Try not to go over 60 mgs. the less you take the easier will be to taper down. I only wish somebody was there to tell me. To these clinics you are only a customer,not a patient.Most of these counselors are there to finish up there certification to get a lic.So you will go through several. Good luck and God bless.

— 72.✗.✗.62
0

April 11, 2014, 4:20pm

My gf has been on Methadone maintenance for five years successfully, to replace her heroin habit. But our life is tied to this methadone clinic either with daily trips or random call-backs. She has had major sleep disorder and has undergone sleep disorder testing and the sleep doctor prescibed things such as ambien.. etc which was rejected by her program so she has now lost her two week take home bottles and we cant even take an overnite trip without a 2 to 3 week notice and often those requests are rejected.
So WE want to move on away from the program that is so overbearing and controlling and have been looking at a transition to suboxone.. We had a meeting with the doctor at her program to discuss this and he totally rejects the idea becasue 1) Methadone has been working so well 2) that the differences in this article are niot true and that suboxone and methadone are basically the same!
She is in her mid forties, I am a consulting engineer and have turned down lucrative offers because there was no methadone program nearby.
I have other concerns with the long term association in any daily maintenance program---- all her friends are from the program and many still abusing, by selling their meds (methadone or suboxone) and association with other patients makes availability of other addictive substances-benzos- easily available.
what is our best course to move forward. The program doctor does not want her to move away from methadone.. We just feel stuck.

— 71.✗.✗.117
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March 7, 2014, 8:39am

Is there an age requirement for suboxone? I think it could help with the urges. Im in mass, if anyone knows it would be helpful.

— 198.✗.✗.28
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January 7, 2014, 12:59am

I was prescribed pain killers after my back surgery and took them for a year and then became dependent on them, once the doctor heard about this he kicked me to the curb so not wanting to go thru the withdraws I had to buy pills off the street which lead to heroine abuse. Which led me to a methodone clinic which in all cases probably saved my life. My highest dose was 150 mgs and after a couple of years I was tapered down to 17 mgs which I'm at now. You have tobe ready to quit to go to methodone or it won't work

— 98.✗.✗.20
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October 6, 2013, 9:38pm

I ran out of suboxone so im going to take methadone instead. I hope it helps!!

— 98.✗.✗.22
0

August 28, 2013, 10:34am

Sorry to hear about your sister. This only happens to people who have absolutely NO tolerance to opiates, usually young children who accidentally come across a Suboxone film (I say the Film, because the Film dissolves so fast that a young child may not spit it out fast enough to avoid absorbing it into their blood). Although it's nearly impossible for addicted adults to overdose on Suboxone, young children with no tolerance can and sometimes do experience a fatal overdose, when they get the Film. The tablets, however, are almost impossible to accidentally overdose on, because anyone who accidentally puts it in their mouth (especially young children) will spit it out before the damage is done, because the large tablet takes a couple minutes to dissolve, whereas the Film takes only about 2 seconds.

— 68.✗.✗.135
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May 31, 2013, 5:55pm

My sister died of an accidental overdose of soboxone!!!!!

— 208.✗.✗.5
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May 4, 2013, 2:00pm

Methadone helps those who have a severe drug addiction and is more of a last resort drug to defeat the cravings of putting you or anyone else at risk to get your fix. I have tried both Subs and Methadone and both are good if you are serious and have the money and means to completely stay away from all narcotics than I would suggest you go with Subs but if you are a chronic abuser and always relapsing than Methadone I would strongly recommend.

— 184.✗.✗.91
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January 22, 2013, 12:46am

Actually, the naloxone in suboxone does not cause any withdrawal symptoms unless it is injected rather than taken sublingually. What you are saying is a common misconception. There is a chance of precipitated withdrawal if suboxone is inducted while other full agonist opiods are present in the patient because buprenorphine will displace them from receptors and take over. But since buprenorphine is only a partial agonist, it will activate the receptor to a lesser degree, and withdrawal symptoms will occur.

— 24.✗.✗.72
0

December 22, 2012, 8:31am

Suboxone is a wonderful drug for an addict who really wants to quit. Amazingly it takes away the crazy craving even with a bottle of pills within arm reach. I highly recommend it to anyone who feels pain pills are out of control in their life. Highly recommend!

— 70.✗.✗.30
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December 1, 2012, 12:15am

Suboxone IS an effective agent against withdrawl symptoms. It is first administered while a patient is in withdrawl from opioids. Furthermore, it suppresses withdrawl symptoms and fills the opioid receptors in the brain preventing users from feeling the need to ingest or inject opiates. The nalaxone in the drug will cause a patient to go into withdrawl immediately if any amount of an opiate is administered into their body. Therefore, this medication can only be initially administered when no opioids are present with the body--also known as during withdrawl. Where do you get your information from, Wiki-sites?

— 71.✗.✗.196
0

May 1, 2014, 12:48am

Clearly, the best thing is to be off of all medications, entirely, if possible (and I emphasize- if possible). All medications have serious side effects, and are disruptive to normal metabolism. This should be the goal and focal point, of all addiction treatment- not maintenance, but freedom from dependence.

— 98.✗.✗.39
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