In the journey towards recovery from opioid addiction, choosing the right medication-assisted treatment (MAT) is a crucial step. Two commonly prescribed medications in MAT are methadone and Suboxone.
Both have been proven effective but differ in their mechanisms, side effects, and administration. This blog post aims to provide a comprehensive understanding of methadone and Suboxone treatments, helping individuals make informed decisions in their recovery process.
1. What is methadone and how does it work?
By blocking the brain’s opioid receptors, Methadone blunts the euphoric effects associated with opioids like heroin, while also alleviating opioid cravings and withdrawal symptoms.1
Its effectiveness lies in its ability to be a full opioid agonist and provide a stable, controlled release of opioid effects. This stability is crucial in preventing the peaks and troughs in blood levels that often lead to a cycle of addiction.1
The administration of methadone is highly regulated. Patients typically begin with a closely monitored dosage at a clinic, which is adjusted over time to reach an optimal maintenance level. This supervised setting helps mitigate the risks of overdose and misuse, ensuring that the treatment is both safe and effective.
Additionally, Methadone’s impact goes beyond physical symptoms; it helps individuals rebuild their lives by improving social functioning and reducing criminal behavior associated with drug use.
However, the requirement for daily clinic visits can be a challenge for some, making adherence to the treatment a significant commitment.
2. What is Suboxone and how is it different from methadone?
Suboxone is a partial agonist that represents a newer class of medication in MAT, introduced in the early 2000s. It combines buprenorphine, a partial opioid agonist, with naloxone, an opioid antagonist.2
Buprenorphine’s partial agonist properties mean it activates the opioid receptors in the brain but to a much lesser degree compared to Methadone. This results in a lower potential for misuse, a ceiling effect on opioid effects, and a reduced risk of respiratory depression, a serious side effect associated with opioid use.2
Naloxone, the second component, is included to deter intravenous misuse. If Suboxone is injected, naloxone becomes active and can precipitate and ease withdrawal symptoms. However, when taken as prescribed—usually sublingually—naloxone has negligible effects.3
Suboxone’s formulation allows for more flexibility in treatment. Patients can start Suboxone in a wider range of settings, including primary care offices, and eventually take the medication at home. This greater accessibility can be a significant advantage for patients who have commitments like work or family that make daily clinic visits impractical.4
Despite these differences, both methadone and Suboxone have shown to be effective in reducing the harm of opioid addiction. The choice between them often comes down to individual health profiles, lifestyle considerations, and personal preferences.
3. How are methadone and Suboxone administered?
The administration of methadone and Suboxone differs significantly, impacting the daily life of the patient.
Methadone
Methadone is usually dispensed in liquid form at specialized outpatient clinics, known as methadone clinics. Initially, patients are required to visit the clinic daily to receive their dose under medical supervision.2
This frequent monitoring is essential in the early stages of treatment to adjust dosages and ensure safety. Over time, as patients demonstrate stability and compliance, they may earn “take-home” privileges, allowing them to take doses at home between clinic visits. This structure provides a consistent support system but can be challenging for those with work or family commitments.
Suboxone
Suboxone offers more flexibility. It’s typically prescribed in film or tablet form and can be taken at home. Patients usually begin Suboxone treatment under a doctor’s supervision, either in a clinic or a private office.
After the initial phase, patients can receive a prescription that they fill at a pharmacy, similar to other medications. This flexibility can be particularly beneficial for individuals who have steady employment, strong support systems, or live far from treatment clinics.
4. What are the side effects of methadone and Suboxone?
While both medications are effective in treating opioid dependency, they can have different side effects.
Methadone
Common side effects of methadone include drowsiness, dizziness, sedation, nausea, vomiting, increased sweating, constipation, weight gain, and sexual dysfunction.
In rare cases, it can cause respiratory depression, particularly in the initial stages of treatment or when the dosage is increased. Long-term use of methadone can also affect bone density and cause menstrual irregularities in women.5
Suboxone
Suboxone can cause side effects like headaches, nausea, vomiting, drug withdrawal syndrome, numb mouth, constipation, pain, increased sweating, insomnia, and swelling in the extremities.
The presence of naloxone in Suboxone can precipitate opioid withdrawal symptoms if misused intravenously. However, when taken as prescribed, it generally has a lower risk of respiratory depression compared to Methadone.6
5. Who is eligible for methadone or Suboxone treatment?
The eligibility for methadone and Suboxone treatments varies and is determined based on individual patient needs and histories.
Methadone
Methadone is often recommended for individuals with a long history of opioid addiction, especially those who have not succeeded with other treatments. Due to its rigorous administration protocol, it’s suitable for patients who can commit to regular clinic visits and who might benefit from the structured environment of a methadone clinic.
Suboxone
Suboxone is often preferred for patients with a less extensive history of opioid use or those who require more flexibility in their treatment plan. Its safer profile in terms of respiratory depression makes it a suitable first-line treatment for many. It’s also a good option for patients transitioning from methadone or for those who need a medication that can be self-administered at home.
6. Are there any risks of dependency on methadone or Suboxone?
While methadone and Suboxone are used to treat opioid dependency, they themselves carry a risk of dependency if not properly managed.
Methadone
Methadone has a higher risk of dependency compared to Suboxone. Patients can develop physical dependence on methadone, meaning they might experience withdrawal symptoms if they abruptly stop taking it.
The risk is managed through careful dosing and gradual tapering off the drug under medical supervision. It’s important to note that dependency is different from addiction; methadone dependency in a controlled, therapeutic context does not equate to the compulsive, harmful behaviors seen in addiction.
Suboxone
Suboxone’s risk of dependency is generally lower due to its partial agonist nature. Buprenorphine has a ceiling effect, which reduces the potential for misuse. However, physical dependence can still occur.
The naloxone component in Suboxone is designed to deter misuse and is effective if there are other opiates present in the system. Regardless of the method of administration, if Suboxone is used while other opiates are present, it can trigger precipitated withdrawal.
The risk of dependency on Suboxone, similar to Methadone, is managed through controlled dosing and regular monitoring by healthcare professionals.3
7. How long does treatment with methadone or Suboxone last?
The duration of treatment with methadone or Suboxone varies based on individual needs, and there is no one-size-fits-all answer.
Methadone
Some individuals may require long-term or even lifelong treatment with methadone. The duration of treatment is influenced by several factors, including the severity and duration of opioid addiction, individual health status, and life circumstances. Long-term treatment has been shown to be more effective than short-term detoxification, as it provides sustained support and stability.5
Suboxone
The treatment duration with Suboxone can also vary. Some patients may use Suboxone for a shorter period as part of a step-down approach to eventually achieve complete abstinence, while others may need longer-term treatment.
The decision to taper off Suboxone is typically made in consultation with a healthcare provider and is based on a patient’s stability, overall health, and ability to cope with potential withdrawal symptoms.6
Opioid Addiction Treatment Starts Here
Methadone and Suboxone offer different paths to the same destination for addiction treatments: recovery from opioid addiction in a medication-assisted therapy program. Understanding the differences and consulting with healthcare professionals are key steps in choosing the right treatment plan.
At Lumina Recovery, we’re committed to guiding you through these choices to treat opioid addiction and supporting your journey towards a healthier, opioid-free life with our treatment programs. Contact us today.
Sources:
- https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-do-medications-to-treat-opioid-addiction-work
- https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/buprenorphine
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701/
- https://store.samhsa.gov/sites/default/files/pep21-06-01-002.pdf
- https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/methadone
- https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Buprenorphine/Buprenorphine-Naloxone-(Suboxone)