• Heather L. Roe, DO

Suboxone vs Methadone

An overview of the two most common medications for opioid dependence


 

Suboxone and methadone are both FDA-approved medications to treat opiate use disorder; the use of opiates includes prescription pain pills, heroin, fentanyl, etc. It can be difficult to know what the best option for you is. Below we have created a table comparing the two treatment options to help guide your decision-making. Please contact our office if you have further questions.




SUBOXONE

METHADONE

How it works in the brain

Partial opioid agonist

Full opioid agonist

Suboxone is unique in that it only weakly stimulates the release of endorphins, lowering its potential for misuse

How it helps

Prevents cravings, withdrawal, and overdose

Prevents cravings, withdrawals, and overdose

Safety profile

Has ceiling effect; difficult to overdose. Few medication interactions

No ceiling effect; risk of overdose. Interacts with several other medications

Suboxone binds the opioid receptors and weakly stimulates them. Even intentional excess ingestion cannot lead to overdose.

How to get it

Prescribed in a doctor's office or another medical setting. Prescriptions are filled by the patient's pharmacy and taken to their home

Must be dispensed with witnessed dosing in a specialty clinic known as an OTP (Opiate Treatment Program/"Methadone Clinic")

Suboxone's safety profile allows it to be prescribed from a regular doctor's office, whereas methadone for OUD (opioid use disorder) must be dispensed by an OTP. The daily dosing requirement of methadone programs makes it a challenging option for people with conflicting work schedules or who live too far away to travel to a clinic daily

Amount of Structure

The patient generally is seen weekly to monthly depending on their stability and comfort level

Requires daily visits for medication dosing; over months to years of sobriety, patients can earn "take homes" and reduced attendance

Although methadone can be prescribed by a pain specialist for pain management, federal law requires methadone for OUD to be dispensed by an OTP

Dosing forms

Comes in tabs or films that are dosed sublingually (under the tongue)

Comes in tabs, wafers, or liquid. Swallowed

Swallowed Suboxone has negligible effect. Must be absorbed in the mouth

Typical dose

Most individuals stabilize of 12-16mg daily. Max dose is 24mg daily.

Typical dose 60-120mg daily. Taken once per day at OTP until take home doses earned.

Time to a stable dose

Usually established in 1-2 days

Usual starting dose 30mg with an increase every few days. Usually, 1-2 weeks to reach a stable dose

Safe in pregnancy

Yes

Yes


After over a decade of practice in Addiction Medicine, I have found that both of these medications are invaluable to individuals seeking treatment. Each individual patient's situation makes them a better candidate for one option or the other. I hope this article will provide some basic guidance about these choices. If you remain uncertain, an experienced Addictionologist can help you weigh the options and help you connect to the treatment that would provide you with the greatest chance of success.

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