How to decide if Suboxone or Methadone is best for you

Until recently, people struggling with opiate addiction have had very few options for long-lasting recovery. Withdrawals from long-term use of heroin and opiate painkillers such as oxycodone and fentanyl can be excruciating. In the past few years, the opiate epidemic has raised concerns and newfound support for replacement therapies such as methadone and Suboxone.

Recovery is possible with the right support in place. If you are looking for the best treatment option for yourself or someone you love, it is important to understand the benefits and drawbacks of Suboxone and methadone.

What Is Methadone?

Developed by German scientists during World War II, methadone is a narcotic opioid analgesic that works similarly to morphine. Initially, methadone was primarily used for pain relief and for those who have an adverse reaction to opioids from another class, such as morphine.

Due to its long-lasting effects, doctors eventually recognized its implications for those addicted to harmful opiates. For decades methadone treatment was one of the only treatments available. In spite of many red flags, doctors had little choice but to accept this option.

What Is a Methadone Clinic?

Methadone can be fatal if abused. Due to its strong euphoric effects, it also has a high street value. For these reasons, methadone is one of the most highly controlled substances in the world. To stop potential abuse, methadone is primarily dispensed in clinics daily.

When addicts seek treatment at one of these clinics, they are set up with an appointment with a doctor on-site. Next, the patient is usually asked to take a mandatory urinalysis to confirm that a patient is opiate dependent. This sample is also checked for other substances that could interact with methadone, such as cocaine or benzodiazepines.

The patient meets with a doctor, who determines if the patient is a viable candidate for treatment. The doctor then writes a prescription for methadone that is sent directly to a dispensary, which is usually located at the same location.

Unlike most prescriptions, this will usually have a range from 30 mg and up. Due to the potency of methadone, most clinics start every patient at a lower dose and will increase daily by 5 mg intervals until the patient feels the dose is comfortable.

In conjunction with the methadone treatment, these clinics require regular meetings with a licensed therapist. In addition to individual care, these clinics also usually require a form of group therapy.

The Benefits of Methadone Treatment

Methadone has been in use for over 60 years to treat individuals struggling with addiction to opiates. For this reason, there is a considerable amount of clinical research available for this treatment. With a 24-hour minimum half-life, methadone can be effectively given once daily.

Methadone is widely available, and costs for treatment are determined on a sliding scale, depending on an individual’s income. Clinics are not required to limit the number of patients allowed to receive treatment, which effectively eliminates the amount of time a person has to wait to receive treatment.

Daily trips to the methadone clinic may be a good structure for patients who require more accountability. When patients eventually become tolerant to the drug, they have the freedom to increase their dose.

The Drawbacks of Methadone Maintenance

While methadone maintenance has been around for a long time, there is no shortage of opponents to this treatment method. There is no doubt that methadone treatment is a desirable alternative to heroin addiction. However, research has uncovered many reasons to take a second look at whether methadone is the best option available.

Individuals withdrawing from these drugs often find that methadone offers the same euphoria and sense of well-being as the drugs they are leaving behind. For this reason, many critics of methadone feel that people receiving this treatment are simply trading one drug for another.

Methadone is as addictive as heroin, and many consider it to be even more addictive. This means that patients are still chasing the feeling that heroin and other opiates produce. People receiving methadone treatment can still use opiates by “overriding” the drug.

It is easy for patients to increase their dose of methadone, but very difficult to decrease. For example, a patient receiving a daily dose of 35 mg of methadone could increase their dose up to 5 mg every day. In one week, they will have doubled their daily dosage.

However, if that same patient were to decrease their 35 mg dosage, it would be a different matter. It is strongly recommended that a patient never exceed a 5% decrease per week, or 1.75 mg, in that same period.

This is due in part to the severity of withdrawal symptoms when detoxing from methadone, which is often described to be more severe than heroin withdrawals. For this and other reasons, many patients receiving methadone treatment refer to it as “liquid handcuffs.”

Methadone can be extremely dangerous, especially for people who choose to take it with other illicit drugs. Often people who are seeking treatment have difficulty with self-control, and methadone treatment still has them chasing a high.

When taken in combination with benzodiazepine medications such as Xanax, users could enhance the euphoric feeling of methadone. When misused, methadone is responsible for more than twice as many overdoses than any other prescription drug.

Methadone has also been linked to many harmful side-effects. Methadone disrupts the brain’s cognitive process and negatively affects working and verbal memory. Often people taking methadone complain of “mental cloudiness.”

Other critics of this treatment say the restrictive system of daily dosing in a clinical environment is another drawback of methadone maintenance. Patients receiving methadone maintenance are required to come in daily to take their medication.

This is done under the supervision of a certified professional. Patients must come in during a specific window of time. This rigid system makes it extremely difficult for patients to travel or maintain a work schedule.

What Is Suboxone?

In 2002, a new medication called Suboxone was released to the market. Suboxone is a combination of Buprenorphine and Naloxone and belongs to a class of drugs called opioid agonist-antagonists. The combination of these two drugs made for a completely different experience for people seeking treatment.

Buprenorphine is an opioid used to treat opioid dependence, chronic pain, and acute pain. Buprenorphine is different from other opioids because it only attaches only to part of the opioid receptor. This limits its euphoric effects, but still functions to stop withdrawals and cravings. Naloxone blocks the effects of opioids, and when taken in conjunction with Buprenorphine, it decreases the risk of misuse.

What Is A Suboxone Doctor?

Even though Suboxone is less controlled than methadone due to its low risk of abuse, it still has to be prescribed by a specially certified physician. The initial process of receiving Suboxone treatment is similar to a methadone clinic. A urinalysis is required to make sure the patient is not taking substances that negatively interact with Suboxone. A doctor will prescribe Suboxone after completing a medical analysis.

Suboxone is a Schedule III controlled substance under the Controlled Substance Act of 2000. This is a class below methadone. This means Suboxone is less controlled than methadone and is often prescribed in 30-day increments.

Patients are required to get counseling and random urine screenings at the beginning of treatment. However, if a patient shows that they are compliant with the treatment, they are often only required to come in once a month for counseling.

The Benefits of Suboxone Treatment

Suboxone is designed for safety. It does not have the euphoric effects associated with methadone, but it does stop cravings and withdrawal symptoms. In addition, Suboxone effectively takes away the pleasurable effects of other opiates such as heroin. Women who become pregnant can safely start or continue Suboxone treatment.

Even at high doses, Suboxone treatment is normally well-tolerated. Most patients report feeling “like normal” again when receiving Suboxone treatment.

Withdrawals from Suboxone are less severe than with other opiates. Suboxone has a long enough half-life to allow doctors to taper doses down to every other day, eventually allowing patients to come off the medication completely.

Monthly prescriptions and weekly therapy sessions help those receiving Suboxone treatment to maintain work and travel schedules. This also helps addicts escape the stigma associated with drug treatment.

Suboxone doctors are now more widely available than ever. Suboxone is covered by most insurances. Newly-released generics and pharmacy coupon programs also help lower the cost. For individuals who want a painless transition to Suboxone from methadone, the FDA recently released the drug Lucemyra to help the transition.

 The Drawbacks of Suboxone Treatment

While there are some risks while taking Suboxone, they are usually mild. Suboxone is less likely to work on individuals who still have a desire for the euphoric effects of opiates.

People taking Suboxone can become dependent on it, while withdrawals are milder than other opioids. For patients with no insurance, Suboxone can be more expensive. Some patients report a bad taste when taking it sublingually.

Final Word

Suboxone offers an optimistic alternative to traditional methadone therapy, which can be dangerous and misused. At Right Path Addiction Treatment Centers, we combine MAT (medically-assisted treatment) with 12-step counseling to help you or your loved one move forward from opioid addiction.


Written by Sergey Zhitar, MD Medical Director

Native of Moldova, Dr. Zhitar is Board Certified in Addiction Medicine as well as Internal Medicine and completed his training at UPMC Shadyside, Pittsburgh, PA in 2000.

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