Both methadone and Suboxone can treat opioid use disorder. While both drugs bind to opioid receptors, Suboxone contains an extra medication to help decrease misuse.

Methadone is a synthetic long-term opioid agonist. This means it works on and activates opioid receptors, similar to other prescription opioids. People who take methadone for opioid use disorder can experience a reduction in opioid cravings and other withdrawal symptoms, which helps them stop taking other opioids.

Suboxone contains two medications: buprenorphine, which is an opioid partial agonist, and naloxone. Naloxone is an opioid antagonist, meaning it can block the effects of opioids. Naloxone can also treat opioid overdoses when people use it intranasally as the brand name drug Narcan.

People can experience intense, painful, and sometimes dangerous effects from opioid withdrawal. Taking medication to treat those symptoms may improve the chances of achieving sobriety.

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Both Suboxone and methadone are first-line treatments for opioid use disorder. They typically lead to better outcomes for those who take them.

Methadone

Methadone is a single medication and an opioid agonist. It works by stimulating opioid receptors in the brain. This can ease withdrawal symptoms, which is important, as many people identify withdrawal symptoms as the reason for returning to opioid use. As a result, methadone can reduce the risk of that occurring.

Methadone also binds very tightly to opioid receptors, making it hard for other opioids to bind to these receptors. Due to this, methadone decreases the risk of feeling the effects of other opioids and overdosing on opioids.

Methadone can also treat neonatal abstinence syndrome (NAS). NAS is a condition that occurs when a fetus is exposed to opioids through the pregnant parent, but then stops being exposed to opioids after they are born and outside of the parent’s body. The abrupt change in opioid exposure can cause opioid withdrawal symptoms in the baby.

Doctors may also use methadone to treat some types of chronic pain that are unresponsive to other opioids.

Suboxone

Suboxone is the brand name for a combination of the medications buprenorphine and naloxone.

Buprenorphine is an opioid partial agonist, which means it stimulates opioid receptors in the brain, but it has a ceiling effect, unlike other opioid medications. This can help reduce symptoms of opioid cravings and withdrawal, similar to methadone.

Naloxone is an opioid antagonist, which reduces the ability of opioids to act on the brain’s opioid receptors. However, in this case, naloxone is an inactive medication when people take it appropriately, which is under the tongue. This means it has no action in the body unless a person misuses it, such as by injecting it.

The buprenorphine in Suboxone reduces opioid cravings and withdrawal symptoms. Also, like methadone, it binds very tightly to opioid receptors, making it hard for other opioids to bind to them. Due to this, buprenorphine also decreases the risk of feeling the effects of other opioids and opioid overdose.

People should note that both medications are opioids and therefore carry the risk of misuse. However, misuse of these medications is more commonly seen for therapeutic purposes rather than to achieve a high, as seen with other opioids. And as with other opioids, the risk of addiction is low when people take these medications as prescribed.

Below are some similarities between the two drugs.

Similarities between methadone and Suboxone

  • Synthetic medications: Both medications contain a synthetic opioid: methadone or buprenorphine.
  • Effects on withdrawal: Both can ease withdrawal symptoms by stimulating the brain’s opioid receptors.
  • Risk of misuse: Both carry the risk of misuse, but misuse is far less common than with other opioids and is usually for therapeutic purposes rather than to get high.
  • Outcomes: Both can increase the likelihood of achieving treatment goals.
  • Prescription: Both medications are prescription only.
  • Safety: Both medications are safe for long-term use and more effective when a person takes them for long durations.

There are also important differences.

Differences between methadone and Suboxone

  • Ingredients: “Methadone” is the name of both the drug and the active ingredient. Suboxone contains two ingredients: buprenorphine and naloxone.
  • Effects in the body: Methadone is a full opioid agonist, while buprenorphine is a partial opioid agonist with a “ceiling effect,” meaning that the risk of overdose is less with Suboxone compared with methadone.
  • Safety during pregnancy: While doctors can give either medication during pregnancy, they may prefer buprenorphine-containing medications over methadone due to the “ceiling effect” lessening the risk of NAS.
  • Dosing: The dosing for methadone is much higher than that of Suboxone, and the rate at which the doses are increased also varies between the two medications.

The risks and side effects of Suboxone and methadone are similar.

  • Physical dependence: Given that both medications are opioids designed to be taken long term, the body can develop a physical dependence on them, meaning it needs them to function properly. An abrupt decrease in dose can cause withdrawal symptoms.
  • Overdose: It is possible to overdose on both medications, especially if a person takes them with alcohol, sedatives, or another opioid. The overdose risk is lower with Suboxone because of the unique properties of buprenorphine.
  • Heart rhythm changes: One common issue with opioids is QT prolongation, which may cause irregular heart rhythms.
  • Negative side effects: Some people experience headaches, nausea, dizziness, dry mouth, or other side effects.

Most research suggests that side effects tend to be more severe with methadone.

Both medications can cause withdrawal effects, especially if someone stops taking them abruptly. For this reason, if a person has to stop treatment with either of these medications, doctors typically recommend gradually tapering the dosage over several days or weeks.

Methadone and buprenorphine both have longer half-lives than most other opioids. A half-life is the time it takes for half of the drug to leave the body. This means that, after stopping use, it may take longer for withdrawal symptoms to begin. They may also be less severe.

Suddenly stopping these medications increases the risk of withdrawal symptoms, which may include:

  • anxiety
  • depression
  • headache
  • nausea
  • vomiting
  • feeling sick
  • rapid heart rate

Like most drugs, Suboxone and methadone may interact with other medications.

Methadone

Certain medications may increase the effects of methadone and the risk of overdose, including:

  • a group of antianxiety medications called benzodiazepines, including Xanax and Valium
  • ciprofloxacin
  • alcohol
  • fluconazole, a common yeast infection treatment
  • cimetidine
  • fluoxetine

Other medications may decrease the efficacy of methadone. They include:

  • phenobarbital
  • efavirenz
  • carbamazepine
  • ritonavir
  • rifampin
  • phenytoin

The risk of opioid overdose is significantly higher with methadone compared with buprenorphine. This is because the brain responds to it as it would to other opioids, given that methadone is a full opioid agonist, whereas buprenorphine is a partial opioid agonist.

Suboxone

Suboxone interacts with some drugs in a way that may increase the risk of overdose, including:

  • sedative drugs
  • alcohol
  • methadone
  • hypnotics
  • antihistamines

It is generally unsafe for people who have diseases affecting the central nervous system, such as dementia, head trauma, and increased intracranial pressure, to take opioids, including Suboxone and methadone.

Suboxone is typically the preferred treatment in pregnant people, though experts agree that people can use either medication.

During detoxification, people should inform healthcare professionals about any other medical conditions they have and medications they take. This allows the healthcare team to make treatment decisions accordingly. If a person needs short- or long-term opioid pain medication, they should discuss this with their doctor so they can adjust treatment plans.

Both Suboxone and methadone can treat opioid use disorder and increase the chances of achieving treatment goals.

People may find even better outcomes when pairing these medications with therapy, though this is not necessary. Additionally, education about addiction, drug use, and engagement with healthcare professionals may also help. Finally, people will have the best outcomes when taking these medications long term.

All opioids carry the risk of physical dependence and misuse, including opioids that can treat opioid use disorders. Individuals should never take more than the recommended dosage.

If a person experiences difficulties with opioid use, they should talk with a doctor or healthcare professional as soon as possible.