Methadone vs. Suboxone: Differences, Side Effects & Efficacy

Key Takeaways

• Opioid use disorder (OUD) is a condition characterized by the problematic use of opioids. 
• Medications are often used to help people overcome OUD, including methadone and suboxone. 
• Methadone is a full opioid agonist used for OUD treatment, with a high potential for addiction and severe withdrawal symptoms.
• Suboxone, combining buprenorphine and naloxone, is used to alleviate withdrawal symptoms and cravings in OUD, with a lower risk of misuse and dependency.
• Methadone has been associated with higher retention rates in treatment programs but also with a higher risk of mortality, especially within the first month of treatment.
• Suboxone is considered safer, reducing the risk of overdose and respiratory depression, and can be prescribed in various healthcare settings.

Methadone and Suboxone

Opioid use disorder (OUD) is a medical condition characterized by a problematic pattern of opioid use that leads to significant impairment or distress. It is often a very difficult affliction for people to overcome without professional help. 

Part of the reason that professional help is often effective is that healthcare providers can leverage a variety of medications, which may help alleviate withdrawal symptoms, ease cravings, and potentially prevent relapse-related overdoses.

But while there are several different medications healthcare practitioners can prescribe, two – methadone and suboxone – are perhaps the most commonly employed. 

Both medications have a number of similarities, but they also have significant differences, which can make one or the other better suited for some situations.  

What Is Methadone: An Overview  

Methadone is a synthetic opioid agonist used extensively for both pain management and OUD treatment. 

Approved by the US Food and Drug Administration (FDA), it serves as a crucial component of medication-assisted treatment (MAT), offering a solution for detoxification and maintenance in OUD. 

Some key facts about methadone include:

• Methadone is long-acting. Methadone is a long-acting opioid, which means it stays in the body for an extended period. This helps stabilize individuals by preventing the peaks and valleys of shorter-acting opioids.
• It is a full opioid agonist. Methadone binds to the same opioid receptors in the brain as other opioids. This can help it reduce cravings and withdrawal symptoms, but it does so without producing the same high.

• Methadone reduces withdrawal symptoms. Methadone alleviates many of the uncomfortable symptoms associated with opioid withdrawal, making it easier for individuals to stop using other opioids.
• It decreases cravings. By occupying opioid receptors, methadone helps to diminish cravings for opioids.
• Methadone facilitates recovery. Many people in treatment find that methadone helps them focus on recovery, engage in therapy, and rebuild their lives.

• It’s typically administered in a controlled setting. Methadone is typically dispensed in a clinic or healthcare setting, often requiring daily visits, especially during the initial stages of treatment.
• Methadone can be administered in a variety of ways. Available in various formulations, methadone can be administered orally, intramuscularly, intravenously, and even epidurally. 

Methadone’s effectiveness in reducing opioid use is supported by substantial evidence, including a comprehensive Cochrane review, which found that patients on methadone had significantly fewer opioid-positive drug tests and were more likely to remain in treatment compared to controls.

What Is Suboxone: An Overview

Suboxone is a medication used primarily for the treatment of OUD and combines two active ingredients: buprenorphine and naloxone. It plays a vital role in MAT, helping individuals manage their addiction while minimizing withdrawal symptoms and cravings.

Here are some key facts about Suboxone:

• Suboxone is also long-lasting. Buprenorphine, a partial opioid agonist, has a long half-life, providing stable levels in the body. This helps reduce the fluctuations associated with shorter-acting opioids, making it easier for individuals to maintain stability.
• Suboxone is a partial opioid agonist: Unlike full agonists, buprenorphine activates opioid receptors in the brain but to a lesser degree. This helps relieve cravings and withdrawal symptoms without producing the intense high associated with other opioids.
• Suboxone helps to reduce withdrawal symptoms. Suboxone effectively alleviates the uncomfortable symptoms of opioid withdrawal, facilitating a smoother transition away from more harmful opioids.
• Suboxone also decreases cravings. By occupying opioid receptors, Suboxone diminishes cravings for opioids, helping individuals focus on their recovery.
• Suboxone is useful for supporting recovery. Many people find that Suboxone allows them to engage in therapy and other recovery activities, promoting a healthier lifestyle.
• Suboxone comes in multiple forms. Suboxone is available in film or tablet form, which can be taken at home after an initial assessment and prescription by a certified healthcare provider.

Research supports Suboxone’s effectiveness in reducing opioid use. Studies show that individuals on Suboxone are more likely to remain in treatment and have fewer opioid-positive drug tests compared to those not receiving medication-assisted treatment.

Methadone vs. Suboxone: Common Side Effects

It is always important to consider potential side effects when choosing between two medications. In some respects, methadone and suboxone present similar side effect risks, but they also present a few key differences. 

Common Side Effects of Methadone and Suboxone

Common side effects of both medications are generally mild, with many patients feeling like the benefits of the medications outweigh the side effects that sometimes occur. 

Methadone:

• Sedation: Can cause drowsiness or sedation.
• Constipation: A common side effect due to its opioid nature.
• Nausea and Vomiting: Some individuals may experience gastrointestinal issues.
• Respiratory Depression: Risk of slowed breathing, particularly at higher doses.
• Sweating: Increased perspiration can occur.
• Weight Gain: Some users report changes in weight.

Suboxone:

• Headache: Frequent complaints of headache among users.
• Nausea: Can also cause gastrointestinal distress, though often less severe than methadone.
• Constipation: Similar to methadone, though generally less intense.
• Withdrawal Symptoms: In some cases, suboxone may not eliminate withdrawal symptoms if not used correctly.
• Sweating: Increased sweating may occur.
• Insomnia: Difficulty sleeping can be a concern.

The Serious Side Effects of Methadone and Suboxone

While rare, both methadone and suboxone can occasionally trigger serious side effects. Some of the most notable are listed below. 

Methadone:

• Risk of Overdose: High risk if misused, especially when combined with other depressants.
• Cardiac Issues: Can cause QT interval prolongation, leading to arrhythmias in some individuals.
• Potential for Dependence: Can lead to physical dependence and withdrawal symptoms upon discontinuation.

Suboxone:

• Respiratory Depression: Although lower risk than full agonists, it can still occur, especially with misuse.
• Risk of Hepatotoxicity: Rarely, buprenorphine can affect liver function.
• Withdrawal Symptoms: Can induce withdrawal symptoms if not dosed appropriately or if used improperly.

Key Side Effect Differences Between Methadone and Suboxone

Ultimately, the key differences between methadone and suboxone side effects relate to the severity of the side effects and the potential for dependence. 

Generally speaking, methadone tends to produce more severe side effects related to respiratory depression, and it presents a more serious overdose risk. Suboxone generally has a lower risk of overdose due to its partial agonist nature.

While both medications can cause dependence, suboxone’s combination with naloxone is specifically designed to reduce misuse potential and may lead to milder withdrawal symptoms when tapering.

Effectiveness: Methadone vs. Suboxone for Opioid Addiction Treatment

When comparing the effectiveness of methadone and suboxone in treating opioid addiction, it is essential to consider various factors such as treatment retention, reduction in opioid use, and overall patient outcomes. 

Methadone has been used since 1947 and is known for its effectiveness in reducing opioid use and associated risks such as infectious disease transmission and criminal behavior. 

Patients on methadone also have a higher likelihood of staying in treatment compared to those on placebo treatments. Studies show that methadone treatment can be significantly beneficial even without regular counseling services, suggesting its strong efficacy.

Suboxone has been found to have similar effectiveness to methadone in terms of opioid-positive drug tests and self-reported heroin use when administered in medium-to-high doses. 

However, buprenorphine at lower doses or with flexible dosing regimens may be less effective than methadone in retaining patients in treatment. Both medications increase the likelihood of treatment retention, which correlates with reduced overdose mortality, lower risk of HIV and HCV transmission, reduced criminal justice involvement, and improved chances of employment. 

Despite these similarities in effectiveness, there are differences in treatment retention, with methadone often showing better retention rates than suboxone. This highlights the need for tailored interventions to improve patient retention and consider individual patient needs when choosing between these medications for opioid addiction treatment.

Comparative Safety Profiles: Methadone vs. Suboxone

When comparing the safety of methadone and suboxone, it is important to consider their potential risks and necessary precautions. 

Methadone, a full opioid agonist, has a higher potential for addiction and may lead to more severe withdrawal symptoms, which can increase dependence on the medication. Some individuals may require long-term methadone treatment to avoid returning to opioid use. In contrast, suboxone is designed to prevent misuse and is generally considered to have a lower risk of addiction and overdose.

Suboxone’s formulation aims to reduce the likelihood of misuse because naloxone triggers withdrawal symptoms when injected, thus discouraging non-prescribed routes of administration. Treatment retention rates are generally better with methadone, which may be due to its stronger opioid effects compared to buprenorphine. However, both medications are effective in reducing opioid use and associated risks when administered at appropriate doses.

Healthcare providers must weigh the benefits and risks of each medication, considering individual patient circumstances. 

Methadone may require more stringent monitoring due to its higher risk profile, while Suboxone may offer a safer alternative for those at risk of misuse. Nonetheless, both medications are key components in the treatment of opioid use disorder and can significantly improve patient outcomes when used as part of a comprehensive treatment plan.

Get Help for Opioid Use Disorder Now

For those seeking addiction or mental health treatment, The Recovery Village Indianapolis Drug and Alcohol Rehab stands as a beacon of hope. Located within the heart of Indy, we offer an array of treatment options, including medical detox and inpatient rehab for substance abuse and a residential rehab program for mental health disorders. 

When you or a loved one are ready to embark on the path to recovery, our Recovery Advocates are here, ready to assist. Reach out to learn more about our tailored treatment programs, designed to cater to your specific needs and situation.