Buprenorphine and methadone are both FDA-approved medications used to treat opioid addiction.
While they work in similar ways, there are some important differences you should be aware of before deciding which medication is best for your needs.
In this article, we will compare both medications and cover:
- How each medication works to treat opioid addictions
- The history of both buprenorphine and methadone
- How each medication is formulated for safety
- How both medications compare in price
- How effective both medications are
- How the accessibility of buprenorphine and methadone compared
- Who is better suited to each medication.
Let’s get into it.
What is Buprenorphine?
Buprenorphine is an FDA-approved medication used as part of Medication-Assisted Treatment (MAT) to help people with Opioid Use Disorder (OUD) manage their opioid addictions.
The medication can be taken in a number of forms such as sublingual tablets, buccal films, or injections.
The medication can be prescribed by a medical professional if they deem it appropriate, and you do not have any health conditions that may put you at risk of adverse effects.
Buprenorphine works by acting on the Mu-opioid receptors found in the brain.
It is called a partial opioid agonist, which means that it weakly binds to opioid receptors and mimics the effects of other opioids without being as addictive or dangerous.
Because Buprenorphine binds to the same place as other opioids do, it helps to decrease opioid drug cravings and withdrawal symptoms.
Because it works like other opioids such as morphine, it can be used as a safer way to treat pain.
What is Methadone?
Methadone is another FDA-approved medication used to treat Opioid Use Disorder, along with chronic pain conditions. This therapy is referred to as Opioid Agonist Treatment.
Methadone is a long-acting opioid agonist. This means that it works by binding to opioid receptors in the brain to help manage withdrawal symptoms and reduce pain. Unlike other opioids, it works on the body over a long period of time.
For people who suffer from opioid dependence, it can be used to help people detoxify from other illegal and prescription opioids.
Methadone helps to reduce drug withdrawals and opioid cravings. And it can also be used as maintenance therapy to help people who have detoxified from opioid drugs, to help with abstinence.
Buprenorphine Vs Methadone: A Comparison
History
Methadone is an older medication compared to buprenorphine.
Methadone has been used for numerous decades both to treat pain and manage opioid withdrawal. It was first made during WWII, where it was used as an alternative to morphine, to treat pain.
Methadone was first used in the 60s, to help people who were addicted to heroin to manage their addiction.
It was officially approved by the FDA for the treatment of Opioid Use Disorder in 1972. In 1974, the Narcotic Addict Treatment Act limited methadone treatment to special methadone treatment centers.
In comparison to methadone, Buprenorphine history is more recent.
Buprenorphine was first used as a way to treat pain in the 70s. About 20 years later, researchers started looking at its potential to treat opioid addictions. By 2002, the FDA approved its use for treating Opioid Use Disorder.
“Ceiling Effect”
The “Ceiling effect” is one of the main differences between methadone and buprenorphine.
Because Buprenorphine only partially binds to opioid receptors, its effects eventually stop increasing once you hit a certain dose.
What this means is that even if you take high doses of the medication, you will not experience the same euphoria or adverse reactions as you would with methadone (a full opioid agonist). This also lowers the risk of opioid overdose.
This is called the “ceiling effect” as once you hit the ceiling with buprenorphine, you will not experience any further effects. Methadone does not have this quality. According to studies:
“Buprenorphine causes less respiratory depression than methadone due to its ceiling effect and, thus, has lower overdose potential.”
Abuse Formula
Because both medications are opioids, they both have the potential to be misused and carry a risk of physical dependence.
Methadone is classified as a Schedule II controlled substance under the DEA. This means that it is considered to have a “high potential for abuse”.
Buprenorphine, on the other hand, is a schedule III drug, meaning that its abuse has a moderate or low risk of physical dependence or high psychological dependence.
In order to try to avoid misuse and risk of addiction and overdose, both medications have safety nets built.
For methadone, there is a strict limit on how much someone can take home.
This means that it is difficult for someone to obtain large amounts of the medication. The tablets are also difficult to crush.
On the other hand, Buprenorphine has more safety features in built. Because it is only a partial agonist, it has a ceiling effect.
This means that even if large amounts of the medication are taken, it is difficult to reach any euphoric effects.
Buprenorphine is also often combined with another medication called naloxone. This medication blocks the effects of buprenorphine if taken intravenously.
Price
The prices for both buprenorphine and methadone treatment are quite similar.
It is estimated that the average weekly cost of methadone treatment is $126.00 a week without medical insurance or other financial support. On the other hand, treatment with buprenorphine is about $115.00 a week.
If you are receiving treatment with either medication, you will need to attend regular follow-up appointments to monitor your progress (which can add to the treatment cost).
It is important to note that Medicaid usually covers the cost for both buprenorphine and methadone treatment as part of Medication-Assisted-Treatment of Opioid Use Disorder if you are eligible.
Private medical insurance will also usually cover the cost of both treatments at least on a partial basis, depending on your plan.
Uses and Effectiveness in Treatment
Because the medications are unique, they have slightly different uses and vary in their effectiveness.
Studies looking at effectiveness, such as abstinence from heroin, found that both medications were as effective as each other in preventing heroin use if the treatment plan was adhered to.
They were also equally effective in relieving opioid withdrawal symptoms.
However, people were more likely to continue taking methadone compared to buprenorphine.
Since methadone is a stronger medication, it is usually administered in severe cases of opioid addiction. Meanwhile, buprenorphine is usually most effective in mild to moderate cases of opioid dependence.
Side Effects and Safety
As buprenorphine has a ceiling effect, there is less risk of respiratory depression (dangerously shallow breathing) even if high doses of the medication are used. This makes the risk of overdose with buprenorphine lower than with methadone.
Since buprenorphine can also be administered with naloxone (an opioid receptor blocker), it deters people from using the medication intravenously.
The combination of both medications acts to block the effects of the opioids when used intravenously, deterring people from misusing the medication.
Studies looking at the risk of adverse events found no difference between the risk of adverse effects between treatment with buprenorphine vs methadone.
Accessibility and Use
In general, buprenorphine is more accessible compared to methadone.
Recently, a bill has been passed that allows all doctors who have a current DEA registration that includes Schedule III authority to prescribe buprenorphine. Once prescribed, you can pick up buprenorphine and take it home with you.
Methadone, on the other hand, has more regulations. When you are first prescribed the medication by specialized doctors, you need to take the medication at a designated clinic.
Once you have met certain criteria and taken the medication in these clinics for a sufficient period, you can take small amounts of the medication home.
Both medications can be used long-term as part of what is called maintenance therapy.
Patient Considerations/Who Is A Candidate For It
Like any medication, your doctor will check if you are a suitable candidate for each medication.
If you are diagnosed with Opioid Use Disorder and meet other criteria, you can be prescribed either medication.
To be diagnosed with Opioid Use Disorder, you must have met certain criteria.
These often include using more opioids than intended, experiencing a craving for these drugs, developing a tolerance to opioids, and the addiction exerting a level of control over your life.
There are also certain health considerations that are made before prescribing both medications. Because they work in very similar ways, these considerations are often the same.
They include:
- Whether you have taken either methadone or buprenorphine before
- If you usually have problems with breathing, including sleep apnea
- If you have had liver diseases or a history of liver problems
- If you have had problems with your kidneys
- If you have an enlarged prostate, or problems urinating
- If you have a history of past head injuries
- Whether you suffer from mental illnesses
- Whether you have ever had, or have problems with alcohol use
- If you have problems with your adrenal glands
- If you have problems with your stomach.
The point of difference relates to severity. Severe opioid addictions are usually treated with methadone, whereas mild to moderate addictions are usually treated with buprenorphine.
Additionally, both medications can be used if you are pregnant or breastfeeding. However, it is extremely important that you let your doctor know if you are or intend to become pregnant.
Final Thoughts
While methadone and buprenorphine are both effective ways to help combat opioid addictions by alleviating withdrawal symptoms and controlling drug cravings, there are important differences between the medications.
Methadone is an older and stronger medication and is classed as a full opioid agonist. Therefore, it is best used to treat severe Opioid Use Disorder.
It is known to have a higher risk of overdose, and therefore there are more rules and regulations surrounding its use.
On the other hand, Buprenorphine is a newer medication that only partially binds to opioid receptors.
This means that there is a ceiling effect, making it a less risky medication in general. What this also means is that the medication is best used to treat mild to moderate opioid addictions.
If you are considering using either medication, it is important that you meet with a healthcare professional so that you can discuss the potential risks and benefits of each and decide which is best for you.
