The opioid epidemic is a battle against addiction that has existed for decades. For some, the result of this includes life-threatening disorders such as OUD (Opioid Use Disorder).
Thankfully, advances in scientific knowledge have allowed our researchers to develop a variety of treatments to combat this, including certain medications. Two of these medicines include Suboxone and methadone.
In this article, we’ll compare and explore these two medicines together and look at their effectiveness, side effects, cost, and other aspects you need to know about them. Let’s dive right in.
What Is Methadone?
Methadone treats opioid use disorders as an opioid antagonist. The medication works by reducing cravings and withdrawals, as well as blocking the effects of opioids.
The development of methadone began during World War II when a morphine shortage occurred in Germany. Following this, the medication was introduced to the United States as an analgesic. The use of methadone as a treatment for opioid addiction did not come into full force till the late 1950s and early 1960s.
When used as directed, methadone is safe and works well for patients affected by OUD. As a result, previous opioid users can recover and achieve greater life outcomes.
Methadone affects how the brain and nervous system respond to pain, dulling or nullifying it entirely.
The drug lessens painful symptoms that opioid withdrawals can cause while also blocking the euphoric effects that opioids such as heroin provide.
What Is Suboxone?
Suboxone is another medication that is used to Opioid Use Disorder, and it does so via its unique combination of buprenorphine and naloxone. These components act as either a partial antagonist or agonist to opioid receptors.
Naloxone is an opioid antagonist and reverses opioid overdose symptoms. It reacts with opioid receptors and prevents opioids from activating them. When these receptors are blocked, opioids can’t take effect – hence the term “antagonist”.
On the other hand, Buprenorphine is a partial opioid agonist. It works by binding to the same receptors (a property called high binding affinity) and providing very mild opioid effects.
This helps to reduce withdrawals and cravings that a patient may feel, while also minimizing the risk of overdose.
Together, buprenorphine and naloxone provide a valuable medication-assisted treatment for patients suffering from opioid addiction.
Methadone vs. Suboxone
| Methadone | Suboxone | |
| Administration | Taken orally | Taken orally, usually under the tongue |
| Requires a doctor’s prescription. | Requires a doctor’s prescription | |
| Dose typically doesn’t exceed 20 mg per day | Highest recommended dose is 24 mg (buprenorphine) and 6 mg (naloxone) per day | |
| Effectiveness | Mixed evidence on which is more effective | Effectiveness varies by individual |
| Some studies show higher retention in methadone treatment | Similar efficacy in reducing illicit drug use | |
| Serious Side Effects | Potential for addiction and overdose risk | Risk of attachment and addiction |
| Seizures, anaphylactic reactions, hallucinations, paranoia | Respiratory issues, depression, nausea, fainting, anxiety | |
| Cost and Accessibility | Can be expensive without insurance | Cost varies by provider and generic options |
| May require state or federal program assistance | Often covered by health insurance and is generally cheaper | |
| Withdrawal & Dependence | Schedule 2 controlled substance, potential for dependence and withdrawal | Potential for dependence, reduced by naloxone |
Administration
Methadone: Across the United States, there are many methadone clinics that treat opioid users with this medication. Clinics can be private or public, but are both regulated by state and federal laws.
The medication must be prescribed by a doctor, and is available as a pill or liquid. The dose, which typically doesn’t exceed 20 mg per day, can be adjusted under the doctor’s strict supervision if it is well-tolerated.
Suboxone: Office-based opioid treatment is a program set up for primary care providers who have completed specific training. It allows them to prescribe medication for OUDs within their own clinical setting.
Suboxone is prescribed as either film (strips) or pills, and both forms provide very similar effects when treating OUD. The method of administration comes down to the preference of the patient.
Effectiveness
There is conflicting evidence amongst studies on whether methadone or suboxone is more effective.
In saying that, effectiveness is largely dependent on the individual, and there are only minor differences between the two treatments.
A study from APA PsycNet investigated the effectiveness of Suboxone and methadone. Of the patients who took part in the study, more were likely to stay in methadone treatment.
However, the prevalence of positive illicit drug screens at six months remained consistent for both, suggesting that both medications had equal efficacy.
Another article also compared studies through 2008, 2009, and 2014, with a particular eye for retention rates among the surveyed studies.
For instance, in the 2009 trial, prison inmates who had OUD and were on Suboxone had higher rates of treatment completion.
On the other hand, methadone had higher completion rates in the 2014 trial – especially at greater doses.
These studies demonstrate that regardless of the medication of choice, both drugs are effective for treating OUD.
Serious Side Effects
Methadone
- Potential for addiction (risk of overdose)
- Seizures
- Anaphylactic reactions
- Hallucination
- Paranoia.
Suboxone
- Attachment to Suboxone (relaxation effect can make it addictive)
- Respiratory depression (slows breathing and causes lack of oxygen in the body)
- Nausea
- Fainting
- Insomnia
- Irregular heartbeat.
Cost and Accessibility
Methadone: Getting methadone isn’t easy due to the standards required for narcotic addiction treatment.
Patients can pay with health insurance or through state and federal programs; however, if patients don’t have insurance, standard rates apply.
Preliminary cost estimates for methadone treatment are $6,552 per year.
Suboxone: Many providers accept health insurance coverage for Suboxone, both fully and partially.
There are also cost-assistance programs that can reduce costs by up to $75 a month.
Without insurance, there are no exact costs that can be indicated as pricing will vary depending on the provider as well as the form of treatment.
The availability of Suboxone is often better than methadone in many instances. Medical professionals who are authorized to prescribe the drug can distribute it in a greater range of settings, such as within their own offices or clinics.
Withdrawal and Dependence Potential
Methadone: Methadone falls under the classification of a Schedule 2 controlled substance.
This means it may have the potential to be abused, which can lead to dependence and withdrawal symptoms.
This classification is why opioid treatment programs with SAMHSA (Substance Abuse and Mental Health Services Administration) approval are the only places authorized to distribute the medication.
Suboxone: Suboxone has the potential to produce withdrawal effects, as it can also be addictive.
The potential for dependence comes from the buprenorphine component of the drug as it is a partial agonist of opioid receptors.
However, naloxone (the antagonist) reduces the likelihood of this happening, which suggests that the risk of dependence is lower in Suboxone than methadone.
Conclusion
The battle against opioid addictions has seen the emergence of the medications methadone and Suboxone. Both drugs have the similar aim of treating OUDs.
While there are concerns about these medications being addictive, the bigger picture suggests that they are effective and safe for use as treatment.
Neither has a significant edge over the other in regard to effectiveness. As such, the choice of what to prescribe to patients may ultimately come down to factors such as regulation, cost, and individual needs.
References:
2. https://psychiatry.uams.edu/clinical-care/cast/what-is-methadone/
3. https://www.dea.gov/sites/default/files/2020-06/Methadone-2020.pdf
4. https://www.westbridge.org/wp-content/uploads/2014/06/Enc-of-Neuroscience-Methadone.pdf
5. https://pubchem.ncbi.nlm.nih.gov/compound/Naloxone#section=Structures
6. https://pubchem.ncbi.nlm.nih.gov/compound/644073
7. https://americanaddictioncenters.org/methadone-addiction/clinic-facts
11. https://psycnet.apa.org/record/2014-30830-001
13. https://americanaddictioncenters.org/methadone-addiction/side-effects
14. https://recoverycentersofamerica.com/blogs/the-cost-of-methadone-treatments/
16. https://www.ncbi.nlm.nih.gov/books/NBK232114/
17. https://rehabs.com/insurance-coverage/suboxone/
18. https://americanaddictioncenters.org/insurance-coverage/suboxone
20. https://americanaddictioncenters.org/suboxone/side-effects
