Suboxone vs. Methadone: How Do They Differ?

What is Suboxone?

Suboxone is a prescription medication that treats OUD in adults. It is intended to be used as part of a comprehensive treatment plan that includes counseling and guidance behavioral therapy. Suboxone is a combination medication that contains two active ingredients: buprenorphine and naloxone.

Suboxone comes as a film or tablet for sublingual use, meaning it dissolves under your tongue. Generic versions are also available. The film should not be swallowed or swallowed whole. Instead, dissolve it under your tongue or against your inner cheek. Suboxone starts working quickly and reaches its full effect within one to three hours. The usual maintenance dose is 16 mg/4 mg buprenorphine/naloxone per day. It is usually taken long-term or indefinitely.

Zubsolv is a sublingual tablet that works in the same way as Suboxone, but has a slightly different dosage.

Benefits of Suboxone

Suboxone can be a very effective treatment for opioid addiction when used as part of a comprehensive plan that includes counseling. Some benefits of Suboxone include:

• Can be used at home
• Lower risk of fatal overdose
• Reduced nausea
• Reduces the risk of preterm labor and neonatal birth withdrawal symptoms
• Safe to use during pregnancy

What is methadone?

Methadone (a brand name is Methadose) is a full opioid agonist. It works by activating opioid receptors in the brain, like other opioids, but in a more controlled manner. It reduces cravings and withdrawal symptoms without causing the intense euphoria (“high”) associated with other opioids.

Methadone is usually taken as an oral liquid, but it is also available in tablet and injectable forms. Due to its potency and risk of abuse, methadone is provided under close supervision, especially during the early stages of treatment.

In addition to opioid use disorders, methadone is also approved by the Food and Drug Administration (FDA) for the treatment of pain. And it is sometimes used off-label to treat neonatal abstinence syndromeThis happens when a newborn experiences withdrawal symptoms from medications, such as opioids, that the pregnant person took during pregnancy.

Benefits of methadone

Methadone has been a cornerstone of opioid treatment programs for decades and is one of the most studied treatments for opioid use disorder.

Methadone usually requires daily dosing in a clinic. Since the pandemic, some states have allowed new services:

• Doses for home use
• Mobile units
• Integrated outpatient programs

This makes it easier for more people, especially in remote areas, to receive necessary treatment. Long-term methadone therapy has proven to be very effective in reducing the risks of relapse and overdose, while improving overall well-being.

Suboxone vs. methadone for OUD

Research shows that treatment with anti-opioid medications saves lives. Both methadone and buprenorphine (an ingredient in Suboxone) have been proven to reduce the risk of death, including death from opioid-related overdoses. Methadone and buprenorphine are considered equally effective in reducing opioid use.

Methadone has been shown to be better at reducing cravings, but carries a higher risk of overdose (more on this later).

Side effects of Suboxone vs. methadone

Both Suboxone and methadone have side effects that range from mild to life-threatening.

Because of the differences in the way they work, morphine is more likely to cause extreme sedation and respiratory depression (slowed, shallow breathing), especially in the early stages of treatment or when taken in higher doses. Suboxone is less likely to cause excessive sedation, making it a safer option in most cases.

Although not an exhaustive list, the table below compares the most common and potentially serious side effects of Suboxone and methadone.

Suboxone vs methadone
	Suboxone (Buprenorphine/Naloxone)	Methadone
Common side effects	Mouth discomfort or irritation; redness of the mucous membranes in the mouth; headache; nausea; vomiting; sweating; constipation; insomnia; swelling of the limbs; dizziness	Light-headed feeling; dizziness; sedation; nausea; vomiting; sweating; constipation
Serious and potentially life-threatening side effects	Problems breathing (respiratory depression); extreme sedation or drowsiness; liver problems; opioid withdrawal; risk of abuse; serious drug interactions; allergic reaction	Problems with breathing; extreme sedation or drowsiness; heart rhythm problems; serotonin syndrome (symptoms such as diarrhea, seizures, hallucinations and fever); low blood sugar; low blood pressure; seizures; risk of abuse; serious drug interactions; allergic reaction

Risks of methadone and suboxone

When considering Suboxone and methadone for opioid use disorder, it is important to understand the risks and safety concerns associated with both medications. Both drugs can have serious interactions with other substances, such as:

Combining this with Suboxone or methadone can lead to dangerous effects, including severe sedation and life-threatening respiratory depression.

Methadone, because of its long half-life (how long it takes for the drug’s active ingredients to reduce by 50%), requires careful dose management to avoid overdose and drug buildup in the body. It is also associated with a potentially fatal heart rhythm disorder called QT prolongation. Therefore, regular cardiac monitoring is recommended, especially in people with pre-existing cardiac arrhythmias. heart disease.

Although Suboxone is generally safer, it still carries risks, especially when mixed with alcohol or other central nervous system depressants. Both medications should be used with caution in individuals with liver problems, and consultation with a healthcare provider is critical to ensure safe and effective treatment.

Make sure your healthcare provider knows if you become pregnant at any time during treatment. Although both methadone and Suboxone are sometimes necessary to treat opioid use disorder in pregnant people, it is important to be aware of the risks.

More specifically, the use of methadone or Suboxone during pregnancy can lead to pre-eclampsia neonatal abstinence syndrome. This does not mean that treatment should be stopped, but it does emphasize the need for frequent monitoring by healthcare professionals to care for both the birthing woman and the newborn.

Summary

Suboxone and methadone are both effective options for treating opioid use disorder, but they work differently and have their own pros and cons. Suboxone is often safer, with a lower chance of abuse, and convenient because you can usually take it in the privacy of your home. Methadone, on the other hand, requires more medical supervision due to its higher risk of abuse and possible complications, but it may be better for those who have not had success with other treatments.

Ultimately, the choice between Suboxone and methadone should be made together with your healthcare provider, taking into account your specific situation and needs. With the right support and treatment plan, recovery from opioid use disorder is within reach.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts in our articles. To learn more about how we fact-check and keep our content accurate, trustworthy and reliable, read our editorial process.

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2. Centers for Disease Control and Prevention. Opioid use disorder: diagnosis.

3. Centers for Disease Control and Prevention. Commonly used terms.

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6. Daily Med. Methadone label.

7. Patrick SW, Barfield WD, Poindexter BB; Committee on Fetus and Newborn, Committee on Substance Use and Prevention. Neonatal opioid withdrawal syndrome. Pediatrics. 2020;146(5):e2020029074. doi:10.1542/peds.2020-029074

8. Office of Addiction Treatment and Support. Medications for the treatment of opioid use disorders.

9. Mattick RP, Breen C, Kimber J, et al.Maintenance treatment with buprenorphine versus placebo or methadone maintenance in opioid addiction. Cochrane Database System Rev.

10. Daily Med. Methadone label.

11. Mattick RP, Breen C, Kimber J, et al. Maintenance treatment with buprenorphine versus placebo or methadone maintenance in opioid addiction. Cochrane Database System Rev.

By means of Patricia Weiser, PharmD

Patricia Weiser, PharmD, is a licensed pharmacist and freelance medical writer. She has more than 14 years of professional experience.

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