When you or someone you care about is struggling with opioid abuse and addiction, finding the right form of treatment is vital to a successful recovery. Of all the options you have, one of the most popular is medication-assisted treatment (MAT) using either methadone or Suboxone®. Many misconceptions surround MAT, making people question if it’s right for them or if it’s effective. Learning more about the two medications is the first step in understanding the treatment options and determining which one is best for you or your loved one.
What Is Medication-Assisted Treatment?
MAT is a treatment that combines counseling and medication to make recovery possible. In this type of outpatient program, participants receive daily medication that makes it possible to participate in the treatment necessary to change thoughts and behaviors related to addiction. You can use MAT over the long term, or temporarily as a way to taper off of illicit opioids. Evidence shows MAT is more successful than either behavioral intervention or medications used alone, making it the most effective treatment for opioid use disorder.
MAT works by preventing the symptoms of opioid withdrawal. After you use opioids heavily for more than a couple of weeks, your brain becomes accustomed to the drug and its effects. Your brain adjusts a variety of chemical levels to accommodate frequent substance abuse, and can’t calibrate quickly enough when you suddenly stop using the substance. The early symptoms of opioid withdrawal include:
- Agitation and irritability
- Anxiety
- Increased tearing
- Insomnia
- Muscle aches
- Sweating
- Yawning
These symptoms are unpleasant, to be sure, but most people can continue to stay abstinent during this phase. After this first phase of withdrawal, the more severe symptoms set in, including:
- Severe abdominal cramping
- Diarrhea
- Nausea and vomiting
- Goosebumps
While these symptoms are not life-threatening, they can feel so excruciating that a person will immediately go back to using opioids just to stop the pain. This stage is where most people struggle or relapse in recovery without intervention. MAT stops these symptoms before they happen, allowing patients to feel normal enough to continue their lives and participate in treatment.
What Is Methadone, and How Does It Work?
The most commonly used medication for MAT is methadone. This medication is a synthetic pain reliever that happens to belong to the opioid family. Methadone is what’s called an opioid agonist, which means it acts on the same opioid receptors in the brain as drugs like heroin and prescription painkillers. Although it binds to and activates the same receptors methadone lasts longer in a person’s system, providing symptom relief for 24 – 36 hours.
When someone dependent on opioids takes methadone at prescribed levels, they don’t experience a high. Instead, the brain is getting enough of the opioid to stop it from entering withdrawal. Methadone helps block painful withdrawal symptoms, but also partially blocks the euphoric effects of drugs of use. Most importantly, the relief of withdrawal symptoms allows an individual to participate in counseling, a mandatory part of any treatment plan including methadone.
Where Did Methadone Come From?
Most people are surprised to learn methadone has been around since the 1930s, when two German scientists synthesized its structure while looking for a painkiller less addictive than morphine. Methadone came to the United States in 1947, when medical professionals used it for its original intended purpose. In the 1960s, however, a resurgence of heroin addiction led to the discovery that methadone can reduce or eliminate the craving for opioid drugs.
In 1972, the federal government published regulations on how to use methadone in the treatment of heroin addiction. Ever since then, MAT with methadone has been the gold standard of opioid addiction treatment.
What Does MAT With Methadone Look Like?
Only medical doctors at licensed clinics can dispense methadone, and it usually comes in tablets or liquid form. The effects of this medication last about 24 to 36 hours, so MAT participants must visit their clinic daily to receive their medication. Methadone treatment has three stages.
1. Induction
The induction, or “acute,” phase starts with the first trip to the physician. Depending on variables such as drug use history, age and weight, your doctor will prescribe an initial dose of methadone and gradually raise it until your withdrawal symptoms are satisfactorily under control.
2. Rehabilitation and Maintenance
Maintenance is the ongoing use of methadone to keep withdrawal symptoms at bay. Once your dosage has stabilized, the work of rehabilitation begins in earnest. The counseling sessions begun in the induction phase will start to yield real-life results as you practice the skills learned during appointments. This phase can last anywhere from a few months to several years. The National Institute on Drug Abuse recommends 12 months as the minimum for methadone treatment.
3. Tapering
Longer treatment times link to better outcomes, but you can choose to taper off the medication at any time, as long as your doctor approves. Your physician will gradually reduce your methadone dose, being careful to avoid the onset of withdrawal symptoms as much as possible. The longer the tapering phase, the better.
Pros and Cons of Methadone
Like any form of medication, methadone comes with pros and cons. These are some of the advantages to MAT with methadone:
- A more than 40-year track record of proven effectiveness
- A rigid dosing system that may give patients a healthy sense of structure and accountability
- A relatively affordable cost
- Wide insurance coverage
Some of the disadvantages of methadone treatment include:
- Stigma against methadone clinics
- The possibility of methadone abuse
- The possibility of continued illicit opioid use
For many people, the rigidity of a methadone treatment program counts in the negative column. Not everyone has the time or desire to visit a clinic every day to receive their medication, but others find the structure helps them stay clean. Regardless of your stance on daily clinic visits, decades of evidence prove the system works.
What Is Suboxone®?
Suboxone® is another synthetic opioid, with a few critical differences. Suboxone® is a combination of the medications buprenorphine and naloxone, and the Food and Drug Administration approved it for use in treating opioid addiction in 2002.
Buprenorphine is only a partial opioid agonist. It can provide enough opioid activity to keep the brain from entering withdrawal, but its effects are significantly less intense than opioid drugs of abuse, as well as methadone.
A key feature of buprenorphine is its ceiling effect. When someone takes buprenorphine, the effects increase with dosage only up to a specific point. Having reached that ceiling, taking more buprenorphine will not result in greater effects. Because of this, there is less risk that someone will misuse or become dependent on buprenorphine.
Addiction professionals use naloxone on its own to reverse the effects of opioid overdose. In Suboxone®, naloxone serves as a strong deterrent for misuse. Naloxone only gets absorbed and activated if the medication gets dissolved and injected, rather than taken orally. If this happens, naloxone will cause you to go into withdrawal immediately — making Suboxone® very unlikely to become a substance of abuse by injection.
What Does MAT With Suboxone® Look Like?
The process of receiving MAT using Suboxone® vs. is similar to that of methadone, with two key differences. The first is that you must be in mild withdrawal before you take your first dose. Buprenorphine, the medication’s main ingredient, has a greater affinity for receptor sites in the brain than methadone and other opioids do. Therefore, the buprenorphine will knock other opioids off the receptor sites, leading to sudden withdrawal if the patient isn’t opioid free when taking the first dose.
The second difference is that in most programs you can take Suboxone® at home. During induction, a doctor or registered nurse will assess your withdrawal symptoms to make sure it’s safe to start the medication, and you’ll likely take your first few doses under supervision. After that, however, you can continue your treatment in the comfort of your home with regularly scheduled appointments at the clinic. Some programs even allow you to begin induction at home.
Pros and Cons of Suboxone®
When considering methadone vs. Suboxone® treatment, keep these advantages in mind:
- Naltrexone as an abuse deterrent
- Greater flexibility in treatment structure
- Inability to use other opioids
The primary disadvantages of this medication are:
- Necessity of mild withdrawal symptoms before induction
- Significantly higher cost
- Less research on long-term effects available
Side Effects of Methadone and Suboxone®
There is no clear winner between methadone vs. Suboxone® when it comes to side effects. While the symptoms you might experience will certainly be less severe than you would feel when going through withdrawals, it’s good to be aware of what you might expect. The most common side effects of methadone are:
- Fatigue
- Abdominal cramping or distress
- Loss of libido
- Irregular heartbeat
- Respiratory depression
The side effects of Suboxone® might be more palatable to some individuals, or they may be less tolerable. They include:
- Dizziness and headache
- Facial numbness
- Insomnia
- Nausea
- Difficulty concentrating
How Does Suboxone® Compare to Methadone?
There’s no question Suboxone® works just as well as methadone, but it doesn’t have the long history of success that methadone does. If you’re wondering about Suboxone® vs. methadone for the treatment of opioid dependence, here are three central factors to consider in your decision.
1. Cost
The cost of MAT is a significant factor in the choice of treatment for most people. While many insurance companies will cover at least part of the cost with prior authorization, the difference in price may be enough reason to choose methadone over Suboxone®.
The cost of methadone treatment ranges from about $42 to $166 per week, with an average price tag of $91. Suboxone®, on the other hand, ranges from around $110 to $160 per week. Over the length of treatment, this price difference may be enough to make methadone the medication of choice depending on individual finances and insurance coverage.
2. Addiction History
Your history of substance abuse will be an essential factor in deciding between Suboxone® and methadone. Because methadone has some potential for abuse, it may not be the best option for someone with a history of frequent relapse. If you’re concerned about relapse, the deterrent factor of the naltrexone in Suboxone® can make abusing the medication so unpleasant you’ll never want to do it again.
On the other hand, methadone’s lack of a ceiling effect means the effect of the medication increases along with dosage. For someone with a lengthy history of addiction who may need more opioid activity to keep the brain from turning on withdrawal, methadone is the preferred drug.
3. Program Flexibility
Outpatient treatment with either medication will require some availability in terms of scheduling. Methadone is the more restrictive medication because it requires you to receive daily doses on-site at the clinic. This requirement can interfere with crucial activities such as work or school, but some people need that structure to stay accountable. Over time, participants can earn take-home privileges, but no patient can ever receive more than one month’s worth of methadone at one time.
The flexibility of being able to take Suboxone® home can allow people to participate in their daily activities more or less as usual. However, Suboxone® has lower treatment retention than methadone, possibly for this very reason.
Choosing a MAT Program
Everyone is different, and only a doctor can ultimately help you determine which program fits your specific needs. No matter whether you choose methadone or Suboxone®, you need a clinic that provides the care and support you need to succeed in recovery from opioid addiction. The most effective treatment is robust on both the medical supervision and counseling fronts.
Successful induction to methadone or Suboxone® requires the knowledge and skilled observation to ensure the treatment is working as it should. Psychological professionals facilitating group or individual counseling have to be able to build rapport with you and provide actionable skills and strategies that will aid your recovery in everyday life. The quality of the program you choose will directly impact your ability to succeed in recovery.
Reaching Recovery With AppleGate
At AppleGate Recovery, we are proud to specialize in office-based opioid treatment for adults struggling with opioid addiction. We use buprenorphine and Suboxone® to provide our patients with the stability they need to pursue a permanent recovery. Our individualized treatment plans take into account your history and circumstances to meet your needs with medication, counseling and a variety of other recovery support services.
You won’t find any judgment at AppleGate. We understand opioid addiction can happen to anyone, and unlike other clinics, we don’t discharge patients for suffering a relapse. Relapse is often part of the process, and we work to address it, rather than punish it.
If you’re ready to receive the compassionate care you need to overcome an addiction to opioids, AppleGate Recovery is here to help. Learn more about our services and how you can take the next steps by calling us at 888-488-5337, or fill out our contact form for more information. No one chooses opioid addiction, but you can choose recovery today.