Two of the most popular medications for treating opioid use disorder work differently to help keep people in recovery.
If you or someone you care about is struggling with opioid misuse and addiction, getting help is a priority. Finding the most suitable form of treatment is vital to a successful recovery. Of all the options available, 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 these treatment options. Their differences can help in determining which one is best for you or your loved one.
What Is Medication-Assisted Treatment?
MAT is a compassionate treatment strategy that blends counseling with medication, facilitating recovery from opioid use disorder. This outpatient program offers two primary medication options: methadone and buprenorphine, each with distinct approaches to treatment. Methadone is typically administered in an Opioid Treatment Program (OTP) setting, where patients visit the clinic daily to receive their medication under medical supervision. This structure supports a consistent, controlled path to recovery. Alternatively, buprenorphine, often prescribed in Office-Based Opioid Treatment (OBOT) programs, allows for less frequent clinic visits. This can provide greater flexibility and autonomy in treatment, accommodating different lifestyles and recovery needs. Both medications effectively enable individuals to engage positively in their treatment journey, shifting their thoughts and behaviors as they rebuild their lives in recovery.
You can use MAT over the long term or temporarily as a way to taper off illicit opioids. Evidence shows MAT is more successful than either behavioral intervention or medications used alone. These benefits make MAT the most effective and popular treatment for opioid use disorder today.
How does Medication-assisted Treatment work?
MAT works by preventing the symptoms of opioid withdrawal. After heavy opioid use for more than several weeks, your brain becomes accustomed to the drug and its effects. Your brain adjusts a variety of neurotransmitters and chemical levels to accommodate frequent substance misuse. After some time, it can no longer 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 for most, they can feel overwhelmingly excruciating. This level of discomfort leads many to relapse and go back to using opioids to stop the pain.
At this stage, most people struggle or relapse in recovery without intervention. It can become deadly as risks of opioid overdose increase when someone attempts to stop and rebounds shortly after. MAT stops withdrawal symptoms before they happen, allowing patients to feel normal enough to participate in treatment long-term.
What Is Methadone?
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. That 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 as illicit opioids, methadone lasts longer in a person’s system. This benefit provides withdrawal symptom relief for 24 – 36 hours per dose.
How does Methadone Work?
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 them to participate in counseling, a mandatory part of methadone treatment.
Opioid Treatment Program (OTP) with Methadone
Only medical doctors at licensed clinics can dispense methadone, and it usually comes in tablets or liquid form. The effects last about 24 to 36 hours, so MAT participants must visit their clinic daily to receive their medication. Methadone treatment has three stages.
Induction Phase
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 provider will prescribe an initial dose of methadone. The dose will gradually increase until your withdrawal symptoms are satisfactorily under control.
Rehabilitation and Maintenance Phase
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 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.
Tapering Phase
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 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 of 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 misuse
- 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. However, others find the structure helps them stay on track. Regardless of your stance on daily clinic visits, decades of evidence prove the system works.
What is Suboxone?
Suboxone is another synthetic opioid medication with a few critical differences. Suboxone is a combination of buprenorphine and naloxone, and the FDA approved it for treating opioid addiction in 2002.
Buprenorphine is a partial opioid agonist. It provides enough opioid activity to keep the brain from entering withdrawal. Although, its effects are significantly less intense than full opioid substances, as well as methadone.
How Does Suboxone Work?
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.
Addiction professionals use naloxone to reverse the effects of opioid overdose. In Suboxone, naloxone serves as a strong deterrent for misuse. When Suboxone gets injected, the naloxone will cause you to go into withdrawal immediately. This makes Suboxone very unlikely to become a substance of intravenous misuse.
Office-based Opioid Treatment (OBOT) with Suboxone
The process of receiving MAT using Suboxone 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. Buprenorphine will knock other opioids off the receptors, leading to sudden withdrawal if the patient has opioids in their system.
The second difference is that in most programs, you can take Suboxone at home. During induction, medical staff will assess your withdrawal symptoms to make sure it’s safe to start the medication. You will likely take your first few doses under supervision. After that, 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:
- Naloxone is a misuse 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
Choosing between Methadone and Suboxone
There is no clear winner between methadone vs. Suboxone when it comes to side effects. The symptoms you might experience from medication will certainly be less severe than you would feel when going through withdrawals. Still, it’s wise 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
- Insomnia
- Nausea
- Difficulty concentrating
There’s no question Suboxone works just as well as methadone. If you’re wondering about Suboxone vs. methadone for opioid treatment, here are three central factors to consider in your decision.
Cost
The cost of MAT is a significant factor in the choice of treatment for most people. Many insurance companies will cover at least part of the cost with prior authorization. Still, the difference in price may be enough reason to choose methadone over Suboxone.
Addiction History
Your history of substance misuse will be an essential factor in deciding between Suboxone and methadone. Because methadone has the potential for misuse, it may not be an option for someone with a history of frequent relapse. If you’re concerned about relapse, the deterrent factor of the naloxone in Suboxone can be to your benefit.
On the other hand, methadone’s lack of a ceiling effect means the effect of the medication increases along with dosage. Methadone is the preferred medication for those with long-standing addiction who need more opioid activity to keep withdrawal symptoms at bay.
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 need that structure to stay accountable. Participants can earn take-home privileges, but no patient may receive more than one month’s worth of methadone at one time.
The flexibility of Suboxone take-homes 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.
Enrolling in a MAT Program
Everyone is different, and only your medical provider can ultimately help you determine which program fits your specific needs. Whether you choose methadone or Suboxone, you need a program that provides care and support to succeed in recovery. The most effective treatment is robust on both the medical supervision and counseling fronts.
Successful methadone or Suboxone MAT requires knowledge and skilled observation to ensure the treatment is working as it should. Substance use counselors facilitating group or individual counseling provide actionable 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 will be in capable hands.
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 care you deserve to overcome addiction, AppleGate Recovery is here to help. Learn more about our services and how you can take the next steps by reading our FAQs. Call 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.