Pros and Cons of Suboxone vs Methadone Treatment

Treatment for opioid use disorder often includes Suboxone (buprenorphine/naloxone) or methadone, which are used as opioid replacement therapy.¹ While both medications are opioid agonists, meaning they stimulate the same brain receptors as opioids, there are differences in how they work and their risk profiles.

This page will explain what both medications are and compare the benefits and considerations of Suboxone and methadone to treat opioid use disorder.

What Is Suboxone?

Suboxone is the brand name of a sublingual medication made up of buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist known for its ability to reverse an opioid overdose.²

Being a partial agonist, buprenorphine stimulates the opioid receptors that normally interact with illicit opioids like heroin and opioid pain medications that are commonly misused.³

However, buprenorphine is only a partial opioid agonist, and has a maximal dose-effect ceiling that is well below significant respiratory depression for most patients. This allows it a higher safety profile.

Buprenorphine is combined with naloxone to discourage injected diversion and misuse. When Suboxone is taken orally, as indicated, naloxone is not activated, but if a person dissolves Suboxone and injects it, they will experience withdrawal symptoms.³

Pros of Using Suboxone for Opioid Addiction Treatment

Suboxone can provide the assistance many people need to stop using illicit opioids or misusing prescription opioids. Studies show that the many benefits of using Suboxone include the following:⁴

• Retains patients in treatment and reduces illicit opioid use more effectively than placebo.
• Reduces or eliminates opioid withdrawal symptoms.
• Blunts or blocks the effects of illicit opioids.
• Reduces or eliminates cravings to use opioids.
• Reduces risk of overdose death.
• Reduces HIV risk behaviors.
• More cost effective than OUD treatment without medication.
• May be prescribed outside of an opioid treatment program (OTP) by individual healthcare practitioners via a federal waiver program. This allows a patient to fill the medication at a pharmacy or take it home from an OTP.

Cons of Suboxone

There are relatively few cons for incorporating Suboxone in a person’s attempt to stop misusing opioids or using illicit opioids. Some potential cons of Suboxone use are:⁵

• The first dose of Suboxone is generally given after opioid withdrawal begins. This is because buprenorphine is a partial agonist with strong receptor affinity that can result in rapid onset of opioid withdrawal in an opioid-dependent person that’s currently opioid intoxicated.
• Mixing benzodiazepines or other CNS depressants with Suboxone can be lethal.
• Although the dose-effect ceiling confers safety advantages that allow easier access, Suboxone may not be sufficient for patients with more severe opioid dependence.⁶
• Although buprenorphine (as well as methadone) can be taken during pregnancy, Suboxone and similar formulations combining buprenorphine and naloxone are not currently recommended due to limited evidence.

What Is Methadone?

Methadone is a medication that is a full opioid agonist.⁷ It works on the same receptors that interact with illicit opioids like heroin and opioid pain medications that are commonly misused.⁷

Unlike buprenorphine, which is a partial agonist, methadone does not have a dose-effect ceiling, and increased medical supervision is required when inducting a person into methadone treatment.⁷

Pros of Methadone Treatment

Since 1965, methadone has been used to successfully transition people away from illicit opioids, such as heroin or misuse of opioid pain medications.⁸ Studies show that the many benefits of using methadone include the following:

• Retains patients in treatment and reduces illicit opioid use more effectively than placebo, medically supervised withdrawal, or no treatment.
• Reduces or eliminates opioid withdrawal symptoms.
• Blunts or blocks the effects of illicit opioids.
• Reduces or eliminates cravings to use opioids.
• Reduces risk of overdose death.
• Reduces HIV risk behaviors.
• More cost effective than OUD treatment without medication.
• Largest, oldest evidence base of all treatment approaches to opioid addiction.
• Reduces risk of HIV and hepatitis C infection.
• Lower rates of cellulitis.
• Associated with reduced criminal behavior.

Cons of Using Methadone for Opioid Dependence

Methadone treatment requires closely supervised medication induction and dose titration over a period of a few weeks to stabilize a person at the right dose.⁵ Some aspects of methadone treatment that should be considered are:

• Available only at federally certified opioid treatment programs (OTPs) and the acute inpatient hospital setting for OUD treatment.⁴
• Mixing methadone with benzodiazepines or other CNS depressants can be lethal.⁵

Suboxone versus Methadone: How Do They Compare?

There are several factors considered when choosing an appropriate treatment medication for opioid use disorder. Some of these factors may be outside of an individual’s control. In the U.S., the following may determine which medication is applicable for a given patient:⁵

• Site of care
• Level of care
• Local availability
• Cost

The following sections will compare additional factors about each medication that may clarify why some people may prefer 1 medication over the other.

Success Rates of Suboxone versus Methadone

Buprenorphine, including Suboxone, has been shown to have similar success rates to methadone (vs. treatment with placebo). People taking buprenorphine at an appropriate dose were nearly twice as likely to stay in treatment than people without opioid replacement therapy.⁹ Another study had a more than 50% success rate for people being able to adhere to treatment for opioid use.¹⁰

In a study that compared methadone versus Suboxone, methadone was found to be more effective at keeping people in treatment (74% retention versus 46% retention).¹¹ But the number of clean urine drug tests between participants of both groups was similar, showing that both medications were helpful for abstinence.¹¹

Side Effects of Suboxone and Methadone

Taking either Suboxone or methadone may result in side effects. These should be weighed against the benefits the medications offer. Some side effects for both medications can include:^3,7

• Nausea.
• Headaches.
• Dizziness.
• Slowed breathing.
• Drowsiness.
• Dry mouth.
• Heart rhythm changes.

Long-Term Risks of Suboxone versus Methadone

Both methadone and Suboxone can be taken on a short-term or long-term basis. However, patients who discontinue OUD medication generally return to illicit opioid use.⁴

Both medications are opioid agonists, which means regular use will result in physiological dependence and, possibly, hyperalgesia, or an increased sensitivity to pain. This could result in a person having to receive higher doses of opioid pain medications should a need for acute pain management arise.⁴

Methadone and Suboxone are both, in general, more effective than abstinence-based treatments and have a lower risk of overdose. Should a patient stop taking the medication, however, opioid overdose is a risk. It is recommended that anybody stopping these medications has naloxone available in case of a return to opioid use and subsequent overdose.⁴

Is Suboxone or Methadone Better?

Both methadone and Suboxone retain patients in treatment and reduce illicit opioid use more effectively than placebo.

Depending on the treatment center or your location, only 1 of the 2 medications may be available.¹ There are many questions to ask, and only a professional can help guide you to the right medication.

Successful treatment and long-term abstinence from opioids have been achieved with both medications.⁴ Mental health professionals can assist you in creating a treatment plan and medication that will give you the best chance of healing from opioid use disorder.

Get Help for Opioid Dependence at Oxford Treatment Center

If you or a loved one are struggling with opioid use disorder, help is available. Medications like Suboxone or methadone can help retain people in treatment, reduce illicit opioid use more effectively than placebo, and eliminate or minimize withdrawal symptoms and cravings for opioids. This can enable you to focus on your long-term recovery efforts.

Inpatient drug and alcohol rehab in Mississippi is available at Oxford Treatment Center. Admissions navigators are available 24/7 to answer your questions and walk you through rehab admissions, drug and alcohol rehab insurance coverage, drug rehab payment options, and more.

Find out about inpatient addiction treatment, outpatient treatment, and other options to overcome opioid use disorder by calling . You can also quickly verify your insurance coverage with our confidential .

Change is possible. If you’re ready for recovery, please call or contact us online today.