Is buprenorphine the same as methadone?
We have been in the midst of an opioid overdose epidemic for many years now. While there are many approaches to treating opioid addiction, or opioid use disorder, medication-assisted treatment has the best track record.
If you are reading this article, you may have already come to the same conclusion. Opioid dependence treatment that makes use of one of several approved medications is the best course of action.
As you may also be aware, the three meds that doctors are allowed to either dispense or prescribe to treat opiate addiction are methadone, buprenorphine, and naltrexone. The first two, methadone and buprenorphine, seem to provide the best hope for long-term success.
However, because both methadone and buprenorphine are classified as opioids, many people are concerned about using them for addiction treatment, even if they are proven to work better than rehab, therapy, or 12-step meetings, without meds. There is significan stigma associated with the use of opioid drugs to treat opioid addiction.
How are buprenorphine and methadone different?
There are many reasons why we should still use these meds to help save the lives of opioid addicted people. Yet, we should also be aware of the significant differences between buprenorphine and methadone.
First, methadone is classified by the federal government as a CII, or Schedule 2 drug, while buprenorphine is a CIII drug. This means that methadone is considered to have a much higher abuse potential compared to buprenorphine.
In fact, methadone, when used to treat opioid addiction, is managed with even tighter controls than almost any other CII drug. While a doctor can write prescriptions for CII drugs, to be filled at local pharmacies, methadone must be dispensed, in person, at a methadone clinic.
Methadone is more likely to get people high. Users quickly develop tolerance to methadone. Opioid tolerance means that the user must take more of the drug to feel the same effect. Methadone can easily cause respiratory depression and overdose if misused.
Buprenorphine, on the other hand, is far safer, having a much lower risk of overdose. Patients who take buprenorphine, also tend not to develop tolerance easily, and it rarely gives anyone a high.
What are the disadvantages of the use of methadone?
Is methadone addictive? Does it get into people’s bones? Can methadone damage your liver or your teeth? Can methadone cause heart problems?
There are many concerns about the dangers of methadone and long-term consequences of methadone use. While some concerns are legitimate, many of the issues people worry about are myths, with little to no truth behind them.
For example, methadone does not get into the bones, and methadone does not cause tooth decay. While methadone might cause dry mouth, which can promote tooth decay, it does not directly lead to teeth decaying and falling out.
While methadone can be addictive, and cause overdose, it is a highly effective, life-saving therapy. The dangers of methadone are mitigated by the tight controls at methadone maintenance clinics, as required by the federal government.
What kind of doctors can prescribe methadone and what kind of doctors can prescribe buprenorphine?
Aside from the actual dangers of the drug, the tight governmental controls on methadone clinics are considered to be a major disadvantage. Buprenorphine, unlike methadone, can be prescribed by doctors in private medical clinics.
A doctor can give a prescription for up to a one month’s supply of buprenorphine to a patient to be filled at their local pharmacy. After the initial early treatment phase, patients can see their buprenorphine provider once each month.
Compared to daily methadone clinic visits, monthly buprenorphine doctor visits are much more appealing. Buprenorphine treatment makes it possible for patients to stay home on their days off from work, and they are able to plan vacations for up to weeks at a time.
In addition to daily clinic visits being a major disadvantage of methadone, many methadone clients believe they are treated poorly at the clinic. Most areas have few, if any methadone clinics.
When a nurse, counselor, or doctor at the local methadone maintenance clinic says something offensive or inappropriate, the patient may feel that they are powerless to resolve the situation. Methadone use leads to a very high level of physical dependence. If the patient stops treatment suddenly, they become very, very physically ill.
Because of methadone dependence, the patient also become psychologically dependent on their status at the methadone clinic. They will submit to poor treatment, including sometimes, emotional abuse. Methadone patients often feel as if they have no way out of the clinic, because of the hold methadone has on them.
What advantages does buprenorphine have over methadone?
Why is Suboxone better than methadone for many patients? As already mentioned, doctors are allowed to write a prescription for buprenorphine that the patient can fill at their local pharmacies. Immediately, you will notice the incredible amount of choices and freedom allowed to the patient.
Patients may choose their buprenorphine pharmacy, and they may choose their buprenorphine doctor. Additionally, patients may also choose their buprenorphine medication.
Buprenorphine is mostly prescribed as a sublingual medication. It is available as both a pill and a film, which is a small rectangular strip.
Sublingual meds are dissolved under the tongue. Buprenorphine taken daily for opioid dependence must be used sublingually, because it is not absorbed in the gastrointestinal tract. Swallowing buprenorphine does not work.
What brands of buprenorphine are available in pharmacies?
Suboxone is the best known brand of buprenorphine. It is technically buprenorphine/naloxone, because it contains the abuse-deterrent drug, naloxone. Suboxone is available as a film or tablet.
ZubSolv is a branded tablet that is known for having more dosage strengths compared to other brands. It also tastes better than Suboxone and other brands, and it dissolves quickly.
Subutex is an older brand that is only now available as a generic tablet. Unlike Suboxone, Subutex does not contain naloxone. Subutex is preferred, unless the patient is either pregnant or has had a previous adverse reaction to naloxone.
Bunavail is a far less popular brand that has the unique property of being buccal, meaning that it is placed inside the cheek, rather than under the tongue. Suboxone Films may be used this way as well.
In addition to the sublingual and buccal buprenorphine tablets and films, there are also injectable forms of buprenorphine. There is Sublocade, available in the US, and Brixadi, available in other countries for now. Additionally, there is the Probuphine implant, a six-month implant that is no longer available in the US.
Sublocade and Brixadi are long-acting injections that can last up to a month at a time. These subcutaneous buprenorphine injections make it possible for a patient to not have to worry about their medication between monthly doctor visits.
In addition to the patient not having to worry, the rest of society will not have to worry about patients who give away or sell their medication. The issue of lost or stolen medication is also not a concern with an buprenorphine shot.
What is stronger? Methadone or Suboxone?
Methadone is generally considered to be stronger than Suboxone. At about 32mg, Suboxone, or any other sublingual buprenorphine, levels off in the patient’s system. This is known as the ceiling effect.
The ceiling effect is protective, but also prevents buprenorphine from providing additional analgesic effects above that strength. Methadone, on the other hand, has no ceiling effect. If we are comparing the two drugs to see which can provide better pain relief as an opioid, methadone would often be the winner for severe chronic pain.
However, Suboxone does still work well as an analgesic, pain reliever for chronic pain. Patients who are opioid-addicted, yet also have chronic pain, may benefit from the pain-relieving effect of Suboxone.
Otherwise, it does not make much sense to compare the two drugs to say which is stronger. Methadone is stronger if we are talking about more side effects and more risk of adverse reactions. Otherwise, both drugs are highly effective in treating opioid addiction.
Is switching from methadone to buprenorphine possible?
Many patients who go to a methadone clinic as this question. Is switching from methadone to Suboxone or switching from methadone to Subutex a possibility?
The reason that patients want to know about this is because of the freedom allowed by going to a Suboxone doctor compared to a methadone maintenance clinic. Most methadone patients must show up every day at the clinic for their daily dose, while Suboxone treatment often only requires a monthly visit.
First, methadone must be tapered down to around 30mg daily. For patients who take much higher dosages, 120mg for example, they will take some time to work with their methadone doctor to reduce the dosage gradually over time.
One issue with taking methadone after Suboxone is that there must be a washout period, where the methadone is stopped and allowed to leave the patient’s system. The waiting period between the last methadone dose and the first Suboxone or Subutex dose is at least 32 hours, yet is often much longer.
Precipitated withdrawal, caused by starting buprenorphine too soon, should be avoided.
If Suboxone is started too soon after methadone, while any methadone remains in the system, the patient will experience precipitated withdrawal. Precipitated withdrawal symptoms are very unpleasant is should be avoided if possible.
Another option is to start Suboxone or Subutex at a very low dose and gradually increase it, even while the patient continues to take methadone. This is a protocol where taking Suboxone and methadone together for a short time is possible.
After about a week of gradually increasing Suboxone to around 12mg to 16mg daily, methadone can be discontinued. This technique is known as the Burnese Method, or microdosing Suboxone.
So, to answer the question, “can you use Suboxone to get off methadone?”, it may be possible using this microdosing solution. Still, going from methadone to Suboxone is not easy, and requires close monitoring by the doctor. The transition from methadone to Suboxone, or transitioning from methadone to Subutex, is not easy.
Is switching from Suboxone to methadone ever a good idea?
You might think there is no reason for a patient to ever make the switch from Suboxone to Methadone. It may seem like a step backwards. Yet, we should not see it that way for the patients who need this switch.
In some cases, Suboxone just does not work for the patient. If the patient relapses frequently while taking Suboxone, and uses potent street opioids, such as fentanyl, they may have more success with methadone.
Methadone can be started right away without having to worry about opioid withdrawal symptoms before starting treatment. Suboxone, on the other hand, requires that the patient wait until they are in a moderate opioid withdrawal state.
A patient taking an opioid drug can walk into a methadone clinic on the same day of opioid use and get started on methadone. Methadone is a full agonist at the opioid receptor, as opposed to buprenorphine, which is a partial agonist.
A patient who goes for substance abuse treatment at a methadone clinic, after switching Suboxone for methadone, may consider switching back from methadone to Suboxone when they are ready.
What about methadone vs Suboxone vs Vivitrol?
Methadone is known to have a 75% success rate. This may be partly due to the ease of getting started, the high potency of methadone, and also the close monitoring of patients due to daily clinic visits.
Suboxone, or buprenorphine in general, has a 50% success rate. While not as high as methadone, is still considered to be very high. Compared to abstinence-based treatment, at a rehab, where success rates may be below 10%, Suboxone is very effective.
Vivitrol is a monthly extended release shot that contains naloxone, an opioid receptor blocker. Vivitrol also has a 50% success rate, just like Suboxone. The advantage of Vivitrol is that it is not an opioid, so patients concerned about taking an opioid for treatment may prefer Vivitrol.
How do I know which treatment is right for me?
Buprenorphine, usually in the form of Suboxone, is most often the right choice. It is relatively easy to get started and it is highly effective. Vivitrol requires a long washout period before starting, so it is better to start the Vivitrol shot during a stay in rehab.
Methadone has become a last alternative at this point, because of the success of buprenorphine. Yet, it still holds an important place in the world of addiction treatment, for when a patient cannot get started with Suboxone treatment or if they repeatedly relapse on Suboxone.
If you are not certain where to go for treatment, it may help to see an experienced addiction treatment doctor who can help you to decide. A concierge addiction treatment physician, for example, is able to consult with you to evaluate your specific situation and help to make a decision.
The type of doctor of facility you decide to visit is up to you. Each person is different and has different needs.
The most important thing to keep in mind is that it is important to act quickly and get started with treatment. Every time a person uses opioids again on the streets, they take great risk.
Medication assisted treatment with buprenorphine, methadone, or naltrexone, is highly effective. Getting started in recovery, while dispensed or prescribed one of these medications will make a great difference in helping you to stay with the program long-term, with the lowest risk of relapse.