When it comes to Suboxone vs methadone, which one is preferred in addiction treatment for opioid addiction?
Methadone, also know by the brand names Dolophine and Methadose, has been used for decades to treat opioid addiction. It has also been used as an effective pain management drug. Suboxone is a combination of buprenorphine and naloxone. It is also used to treat opioid dependence and addiction. Both drugs are highly effective in helping people to quit dangerous street opiates. Is one clearly better than the other?
Methadone, the gold standard for medication-assisted treatment of opiate addiction.
While Suboxone is relatively new to the field of addiction treatment, methadone has been used to help heroin addicts get clean since the 60s. Not only has it stood the test of time, methadone is also known have a 75% success rate, compared to Suboxone’s 50% success rate in treating opiate addiction. So, why don’t all patients addicted to opioids go to a methadone clinic?
The downsides of methadone.
Methadone works, but it is also potentially dangerous. The risk of overdose is high. Because of this risk, methadone is dispensed at special clinics where patients must come in every day to take their daily dose under observation. While patients can earn take-home doses over time, most patients go nearly every single day, early in the morning. Because of the risk of diversion and overdose, methadone is a highly controlled drug with many restrictions. Most doctors cannot prescribe it for opiate addiction treatment.
Suboxone is safer than methadone.
Heroin addicts and people addicted to other opiates now have more choices. They can choose to go to a Suboxone doctor for treatment as an alternative. Because Suboxone is safer than methadone, it is not as tightly controlled. Hence, more doctors are allowed to prescribe it. It is also considered safe for patients to fill their own prescriptions and take the medication on their own without observation. Because of this, patients can get up to a one month supply of Suboxone.
Why would methadone still be used over Suboxone?
Suboxone, or buprenorphine-naloxone, is a unique medication that works as an opiate agonist and a blocker at the same time. Because of this, patients must wait for hours after their last dose of heroin or other opiates before starting buprenorphine. This waiting time can be as long as 24 hours. In some cases, it can be even longer. And, in some cases, Suboxone just doesn’t work. Heroin on the streets is now stronger than ever. It is also now often contaminated with fentanyl, a super potent synthetic opioid. Because of these issues, methadone is still the best choice for some patients. They do not have to wait or go into opioid withdrawal to get started in a methadone treatment program.
So, which drug is best? Suboxone or methadone?
While methadone is clearly better for some patients, I believe that overall, buprenorphine is the better choice for most people. It is safer and has less side effects. Buprenorphine is also more convenient since the patient can get up to a month-long prescription. It is more compatible with daily activities of living. And, patients have mental clarity and few, if any, cravings. They often report feeling as if they are back to normal when they take their Suboxone. By not having to visit the methadone clinic every day, they are not forced to face this daily reminder of their opioid addiction. In fact, there are now monthly injectable and implantable forms of buprenorphine. With these new, long-acting formulations, patients do not even have to take daily medicine.
When it comes to Suboxone, how do the buprenorphine and naloxone ingredients interact with opioid receptors?
Buprenorphine is both a partial opioid agonist and an opioid antagonist. This means that it both blocks and activates the opioid receptors. This is what gives buprenorphine its unique properties and why it is both safe and effective in treating substance abuse with opiates and opioids. Naloxone is included in Suboxone to act as an abuse deterrent to prevent the abuse of Suboxone.
Why don’t the drug companies make a methadone and naloxone combination?
This is a good question. It is certainly being studied and considered. The main reason that it has not already been done is that most patients must go to a specialized clinic every day to take their methadone dose under observation. Since naloxone would be included as an abuse deterrent, it would not be that useful since there is little opportunity for methadone abuse, since the patients are being watched while they take each daily dose. Still, we very well may see a methadone-naloxone combination drug in the near future.