Suboxone vs. methadone, which one works best?
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 better than the other?
Methadone is 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, but methadone is also known to 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 treatment center? For someone recovering from opioid addiction and the effects of opioids, methadone maintenance is a proven, evidence-based treatment.
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 specialized 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. There is little, if any, risk of a euphoric effect. The dangerous effects of methadone are not a concern when it comes to Suboxone.
Suboxone treatment is also considered safe enough that patients can fill their 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.
Buprenorphine was originally used as a pain relief drug. Still, it was observed to be far more effective in treating drug abuse and dependence on heroin, fentanyl, and opioid medications.
This waiting time can be as long as 24 hours. In some cases, it can be even longer. And, in some instances, 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 better for some patients, I believe that, overall, buprenorphine is the better choice for most people. It is safer and has fewer side effects.
Buprenorphine is also more convenient since the patient can get up to a month-long prescription. It is more compatible with the 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.
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. The medication both blocks and activates the opioid receptors. The simultaneous blocking and activating of opioid receptors are what give 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. If someone attempts to inject Suboxone, they will experience immediate withdrawal symptoms due to the naloxone.
Why don’t the drug companies make a methadone and naloxone combination?
That is a good question. It is undoubtedly 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.
Is Vivitrol another alternative to Suboxone and Methadone?
Vivitrol is a monthly injection that contains the drug naltrexone. There has been a lot of buzz around this monthly shot. It is prevalent amongst rehab administrators, law enforcement officers, judges, prison wardens, and concerned parents.
Why does Vivitrol appeal to this particular group of people? Because the company that makes the shot, Alkermes has targeted its marketing to doctors, concerned love ones, and members of the law enforcement and legal community.
Is Vivitrol effective?
In a head-to-head study, Vivitrol performed about as well as Suboxone. That is significant because Suboxone is a controlled opioid medication, and Vivitrol’s active ingredient, naltrexone, is not.
Why not switch all patients who take Suboxone to Vivitrol? One significant issue in starting Vivitrol is that a patient must be opioid-free for an extended time.
After stopping most opioids, a patient must be opioid-free for at least a week before taking naltrexone tablets and then Vivitrol. After stopping Suboxone, due to the long half-life, a patient must wait at least two weeks before starting Vivitrol.
So, where would Vivitrol be an excellent alternative to methadone and Suboxone? Probably the best setting to start Vivitrol is in residential rehab. After being detoxed from opioids and maintained in an opioid-free state, a patient will be prepared to start Vivitrol during their stay in rehab.
Is there one winner in the comparison of these opioid addiction treatment drugs?
It is a good thing that we have so many options for medical treatment when it comes to treating opiate and opioid addiction. There is no one best treatment for all patients.
Each patient is an individual with unique circumstances regarding their opioid addiction. Fortunately, we can give our patients choices and help them make the best decisions that will help them to have the best chance to remain opioid-free long-term.