Methadone vs. Suboxone

Suboxone and Methadone are used to treat patients with opioid dependency or addiction. They are both synthetic opioids.  When someone has been taking opioids (heroine, oxycodone, percocet, and fentanyl) on a daily basis for a long time (more than few months), it causes significant and long-lasting changes in how their brain works (Wang, 1997).  These changes are referred to as neuroadaptations, what this means is that the neurons in the brain adapt to the constant presence of opioid in the brain (Wang, 1997).  For example, we see neuroadaptations of tolerance and withdrawal. Tolerance and withdrawal are key components for diagnosing a substance use disorder, better known as an addiction.  Tolerance refers to when the body needs more and more of a substance or drug to achieve the same effect as before (American Psychiatric Association, 2013).  This is referred to as chasing the high.  Withdrawal is when the body experiences symptoms such as aches, pain, sweating, nausea, or diarrhea when the person no longer has the substance in their system (American Psychiatric Association, 2013).  Therefore, tolerance and withdrawal are hallmarks of opioid dependence.

Methadone and Suboxone are not a cure for opioid dependence; they are a treatment. For it to work, you’ve got to want it to work. Success requires motivation and determination.

What is methadone?

Methadone is a synthetic analgesic drug that is similar to morphine in its effects but longer acting, used as a substitute drug in the treatment of opiate addiction (Centre for Addiction and Mental Health, 2008).  Methadone helps to stabilize the lives of people who are dependent on heroin, and to reduce the harm related to drug use. Methadone has been used in treatment programs since the mid-1960s.  Methadone is a medication that is taken orally. It is diluted with juice such as orange juice. When you first start on methadone, you will be asked to go to your pharmacy each day to drink the medication. As you progress in your treatment, you may be eligible to take home some doses. These are called “carries.”  Drinking methadone won’t get you high, but it can help to keep away the physical drug cravings, or the feeling that you need to get high (Centre for Addiction and Mental Health, 2008).   Some people experience no cravings at all once they’re on methadone. Others may continue to struggle with the “conditioned” cravings, or those that are triggered by something or someone you associate with drug use.  Methadone blocks the euphoric effect of other opioid drugs. For example, if you take a hit of heroin when you’re on methadone, you may not feel it (Centre for Addiction and Mental Health, 2008).

Advantages of Methadone

  • has been extensively researched as a safe and effective treatment option for opiate users
  • cheaper than suboxone
  • can use during pregnancy as opioid withdrawal can threaten the life of the baby
  • can be on methadone for years
  • helps people go back to work and stabilize their lives while addressing their addiction

Disadvantages of Methadone

  • can be abused, so patients will generally start out on daily dispense witness (meaning they must go to a pharmacy each day and have the pharmacist witness their dose in order to get their methadone)
  • can be addictive
  • may experience side effects of sweating, sleepiness or drowsiness, constipation, sexual difficulties, and weight change (Centre for Addiction and Mental Health, 2009).  If you miss your daily dose you will most likely experience these side effects as well as flu-like symptoms.  It is very important you do not miss your dose.
  • risk of overdose
  • no ceiling effect, so doses must be extremely monitored.  You will be asked to provide urine samples, have daily dispense, and have the pharmacist witness you taking your dose.
  • Methadone treatment replaces opioids such as heroin, OxyContin and codeine with another opioid, methadone. You are still opioid dependent, and if you miss more than one dose, you will experience flu-like withdrawal symptoms.

What is suboxone?

Suboxone is a combination pill, composed of both buprenorphine and naloxone. Unlike methadone, Suboxone comes in a pill form and is taken “sublingually”, meaning it is placed under the tongue to dissolve.  Naloxone is a very powerful opioid antagonist, meaning it once taken, it will cause an abrupt and powerful withdrawal syndrome, characterized by nausea, vomiting, diarrhea, muscle cramps, etc. In terms of a pharmacological therapy for opioid addiction, many consider Suboxone to be the “new kid on the block”.  It has been around for some time, both in the United States (where it is slowly surpassing methadone as the treatment of choice) and throughout Europe.  Suboxone is an alternative treatment to methadone, and has been shown to be as safe and effective  with opioid addictions.

Advantages of Suboxone over Methadone

  • less stigmatizing than methadone. Suboxone is a pill, and is therefore a more discreet option for some patients.
  • can often get to a stabilized or maintenance dose within the first or second day
  • has a better safety profile (less likely to cause overdose, little to no effect on heart rhythms)
  • Its formulation means Suboxone is less likely to be used recreationally to get high, and therefore has little street value.
  • may be easier to come off of than methadone
  • fewer side effects, such as constipation, than methadone
  • much harder to abuse so patients are allowed to take it home
  • less addictive than methadone
  • It is a good option for patients who have had issues with methadone, such as side effects or a “wearing off” effect.

Disadvantages of Suboxone over Methadone

  • may not fully satisfy cravings or block withdrawal symptoms for those with high tolerances.
  • have to be in a state of mild to moderate withdrawal before taking methadone
  • more expensive than methadone

Conclusion

Unfortunately, methadone and suboxone clients are still labelled by some as  “still addicted.”  Many people don’t understand opioid depedence treatment, even some people who work in the addiction and health professions. Some drug treatment programs and self-help groups like Narcotics Anonymous (NA) are abstinence-based, and may not accept methadone or suboxone clients. Some doctors and pharmacists are reluctant to work with methadone clients,  fearing they will be pressured to supply prescription drugs. Some employers may not react kindly if they discover that you’re a methadone client. It’s probably fair to say that most people regard methadone and suboxone treatment as a positive step, but there will be exceptions, and you should be prepared for that.

People seeking treatment for an addiction to opioid drugs such as heroin, oxycodone or fentanyl  have easier access to a medication that helps them to stop using and to rebuild their lives (BC Ministry of Health, 2015).  Choosing to start treatment for an addiction is the major first step and some addictions benefit from having medication to address the severe physiological and psychological symptoms.  While I was writing this blog post,  BC’s Ministry of Health announced they would be increasing access to suboxone.

“In the face of the prescription opioid epidemic and other challenges in treating opioid addiction in British Columbia, this is an evidence-based and thoughtful decision,” said Dr. Evan Wood, medical director for addiction services for Vancouver Coastal Health and a professor of medicine at the University of British Columbia. “It has major positive implications for improving opioid addiction care, reducing deaths, illnesses, injuries and ultimately health-care costs in the province.”

When deciding between methadone or suboxone, it is best you consult with your doctor.  The BC Ministry of Health has now made it that clients no longer need to try methadone first, or prove methadone is not appropriate for them.  It is up to you to decide what is best for you.  I encourage you to do some research and consult with your doctor before deciding with treatment is best for you.  It may require you try both.  They are both safe and effective treatments for addressing opiate dependence and addiction.  However, it is not a cure.  It will require motivation and determination.  I encourage clients to do some drug and alcohol counselling, address possible concurrent mental health issues, get connected with a support group, and do some self-care because these treatments are just going to address the physiological aspect of addiction.  Addiction is comprised of physical, psychological, and social factors and so it is important you address all aspects.

 

References

BC Ministry of Health (2015). B.C. increases access to addiction treatment Suboxone. Retrieved from https://news.gov.bc.ca/releases/2015HLTH0079-001698

Centre for Addiction and Mental Health (2008). Methadone Maintenance Treatment: client handbook revised. Retrieved from http://knowledgex.camh.net/amhspecialists/resources_families/mmt_handbook/Documents/mmt_client_hndbk.pdf

Centre for Addiction and Mental Health (2009).  Methadone Maintenance Therapy: Client Information. Retrieved from http://knowledgex.camh.net/amhspecialists/resources_families/Pages/methadone_therapy.aspx

Wang, GJ et al. (1997). Neuropsychopharmacology, 16(2): 174-182.

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