Suboxone vs. Methadone: Opioid MAT Comparison

Medication-assisted treatment (MAT) is an effective approach to opioid addiction when used in combination with other treatments and therapies. Two of the most common medications used in MAT are Suboxone and methadone, but they’re not interchangeable. There are important differences and risks to be aware of with each drug.

What Is Suboxone?

Suboxone is the brand name for a combination medication that includes buprenorphine, an opioid partial agonist, and naloxone, an opioid agonist. Buprenorphine produces some opioid effects, like pain relief and reduced cravings, but milder than full opioid agonists like morphine or heroin.[1] It has a lower risk of overdose and other dangerous side effects. Naloxone can reverse opioid overdoses when used intranasally by blocking opioid receptors, reducing the risk of overdose with Suboxone.

Suboxone gained attention in the U.S. in 2002 as a treatment option for opioid addiction (opioid use disorder).[2] It’s available in pill, sublingual form – a strip that dissolves under your tongue – or an implant that can be put under the skin for lasting effects.

What is Methadone?

Methadone is a synthetic opioid agonist that activates the receptors in the brain with milder effects. It is used in MAT to reduce the intensity and painful symptoms associated with opioid withdrawal. During addiction treatment, methadone can help with ongoing opioid cravings and lasting withdrawal symptoms.

Unlike Suboxone, methadone has been in use for a while. It was developed during World War II by German scientists to address a morphine shortage.[3] In the U.S., it was used as a painkiller in the midcentury. Now, methadone is used mainly in MAT in the form of a liquid, powder, or tablet.

Opioid MAT Comparison: Suboxone and Methadone

Methadone is an older drug and was previously used in medicine as a painkiller. Now, it’s a common drug for MAT because of its ability to relieve severe withdrawal symptoms and help with pain.

Though there are still risks, methadone has gradual, mild effects compared to opioids like fentanyl, morphine, heroin, or oxycodone. It activates the receptors in the brain to ease intense withdrawal symptoms during opioid detox and relieve cravings.[4]

Methadone is a longer-term treatment. You must take methadone for at least 12 months under a doctor’s supervision, then it can be continued on your own. Some people may need to stay on methadone for longer periods, but many people slowly taper off of methadone after treatment.

A key difference between methadone and suboxone is that the former was developed to relieve pain during wartime. Its ability to help with opioid addiction was discovered in the process, which eventually led to the development of Suboxone for MAT. The drug combines the effects of buprenorphine and naloxone to activate the opioid receptors with milder effects to relieve pain and withdrawal symptoms while also reducing the risk of potentially fatal overdose.[5]

The downside of Suboxone is that you have to take it 12 hours after a short-acting opioid like hydrocodone. If you take long-acting opioids like extended-release oxycodone, you have to wait 24 hours to take Suboxone. Otherwise, an uncomfortable and potentially dangerous “precipitated” withdrawal can occur.[6]

Suboxone vs. Methadone Side Effects

Both buprenorphine and naloxone have side effects, but they’re generally mild and may include:[7]

• Nausea
• Vomiting
• Constipation
• Numbness
• Insomnia
• Headaches
• A burning sensation in the mouth
• Pain
• Swelling in the extremities
• Withdrawal symptoms

There is a risk of serotonin syndrome, a rare but potentially life-threatening condition with symptoms like hallucinations, nausea, diarrhea, and seizures.

Methadone also has possible side effects, including:[8]

• Nausea
• Vomiting
• Dizziness
• Drowsiness
• Sweating
• Injection site pain or reaction
• Severe constipation
• Racing heart
• Weak or shallow breathing
• Lightheadedness
• Serotonin syndrome

Suboxone and Methadone Risks

Suboxone and methadone have similar actions on the opioid receptors, so their risks are similar. The possible risks of Suboxone and methadone include slowed breathing, heart arrhythmia, and liver damage at high or frequent doses. Neither Suboxone nor methadone should be combined with other central nervous system depressants like alcohol, benzodiazepines, or sedative drugs.

It’s possible to overdose on Suboxone if you’ve never taken opioids.[9] Methadone can also cause overdose and may increase the risk of seizures.[10] These risks can be avoided by taking these drugs as prescribed, never at higher doses or more frequent doses.

There are possible drug interactions for Suboxone and methadone, including CNS depressants that can decrease breathing or cognitive function to dangerous levels. Make sure to inform your doctor of all drugs you’re taking, including illicit drugs, supplements, and over-the-counter (OTC) medications.

Suboxone and Methadone Abuse and Addiction Potential

Suboxone has a low potential for abuse and addiction because of its effects. Buprenorphine has weak opioid effects, and combined with naloxone, there’s less euphoria that reinforces use. Because of this, Suboxone is regarded as a “safer” MAT drug, but it’s still a Schedule III controlled substance with some risk of abuse or misuse.

Conversely, methadone is a full opioid agonist that binds to the opioid receptors in the brain and activates them, which can cause dependence over time. It’s classified as a Schedule II substance because of the risk of abuse and misuse. According to the CDC, from 2006 to 2014, there were about 5,000 methadone-related deaths annually.[11]

Do Methadone and Suboxone Show Up on Drug Tests?

Yes, specialized drug tests can detect methadone and Suboxone, though some standard opioid panels may not. Employers and programs that require drug testing should be informed of MAT use, which is protected under the Americans with Disabilities Act (ADA).[12]

Are Suboxone and Methadone Controlled?

Both Suboxone and methadone are controlled, but the latter has more drug restrictions. Suboxone can be prescribed by a general practitioner and can be dispensed at a pharmacy, while methadone can only be prescribed by a certified opioid treatment program (OTP). Methadone use must be monitored for at least 12 months.[13]

Choosing Between Suboxone and Methadone

If you or a loved one is struggling with opioid addiction, Suboxone or methadone can be effective as part of a MAT option and comprehensive addiction treatment. However, these are different drugs. 

There’s some evidence that Suboxone may be safer than methadone, but both drugs have risks and a potential for abuse or misuse. Whichever works best for you, it’s crucial to combine them with a comprehensive addiction treatment program that addresses the underlying factors in addiction and supports lasting recovery.

Can You Take Suboxone and Methadone Together?

No, combining Suboxone and methadone is dangerous and increases the risk of severe side effects, including possible overdose. You should only take one MAT drug at a time under medical supervision.

Should I Switch from Methadone to Suboxone?

Suboxone and methadone are both effective for treating opioid addiction, but they are different. If you take one drug and feel like it’s not effective, your doctor can help you determine if switching to another may be a better option for you.

Frequently Asked Questions about Suboxone vs. Methadone