Suboxone vs. Methadone: How Does Suboxone Compare to Methadone?

Methadone and Suboxone (buprenorphine) are both medications used to treat opioid use disorder. This page will describe and compare the 2 drugs.

What is Suboxone and Methadone?

Medications for opioid use disorder (MOUD) are a crucial part of addiction treatment for many people. Suboxone and methadone are widely prescribed to treat people suffering from addiction to opioids. Both these drugs have been shown to reduce withdrawal symptoms and cravings.¹

Methadone has been used to treat opioid addiction for many years. It is an opioid agonist, meaning it binds to opioid receptors in the brain; however, it does not elicit the a euphoric rush in people that have developed a dependency to short-acting opioids like heroin or fentanyl.¹

Suboxone is the brand name of a drug containing buprenorphine and naloxone. Buprenorphine is a partial opioid agonist, which works similarly to methadone–binding to opioid receptors–though to a lesser degree. This action also blocks other opioids from binding to these receptors. The other active ingredient, naloxone, is an opioid antagonist. Naloxone can unbind opioids from receptors and can reverse overdose.¹

Benefits of Methadone

For years, methadone maintenance therapy (MMT) has been a common practice in addiction treatment facilities all over the world. This is because methadone is a very effective painkiller, which offers relief to people struggling with the severe withdrawal symptoms associated with addiction to heroin and other narcotics. These benefits include:¹

• Mild effects of methadone, which makes the drug a safer replacement for opioids addiction during treatment.
• Studies have shown that MMT is responsible for a significant reduction in heroin and opioid addiction, as well as a decrease in risk-taking behaviors like sharing needles.
• Since methadone occupies opioid receptor sites in the brain, individuals don’t feel cravings for other opioids, like heroin or prescription painkillers.
• Uncomfortable withdrawal symptoms associated with opioid detox, such as nausea, vomiting, and other flu-like symptoms, are kept at bay. Since withdrawal is managed, individuals are able to focus on the therapeutic aspect of addiction treatment.

Over time, supervising doctors slowly wean patients off methadone, with the ultimate goal of total abstinence from all substances. That being said, many patients remain on methadone for extended periods.²

Methadone Side Effects

As with any other drug, there are side effects to methadone. These side effects can impact both the body and mind, and they range from mild, such as dry mouth and lightheadedness, to more severe, such as lowered respiratory function.

Other side effects of methadone include:³

• Drowsiness
• Gastrointestinal distress
• Sexual impotence
• Irregular heartbeat
• Depressed respiratory function
• Seizures

There are also certain risks associated with prolonged use of methadone. A study in the journal Addiction and Health found that long-term use of methadone can cause cholestatic pattern liver injury, and other studies suggest that prolonged methadone use could contribute to reduced attention span.⁴

Methadone’s Potential for Misuse

Methadone is a full opioid agonist. This means that the drug binds to opioid receptors in the brain and activates them, creating a chemical reaction that leaves an individual vulnerable to dependence. Methadone is classified as a Schedule II substance in the United States;³ in other words, it is a medically accepted drug that carries the risk of misuse, dependence, and addiction.

Benefits of Suboxone

When someone takes Suboxone, buprenorphine binds to receptors in the brain and activates them only slightly, providing relief from withdrawal symptoms while the naloxone blocks the opioid’s effect, keeping the body from experiencing any kind of high.^1,5

Benefits of Suboxone include:^1,5

• Low misuse potential.
• Mitigates withdrawal symptoms and cravings.
• Unlike methadone, which must be distributed from a clinic, the drug can be prescribed by doctors, nurse practicioners, and physician assistants.

Studies have found that Suboxone has a positive effect on the lives of people recovering from addiction. A study published in the Journal of Community Hospital Internal Medicine Perspectives found that Suboxone treatment correlated to up to 45% fewer emergency room visits among test subjects. It is believed that the Suboxone was integral to keeping these individuals away from opioid abuse.⁶

Suboxone’s Side Effects

A few of the most common side effects individuals taking Suboxone should be mindful of include:⁵

• Headache.
• Dizziness.
• Numbness, especially around the mouth.
• Insomnia.
• Vomiting.
• Trouble concentrating.

In very rare cases, Suboxone can trigger a more severe response. A 2008 article in the American Journal of Emergency Medicine recounts one case in which a dose of Suboxone led to the onset of serotonin syndrome – a condition that involves high body temperatures, agitation, increased reflexes, tremors, sweating, dilated pupils, and diarrhea. However, these cases are few and far between.⁷

Suboxone’s Potential for Misuse

Addiction develops when the reward center in an individual’s brain begins to associate a certain behavior–drugs, sex, or food, for example–with the surge of dopamine that comes along with the action. The brain then begins to crave the dopamine, compelling the body to seek out the behavior that triggered it.⁸

With Suboxone, there is very little potential for that instigating that surge of dopamine. The buprenorphine produces a very weak effect on the brain, and the naloxone decreases the chance of feeling a euphoric effect even further.¹ Suboxone has even been classified as Schedule III by the DEA, indicating that is possesses a moderate to low potential for dependence.⁹

Effectiveness and Success Rates

Both methadone and Suboxone are considered safe and effective methods of treating opioid use disorder.

A 2020 study found that both methadone and buprenorphine were associated with reduced overdose and other opioid-related fatality compared to other treatment approaches.¹⁰

In addition, a 2014 study found that both drugs were more effective than placebos in treatment retention, reducing illicit drug use, reducing criminal activity, and mortality. The study found that methadone was slightly more effective than buprenorphine in treatment retention.¹¹

Both drugs are considered safe and effective for treating pregnant people; however, buprenorphine is associated with more favorable neonatal and maternal outcomes.¹²

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