If you’re thinking about starting medication-assisted treatment (MAT), chances are you’re choosing between Suboxone and methadone, 2 of the most common drugs used in MAT.

Your care team will work with you to choose the right MAT drug for your condition and situation. Still, it’s always good to know about the effects of treatment before you start it.

Suboxone and methadone are both FDA-approved to treat opioid use disorder (OUD).

Both drugs are opioid receptor agonists, which means they block the effects of withdrawal in the brain. Suboxone has the added effect of removing the effect of opioids in the event of a relapse.

There are some other differences as well, including:

  • Side effects
  • Benefits
  • Effectiveness
  • Relapse or dependence risk

Here’s everything you need to know about Suboxone and methadone in medicated-assisted treatment:

What is Suboxone?

Suboxone is a prescription drug with FDA approval to treat opioid use disorder. The drug has 2 active ingredients:

  • Buprenorphine, which blocks opioid receptors to prevent withdrawal symptoms and cravings.
  • Naloxone, which reverses the effects of opioids and prevents you from feeling high.

It comes in a couple forms:

  • An oral film that you dissolve between your gums and cheek or under your tongue
  • An oral tablet that you dissolve under your tongue

What Are the Benefits of Suboxone?

The benefits of Suboxone include:

  • Fewer opioid cravings
  • Less incentive to relapse, since the naloxone prevents you from feeling high
  • Better likelihood of home treatment because there’s less abuse potential

Suboxone is an effective treatment for OUD, including heroin or prescription pill abuse.

Side Effects of Suboxone

Suboxone has side effects that are similar to other opioid drugs, but they’re often more manageable. The side effects of Suboxone include:

  • Constipation
  • Drowsiness
  • Headache
  • Nausea, stomach pain, and vomiting
  • Trouble concentrating
  • Trouble sleeping

You may experience numbness, redness or pain in the mouth if you use the oral film version of Suboxone. This is common and may go away after the first few uses.

Call your doctor right away if you experience any of these serious Suboxone side effects:

  • Arrhythmia, or an irregular heartbeat
  • Cognitive changes
  • Dizziness
  • Fainting
  • Mood changes
  • Slow breathing
  • Trouble waking

These can be signs of a life-threatening reaction or a drug interaction.

What is Methadone?

Methadone is an opioid medication that has FDA approval to treat chronic pain and opioid use disorder.

It works by blocking the opioid receptors in the brain and nervous system. This prevents you from feeling long-term withdrawal and keeps you from having opioid cravings.

Methadone comes in a few forms, such as:

  • An oral tablet
  • A dispersible tablet that you dissolve in liquid before taking
  • A liquid solution
  • An injection

What Are the Benefits of Methadone?

The benefit of methadone is that it blocks opioid withdrawal. Without a medication to control withdrawal, most people with OUD will relapse.

Side Effects of Methadone

Methadone has a high potential for abuse and addiction. It’s very important only to take methadone as directed. Taking extra doses can lead to relapse.

Other side effects of methadone include:

  • Constipation
  • Drowsiness
  • Loss of appetite
  • Mood changes
  • Nausea and stomach pain
  • Sexual problems

Tell your doctor right away if you have any of these serious side effects:

  • Dizziness
  • Chest pain
  • Heart palpitations
  • Fainting
  • Shallow breathing
  • Trouble breathing

These could be a sign of long-QT syndrome, a side effect that can be fatal. You’re more likely to develop this syndrome if you have electrolyte problems or mix methadone with other opioids.

Is Methadone More Effective Than Suboxone?

Suboxone and methadone are both very effective at treating opioid use disorder. However, Suboxone is more effective long-term.

Methadone has a high risk of abuse. That means vulnerable patients may relapse while using methadone. Suboxone can’t be abused, since it contains naloxone to reverse opioid effects, so its long-term outcomes are better.

Additionally, Suboxone is more accessible to patients. There are barriers to accessing methadone, which prevents many patients from staying on it long-term. In fact, long-term treatment rates are higher on Suboxone.

Can You Take Methadone While on Suboxone?

You should not take methadone while you’re on Suboxone. There’s no demonstrated benefit to taking multiple MAT drugs at once. Mixing these drugs can cause severe health problems and even death.

Suboxone and methadone have a major drug interaction. This means you should not take them together.

If you’re taking methadone and add Suboxone, it can lead to immediate withdrawal symptoms. These include:

  • Anxiety, depression, or panic
  • Excessive sweating
  • Fever and chills
  • Full body aches
  • Nausea, vomiting, and diarrhea
  • Twitching, spasming, or cramping muscles
  • Watery eyes and nose

Mixing Suboxone and methadone can cause long-QT syndrome or a disorder that causes heart arrhythmias and can lead to sudden death. You might be at higher risk if you have heart problems or electrolyte problems, like low magnesium or low potassium.

Call your doctor immediately if you experience any of these symptoms after combining Suboxone and methadone:

  • Dizziness
  • Fainting
  • Heart palpitations
  • Lightheadedness
  • Seizures

These symptoms can be a sign of long-QT syndrome caused by the drug interaction, which causes death without treatment in 50% of patients.

Different People Respond to Different MATs

There’s no single MAT drug that works for every person who has opioid use disorder. When you enroll in rehab, your care team will help you choose a treatment plan that’s right for you.

The right fit depends on factors such as:

  • Your substance use disorder (SUD) history
  • Your mental and physical health history
  • Your family history of SUD
  • Your home environment and stability

Depending on your risk factors and your needs, your care team will help you select methadone, Suboxone, or another MAT option.

Some patients don’t respond to MAT on the first try. Despite that, MAT is much more effective than treatment without medication for OUD.

It’s always possible to go back and try another MAT drug if that’s the case. What’s important is that you stay open to trying again, since relapse is part of the recovery journey for most people with opioid use disorder. 

Sources:

  1. Methadone vs. Suboxone: How Do They Differ?
  2. Suboxone Versus Methadone for the Treatment of Opioid Dependence: A Review of the Clinical and Cost-effectiveness
  3. Compared to methadone, Suboxone is associated with lower mortality but also less time in treatment
  4. Drug interactions involving methadone and buprenorphine – Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence
  5. Methadone and Suboxone Drug Interactions

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