Female doctor seated at table with female patient

Medication-assisted treatment (MAT) is an effective treatment used to help people with opioid dependency. This method includes one of three FDA-approved medications to help limit opioid use and withdrawal. Besides medication, MAT also involves counseling and behavioral therapies.

If you or your loved one are considering MAT for opioid dependence, you may have heard about the drugs Suboxone and methadone. Here’s what you should know about the differences between Suboxone vs methadone in MAT.

Suboxone vs Methadone

How Methadone Works

Methadone is a pain reliever that changes how the brain responds to pain. It is an opioid agonist, which means that methadone binds to the brain’s opioid receptors and activates them, creating a sense of pain relief. Methadone can be taken taken once a day in pill, liquid, or wafer forms. One dose leads to 4-8 hours of pain relief.

Methadone has been used for many years among people addicted to heroin and narcotic pain medicines. Unlike other opioid medications, the body absorbs methadone more slowly. This creates pain relief without a strong high.

However, methadone is still potentially addictive. Patients can receive methadone for opioid addiction only under a doctor’s supervision. Methadone itself is dispensed only through an opioid treatment program (OTP) certified by SAMHSA.

Facilities that fall under this OTP provide other services to improve the health and wellbeing of people receiving MAT. This may include addiction-treatment coaching and disease prevention.

More than 100,000 Americans currently use methadone as a maintenance treatment for opioid addiction. The patient’s prescribing physician monitors progress and compliance with the prescription.

Patients may take methadone for different lengths of time. Experts recommend at least 12 months, but some patients may take it for years. When ending methadone treatment, a patient should gradually reduce their dosage to prevent withdrawal. This should be done only under the doctor’s supervision.

Side Effects of Methadone

Like any other medication, methadone can cause side effects. Some minor effects may only last a short time:

  • Drowsiness
  • Dry mouth
  • Lightheadedness
  • Urinary retention
  • Nausea
  • Change in sexual desire

Because it is a type of opiate, some of these side effects may become serious. Stop taking methadone and contact emergency services right away if these side effects appear:

  • Difficult or shallow breathing
  • Fainting or unstable walking
  • Hives or a rash
  • Swelling of the face, mouth, or throat
  • Chest pain
  • Rapid or irregular heartbeat
  • Hallucinations or confusion

Methadone should only be taken exactly as prescribed. Otherwise, there is the risk of overdose, which could lead to death.

Is Methadone Right for Me?

Methadone-based treatment is for patients who are dependent on heroin and narcotic pain medicines, or have a history of opioid dependence.

Patients who are most likely to succeed with methadone treatment are:

  • Committed to participating in a comprehensive MAT program, including counseling and social support
  • Able to give informed consent for the treatment
  • Able to take methadone regularly at scheduled times and dosages (this includes having reliable transportation to a clinic)

MAT with methadone is especially helpful for patients with opioid dependency who:

  • Are HIV positive
  • Receive treatment for HIV or hepatitis C
  • Have been on community methadone maintenance treatment programs
  • Have a history of drug overdose
  • Have a history of self-harm or suicidal behavior related to opioid dependence

Methadone is safe for women who are pregnant or breastfeeding. Women who are pregnant, planning to become pregnant, or breastfeeding should discuss their methadone treatment with their physician.

Methadone should not be used by patients who:

  • Have severe liver disease
  • Are intolerant of methadone or ingredients in methadone formulations
  • Are not also receiving counseling for addiction

How Suboxone Works

Is Suboxone like methadone? Yes and no. Like methadone, Suboxone is another type of medication used in MAT.

Suboxone is a brand name for the prescription drug containing both buprenorphine and naloxone. Buprenorphine is a partial opioid agonist and works by blocking the opiate receptors and reduces a person’s urges. Naloxone can help reverse the effects of opioids.

When used together as Suboxone, the two drugs help limit the effects of opioids, reduce cravings, and prevent withdrawal symptoms. Since it is not a full opioid agonist, Suboxone is less likely to cause fatigue and is easier to taper off.

Suboxone comes as a sublingual tablet or film that is dissolved under the tongue, usually once a day. Suboxone does not create the same high as most opioids, so it is more difficult to become addicted to it.

One difference between methadone and Suboxone is that Suboxone can be prescribed by a physician and taken at home like most other medications. However, experts recommend that the first few doses be given under supervision, since Suboxone can still be misused.

As with methadone, Suboxone treatment may last differently for different people. Most people take Suboxone for 6-12 months, and some people may need to take it for much longer. Taking Suboxone for shorter periods, such as a month, is more likely to lead to a relapse.

A patient should gradually reduce their Suboxone dosage to prevent withdrawal, and only under physician guidance.

Side Effects of Suboxone

Like methadone, Suboxone can have a number of side effects that range from mild to severe. Some of the more common side effects of Suboxone include:

  • Stomach pain or nausea
  • Headache
  • Constipation
  • Vomiting
  • Sweating
  • Sleep difficulties
  • Fatigue or sleepiness

More serious side effects of Suboxone include:

  • Itching, skin rash, or hives
  • Difficulty breathing or slowed breathing
  • Difficulty swallowing
  • Unusual bleeding or bruising
  • Extreme fatigue
  • Flu-like symptoms
  • Pain in the upper right part of the stomach
  • Yellowing of the skin or eyes

It is also important to take Suboxone exactly as prescribed. Otherwise, there is the risk of overdose, which can be fatal.

Is Suboxone Right for Me?

Typically, Suboxone is prescribed for dependence on short-acting opioids, such as heroin and prescription painkillers. It is not usually recommended for long-acting opioids, so a buprenorphine-only medication may be prescribed instead.

Patients who are ideal candidates for Suboxone:

  • Can take the medication regularly, at scheduled times and dosages
  • Are able to follow up with their provider regularly (at least once a week during the first month of treatment)
  • Are committed to attending counseling and other therapy sessions as part of their MAT program
  • Will not misuse Suboxone or other drugs during treatment
  • Can refrain from using alcohol while taking Suboxone

The effects of Suboxone on pregnant and breastfeeding women and their babies is not yet widely known. However, women who take Suboxone while pregnant should be aware that the baby may show withdrawal symptoms at birth, which is treatable

Medication-Assisted Treatment for Opioid Addiction

Limestone Health is a network of Indiana-based outpatient clinics that provides methadone maintenance treatment as well as counseling services for individuals who struggle with opioid addiction. Our treatment program includes evidence-based, effective methods that help manage substance use. Visit our location page to find the clinic nearest you.

Not near one of our locations? Visit our resources page to learn more about addiction and the options available to you or your loved one.