Methadone vs. Suboxone

Written by Abby Doty

& Medically Reviewed by Leila Khurshid BCPS, PharmD

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Last Updated - 07/07/2023

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Updated 07/07/2023

Despite some similarities when used for medication-assisted treatment, methadone and Suboxone have major differences, such as their ingredients and how they work.

Opioid addiction is a serious epidemic that affects the health and social and economic welfare of people all around the world. While recovery from opioid addiction is possible, the process of withdrawal can make many people scared to take the next step toward recovery. One of the many benefits of detoxing at a medical center is their ability to provide drugs, such as methadone or Suboxone, as medication-assisted treatment (MAT) to help ease withdrawal symptoms and prevent relapse.

Is Methadone the Same as Suboxone?

Methadone and Suboxone are different drugs. However, because they are both opioids, they work in similar ways.

Difference Between Methadone and Suboxone

Methadone and Suboxone have many differences. These include:

  • Controlled Substance Status: Methadone is a Schedule II controlled substance, while Suboxone is a Schedule III controlled substance. This means that Suboxone carries a lower risk of abuse, addiction and dependence than methadone.
  • Ingredients: Methadone is the generic name for the opioid methadone sold under the brand names Dolophine and Methadose. In contrast, Suboxone is a brand name for the combination drug buprenorphine/naloxone.
  • How They Work: Methadone is a full opioid agonist, meaning it fully stimulates the brain’s opioid receptors. In contrast, the buprenorphine in Suboxone is a partial opioid agonist, meaning it only partly stimulates the opioid receptors in the brain. In addition, the naloxone component of Suboxone is inactive when the drug is taken as intended by mouth but activates if someone tries to inject it to get high, counteracting the drug so it doesn’t work.
  • Medication Access: While the federal government heavily restricts methadone to frequent dispensing at approved methadone clinics, Suboxone can be ordered by a variety of doctors and obtained at a regular pharmacy.
  • Dosage Forms: When used for MAT, methadone is given as an oral liquid. In contrast, Suboxone comes as sublingual films placed under the tongue.

What Is Suboxone?

Suboxone is a drug used to treat opioid addiction. While Suboxone is similar to methadone, Suboxone does not contain methadone and is a distinct drug. Suboxone contains the active ingredients buprenorphine, a partial opioid agonist that helps fight the symptoms of withdrawal, and naloxone, a drug used to reverse opioid overdoses. The FDA approved the medication in October 2002.

Suboxone comes as a sublingual film, although alternate buprenorphine-containing products come as a tablet. Since Suboxone is a partial agonist, it has less potential for abuse because it was engineered with a “ceiling effect.” This means that even when taken in higher doses, a user will not derive an additional psychological euphoria or high from Suboxone.

What Is Methadone?

Methadone is the most common drug used for treating opioid addiction, and it’s considered a full mu opioid receptor agonist, meaning it fully activates the brain’s opioid receptors. Methadone is an effective tool in opioid recovery because:

  • It’s effective when taken orally.
  • It has a long duration of action.
  • It continues to work even when taken for long periods of time.

Methadone was first used and marketed in Germany in the 1940s as a painkiller. In the 1950s, the use of methadone began in the United States as a treatment for patients detoxing from heroin, but the FDA didn’t approve the drug until 1972. It’s manufactured with more dosing options and formats than Suboxone. When prescribed for MAT, methadone comes as a liquid.

Methadone vs. Suboxone

Methadone and Suboxone are synthetic opioids used to treat patients with opioid dependency or addiction. Both drugs block the effects of opiates, reduce cravings and ease withdrawal symptoms. However, they are far from identical agents. Here are some key differences and similarities between the two:

Drug Class

Although both methadone and Suboxone are opioids, they work on the brain in different ways. Methadone is a full opioid agonist, meaning it fully turns on the brain’s opioid receptors. In contrast, Suboxone is a partial opioid agonist, meaning that it doesn’t fully turn on the receptors, no matter how high a dose you take.

In addition, while methadone only contains methadone as its active ingredient, Suboxone contains both an opioid and a reversal agent. Buprenorphine is the opioid in Suboxone, but the drug also contains the reversal agent naloxone. Although inactive when the drug is taken by mouth, if someone tries to abuse Suboxone by injecting it, naloxone activates and prevents buprenorphine from having an effect.

Side Effects

Although methadone and Suboxone are effective at helping people get through opiate withdrawal and addiction, they don’t come without side effects and risks. However, the side effects of both drugs, while similar in some ways, are not identical.

Methadone side effects include:

  • Constipation
  • Nausea or vomiting
  • Itchy skin
  • Slowed breathing
  • Heart rhythm disturbances, especially when taken with other drugs that also cause heart rhythm changes

In contrast, the most common Suboxone side effects are:

  • Headache
  • Nausea or vomiting
  • Weakness

Withdrawal Symptoms

Although withdrawal symptoms for methadone and Suboxone are similar both to each other and other opioids, the duration of withdrawal is very different for the two drugs.

For methadone, withdrawal starts within 48 hours of the last use and can last up to 20 days. In contrast, for Suboxone, withdrawal starts within 24 hours of the last use and can last up to 10 days.

Withdrawal symptoms themselves are consistent between the two drugs as well as other opioids and include:

  • Nausea or vomiting
  • Anxiety
  • Trouble sleeping
  • Hot or cold flashes
  • Sweating
  • Muscle cramps
  • Runny eyes and nose
  • Diarrhea

Potential for Abuse and Addiction

Although both methadone and Suboxone are opioids that may cause abuse, addiction and dependence, the risk is different depending on the drug. As a Schedule II controlled substance, methadone carries a higher risk of abuse and addiction than Suboxone, a Schedule III controlled substance.

Suboxone is less risky than methadone because it is a partial opioid agonist compared to methadone, which is a full opioid agonist. This means that Suboxone is only partially activating opioid receptors while methadone fully activates them. Another factor is that Suboxone contains the opioid reversal agent naloxone to deter abuse by injection, while methadone does not contain a reversal agent.

Can You Take Methadone and Suboxone Together?

You should not take methadone and Suboxone at the same time. Not only can taking these two opioids increase your risk of an opioid overdose, but the naloxone component of Suboxone may throw you into methadone withdrawal.

If you take methadone and are considering switching to Suboxone, the Suboxone manufacturer instead recommends switching to a different buprenorphine product that does not contain naloxone. This is because Suboxone and methadone have not been tested together, and withdrawal is a possible side effect of the naloxone.

Signs of Methadone and Suboxone Addiction

There are often signs when someone begins to struggle with methadone or Suboxone. These signs are similar to those of other opioid addiction signs and include:

  • Taking more methadone or Suboxone than intended or for a longer time than first intended
  • Unsuccessful attempts to stop or cut back on methadone or Suboxone
  • Spending a lot of time trying to obtain methadone or Suboxone, use the drugs or recover from them
  • Cravings for methadone or Suboxone
  • Methadone or Suboxone use interfering with keeping up with obligations at work, school or home
  • Having interpersonal problems linked to the use of methadone or Suboxone
  • Stopping other activities due to methadone or Suboxone
  • Using methadone or Suboxone even when it is physically dangerous to do so
  • Continuing to use methadone or Suboxone even though you know that doing so is harmful to you
  • Needing more methadone or Suboxone to achieve the same effects you had at first
  • Experiencing withdrawal symptoms when you try to cut back or quit methadone or Suboxone

Risks of Methadone and Suboxone Abuse

Methadone is a full opiate agonist, and it produces greater feelings of euphoria than Suboxone and has a higher risk of addiction. Since the potential for misuse or abuse is so high, doses must be carefully monitored by a physician to ensure a person isn’t taking too much or too little.

The major criticism of methadone is that it’s essentially replacing opioids with a drug that provides similar effects. Methadone is highly addictive, and withdrawal symptoms can be severe when a person becomes dependent on the drug.

Despite the presence of naloxone, which is designed to prevent the euphoric effect, Suboxone still has a high potential for misuse and dependency. The risk of overdose is lower than that of methadone, but it’s still possible. Using other substances with Suboxone, such as alcohol or benzodiazepines, increases the risk of overdose.

Get Help for Opioid Abuse in Colorado

If you’re struggling with opioid addiction and don’t know where to turn, just know that help is available. Opioid addiction can be scary and carries a high risk of overdose. At The Recovery Village at Palmer Lake, we offer a range of treatment programs to help you overcome your opioid addiction. This continuum of care includes medical detox, inpatient rehab, outpatient rehab and aftercare. To learn more about how our team can help and how you can live a fulfilled life in recovery, contact us today.

Sources

Substance Abuse and Mental Health Services Administration. “Medications for Substance Use Disorders.” April 25, 2023. Accessed May 29, 2023.

Drugs.com. “Methadone”>Methadone.” March 29, 2021. Accessed July 6, 2023.

Drugs.com. “Suboxone”>Suboxone.” May 23, 2022. Accessed July 6, 2023.

National Archives. “Code of […]rt C, § 8.12.” Accessed July 6, 2023.

World Health Organization. “Clinical Guidelines for Withdrawal Manag[…]osed Settings.” 2009. Accessed July 6, 2023.

PsychDB. “Opioid Use Disorder (OUD)”>.” May 3, 2021. Accessed July 6, 2023.

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