Suboxone and methadone are prescription medications doctors use to treat opioid use disorder (OUD). These medications work very differently, but either could help you overcome drug cravings and focus on therapy to rebuild your life.
Your doctor can help you make the right choice for your body and your addiction. Here’s what you need to know to prepare for that important conversation about Suboxone vs. methadone with your doctor.
Understanding Suboxone vs. Methadone
Suboxone and methadone are both approved by the U.S. Food and Drug Administration (FDA) in the treatment of OUD. While these medications share some similarities, they also have important differences.
How Does Suboxone Work?
Suboxone is a brand-name medication that contains the partial opioid agonist buprenorphine. It latches loosely to receptors used by opioid drugs. It’s not as strong as methadone, but it’s still capable of easing withdrawal symptoms and drug cravings.[1]
Buprenorphine has a ceiling effect, meaning that its effect doesn’t get stronger at bigger and bigger doses.[1] Despite that trait, buprenorphine can be abused. Manufacturers add naloxone to Suboxone as an abuse-deterrent. If people try to inject the drug, the naloxone takes effect and causes withdrawal symptoms.
Suboxone is provided in tablet and strip formats that can be used at home. The medication is considered safe to use at home as buprenorphine isn’t as strong as other formats, and naloxone blocks a high.
Every day, you’ll put tablets or strips below your tongue. When they melt, you’ll get relief that lasts through the day.
How Does Methadone Work?
Methadone is a generic medication that is a full opioid agonist. It is as strong as other opioid drugs (like heroin), but it’s provided in a very controlled environment. When used as directed, it can ease drug cravings and withdrawal symptoms.[2]
People using methadone must take their doses under the supervision of a medical practitioner. If people can prove they’ve been compliant with the treatment program for long periods, they may be allowed to use the drug at home. However, that’s not always possible.[2]
Methadone is available in liquid, powder, and pill formats, and all can be swallowed. Methadone is addictive, just like other opioids. But it’s considered safer than using a drug like heroin, as it’s taken in controlled doses under medical supervision. Methadone is also made in medical laboratories, so contamination concerns are absent.[3]
Comparing Suboxone & Methadone
This chart can help you understand the differences and similarities between these two medications:[4-9]
| Suboxone (Buprenorphine/Naloxone) | Methadone | |
| FDA-Approved Use | Opioid use disorder | Opioid use disorder |
| Drug Schedule | Schedule III | Schedule II |
| Formats Available | Sublingual film or pill | Tablet and oral concentrate for OUD |
| Typical Dosage | 16 mg buprenorphine every 24 hours | Tablets: 5 mg and 10 mg Oral concentrate: Designed for multiple doses |
| Common Side Effects | Oral side effects, headache, nausea, vomiting, sweating, constipation, insomnia, pain, and swelling in the hands and feet | Lightheadedness, dizziness, sedation, nausea, vomiting, and sweating |
| Safety Concerns | Withdrawal when used too early, respiratory depression, and neonatal withdrawal | Cardiac concerns, respiratory depression, abuse potential, and neonatal withdrawal |
| Addiction Potential | Low, due to the addition of naloxone to each dose | Moderate, due to a requirement for in-person doses |
| Cost | $115 per week | $126 per week |
| Covered by Insurance? | The generic version is often covered, but the brand name may not be | Typically |
| Efficacy | In one study, the treatment failure rate for buprenorphine was 25%, while the failure rate for placebo was 100% | In one study, people using methadone were 4.4 times more likely to stay in treatment compared to those who didn’t use it |
Does One Medication Have a Higher Abuse Potential?
When comparing Suboxone vs. methadone, it’s critical to consider the addictiveness (or abuse potential) of the ingredients.
Methadone is a Schedule II drug, while buprenorphine is a Schedule III substance. This means that experts consider methadone a more dangerous substance from an abuse perspective.
In studies, researchers asked people how the two substances made them feel. Some people admit that they miss the euphoria associated with methadone when they switch to buprenorphine products like Suboxone.[1]
Even so, methadone can be somewhat hard to abuse. The medication is tightly controlled, and in most cases, people must go to clinics to get their doses.
Suboxone, on the other hand, is available as a take-home drug. It’s possible that people in your home could steal your medications to abuse them.
Key Differences Between Suboxone & Methadone
Several different types of OUD medications exist, and understanding their differences is critical. Aside from their ingredients, the following three factors set these two drugs apart:
Method of Use
Suboxone pills and strips are designed to melt inside of your mouth. Methadone drinks or pills are designed to be swallowed, and the ingredients enter your bloodstream through your digestive tract.
Side Effects
Methadone side effects include nausea, vomiting, respiratory depression, and slow breathing.[7] Suboxone side effects include oral issues (like swelling and burning sensations), headache, nausea, vomiting, sweating, constipation, insomnia, pain, and swelling.[4]
Supervision of Doses
Suboxone is designed for independent, at-home use. No one needs to watch you take each dose. Methadone is typically administered under the supervision of a practitioner, such as a doctor or nurse.[2]
Choosing the Right Medication for Opioid Use Disorder
Experts say both buprenorphine and methadone have a strong level of evidence that back them. The medications come with benefits that outweigh the harms.[10]
Your doctor should choose the right medication based on your personal preferences and treatment goals. Be open and honest about where you are and where you want to go in the future. You can find the right medication together, and this can serve as a vital source of support as you navigate the road to sustained recovery.
Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More
- Buprenorphine vs. methadone treatment: A review of evidence in both developed and developing worlds. Whelan P, Remski K. Journal of Neurosciences in Rural Practices. 2012;3(1):45-50.
- Methadone. Substance Abuse and Mental Health Services Administration. Published February 2, 2024.
- Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. World Health Organization. Published 2009. Accessed March 1, 2024.
- Suboxone prescribing information. U.S. Food and Drug Administration. Published March 2021. Accessed March 1, 2024.
- Buprenorphine. Drug Enforcement Administration. Published May 2022. Accessed March 1, 2024.
- How much does opioid treatment cost. National Institute on Drug Abuse. Published December 2021. Accessed March 1, 2024.
- Methadose. U.S. Food and Drug Administration. Published December 2016.
- Drug fact sheet: Methadone. U.S. Drug Enforcement Administration. Published April 2020. Accessed March 1, 2024.
- How effective are medications to treat opioid use disorder? National Institute on Drug Abuse. Published December 2021. Accessed March 1, 2024.
- Buprenorphine maintenance vs. methadone maintenance or placebo for opioid use disorder. Salisbury-Afshar E. American Family Physician. 2015;91(3):165-166.
