Methadone vs. Suboxone: Differences, Similarities & How to Choose
Last Updated Dec 2, 2021
Methadone and Suboxone are two drugs that can help treat opioid use disorder (OUD).
Broadly, methadone is more commonly used and often viewed as more effective. However, Suboxone is at least arguably safer and can still represent an effective alternative treatment if methadone doesn’t work as well for some people.
What Is Methadone?
Methadone is an opiate analgesic, working as what is called a full agonist opioid. This is a class of drug that can be used for moderate to severe pain relief, with methadone generally being reserved for severe pain relief when used for this purpose.
Methadone is also frequently used to prevent withdrawal from opioids, used as part of treatment programs to help people stop narcotic abuse.
What Is Suboxone?
Suboxone is a brand name for a medication that combines the drugs buprenorphine and naloxone. Similar to methadone treatments, Suboxone is used to help treat people who struggle with opioid addiction and abuse.
Buprenorphine is a type of drug called an opioid partial agonist. This essentially means it has an effect similar to full agonist opioids but milder. This is combined with naloxone, a drug that can negate the effect of opioids and prevent a person from achieving a significant high when taking it as part of an addiction treatment.
Benefits of Methadone & Suboxone
Research has shown methadone can be a fairly cost-effective addiction treatment measure compared to buprenorphine alternatives. It can also help with essentially all levels of opioid dependence, whereas Suboxone works best for mild to moderate dependence.
On a broad level, present research suggests methadone treatments seem to be more effective overall for addiction treatment than buprenorphine/naloxone drugs like Suboxone. Note, however, that individuals vary greatly on which is most effective for their addiction treatment.
Suboxone and similar drugs are difficult to overdose on and have less abuse potential when compared to methadone.
While buprenorphine alone can potentially be abused for its euphoric effects, a significant high is difficult to achieve for those who aren’t opioid naïve. This limitation is often called a ceiling effect. Naloxone also serves as an abuse-deterrent ingredient since it will push a person into immediate withdrawal if Suboxone is misused.
Risks of Methadone & Suboxone
Methadone is a full agonist opioid. When not used as prescribed, it has similar effects and comparable abuse potential to other opioids, such as oxycodone or opium. Like these drugs, a person can also overdose on methadone if it is taken in a high enough dose, which can be life-threatening if they don’t receive treatment.
This drug has a long half-life, which on some level is also an advantage, as this means it has a long-lasting effect. However, it also means withdrawal can be fairly long-lasting. Someone on methadone essentially can’t switch to buprenorphine-based treatment, even if it would be more effective, if they are taking a high enough methadone dose.
At high doses, methadone is associated with some health risks. For example, it can cause heart problems. A 2007 survey revealed that only a small portion of physicians were aware of this issue, although that number has likely risen with growing awareness of the opioid epidemic.
Though Suboxone has significantly less abuse potential, when combined with other drugs, buprenorphine can still lead to dangerous overdose symptoms.
Buprenorphine may also be associated with liver damage, sometimes leading to buprenorphine-induced hepatitis.
Certain side effects are associated with both methadone and Suboxone. Symptoms that don’t go away or that seriously impact a person’s quality of life should be discussed with a doctor, even if they’re considered “typical” of the medication.
Call 911 immediately if a person using these medications experiences any symptoms that seem especially severe or life-threatening, whether they’re noted below or not.
Potential side effects of methadone include the following:
- Weight gain
- Dry mouth
- Sore tongue
- Stomach pain
- Difficulty urinating
- Vision problems
- Mood changes
Methadone is an opioid, so it depresses the respiratory system. In high doses, it can cause a person to struggle to draw in enough oxygen and can become life-threatening. The signs of an overdose include the following:
- Unusually dilated pupils
- Slow or shallow breathing
- Difficulty breathing or completely stopped breathing
- Moderate to severe drowsiness or sleepiness
- Cold, clammy skin, which may start to blue
- Muscle weakness
- Unresponsiveness or unconsciousness
Suboxone and similar drugs are associated with the following side effects, primarily due to its buprenorphine component:
- Dry mouth
- Flushing or sweating
- High temperature
- Tremors or palpitations
- Difficulty paying attention
- Drowsiness and fatigue
- Constipation, nausea, and vomiting
Because buprenorphine is an opioid partial agonist, it can also cause respiratory distress and similar overdose symptoms as methadone. However, it is much more difficult for a person to overdose on Suboxone, especially if the drug is not mixed with other substances.
How Withdrawal Works for Each Medication
Methadone withdrawal can be long-lasting. Patients on methadone typically work with their doctor to slowly wean themselves off the drug rather than suddenly quitting use.
Opioid withdrawal is often described as “flu-like” with typical withdrawal symptoms like this:
- Teary eyes
- Joint pain and back ache
- Muscle weakness
- Muscle pain
- Stomach cramps
- Sweating and chills
- Reduced appetite
- Nausea and vomiting
Withdrawal from buprenorphine, one of the two main active ingredients in Suboxone, can also be long-lasting. Symptoms can also be comparable to methadone, with doctors also generally pushing for a similar tapering dosage regimen that slowly reduces the body’s dependence on the drug.
Which Is Best for Treatment of Opioid Use Disorder?
The decision of whether to use methadone or Suboxone for treatment of opioid use disorder will depend on your history of substance abuse, prior attempts at rehabilitation, and medical state. Suboxone is often preferred due to its lower potential for abuse, and its accessibility since patients can take their doses at home.
Both methadone and buprenorphine (Suboxone) are recommended as effective treatments for opioid use disorder. Both have been shown to reduce illicit opioid abuse and promote long-term recovery. Talk to your addiction treatment team about which medication would work best for your situation.
5 Myths About Using Suboxone to Treat Opiate Addiction. (October 2021). Harvard Health Publishing.
Buprenorphine. (April 2022). Substance Abuse and Mental Health Services Administration.
Buprenorphine vs. Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds. (January 2012). Journal of Neurosciences in Rural Practice.
Methadone. (February 2021). MedlinePlus.
Physician Awareness of the Cardiac Effects of Methadone: Results of a National Survey. (2007). Journal of Addictive Diseases.
Buprenorphine vs Methadone Treatment: A Review of Evidence in Both Developed and Developing Worlds. (January–April 2012). Journal of Neurosciences in Rural Practice.
Medications to Treat Opioid Use Disorder Research Report. (December 2021). National Institute on Drug Abuse.
Transferring Patients From Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines. (May–June 2018). Journal of Addiction Medicine.
Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. (February 2020). JAMA Network.