In this article, I’m going to provide you with an in-depth review of the similarities and differences of Suboxone vs methadone. My knowledge and experience of these subjects come from a well-rounded background.
First, I was an opiate addict, and I used both Suboxone and methadone to get off opiates in the past.
Next, I worked as a counselor at an Opiate Treatment Program (OTP) that specializes in Medication-Assisted Treatment (MAT). If they qualified based on a screening with an Intake Specialist (me), our patients could either be placed on methadone, Suboxone, Subutex, or Vivitrol.
90% of my patients were on either Suboxone or methadone, and Medication-Assisted Therapy was my specialty and passion.
Finally, I quit the counseling profession, then went on to become an Opiate Recovery Coach, Blogger, Author, and Speaker…all on the subject of Opiate Detox & Recovery…and I’ve been doing this for over three years now.
You can read my full story here.
Okay…so enough about me.
I simply wanted you to know that I’m not just some writer that studies a topic and then writes an article on it.
I’ve actually lived this, and have been on both sides of the treatment world, as an opiate addict needing help, and as an Opiate Addiction Specialist that helps others.
Coaching and blogging about opiate recovery methods (including Suboxone and methadone) is my Life’s Purpose and Mission.
Suboxone vs Methadone – Overview
Like I stated in the introduction, in this article, I’ll be covering the similarities and differences of Suboxone vs methadone.
Both of these are very effective and proven replacement therapy medications used in the treatment of opioid dependence.
As an Intake Counselor at an OTP, whenever I performed screenings (in person or on the phone), often times I was asked to explain the difference between Suboxone and methadone.
Choosing a powerful opioid replacement medication is a BIG decision.
Thus, I took my time with new and potential admits making sure they understood the similarities and differences, as well as the pros and cons of Suboxone and methadone.
Suboxone Overview
On October 8th, 2002, the FDA announced the approval of Subutex and Suboxone tablets for the treatment of opioid dependence. Subutex and Suboxone also became the first narcotic drugs available for the treatment of opioid dependence that could be prescribed in an office setting under the Drug Addiction Treatment Act (DATA) of 2000.
As a result of these changes in policy, many opiate-dependent individuals were now able to be treated with Subutex and Suboxone.
Some people chose to enroll in OTP’s and received Suboxone in an outpatient treatment setting (which includes counseling), while others opted for treatment under the care of a private physician.
All over the nation, people were getting the help they really needed, and for over 14 years now, Subutex and Suboxone have continued to save lives, careers, homes, marriages, families, and much more.
Suboxone is a prescription medication containing buprenorphine and naloxone. Buprenorphine is a controlled substance and semisynthetic opioid derivative of thebaine.
Buprenorphine attaches and binds to the same opioid receptors in the brain and other parts of the body that drugs like heroin, oxycodone, hydrocodone, morphine, and other opioids bind to.
Once it attaches to these receptors, it mimics the effects that opiate drugs produce (though it’s not as powerful).
For this reason, buprenorphine is known as a “partial opioid agonist.”
The other opiate drugs I just mentioned are known as “full opioid agonists,” because they activate the receptors in a stronger and more complete way than buprenorphine. See the illustration below.
Buprenorphine helps opioid-dependent individuals because the daily use of the drug prevents opioid withdrawal symptoms and opioid cravings.
Buprenorphine is very effective at this.
Naloxone is the other compound present in Suboxone.
Naloxone is a pure opioid antagonist. It’s the drug given to people that overdose because an injection of naloxone puts the opioid-user into instant withdrawal, thus saving them from health issues and death.
Naloxone was put into the Suboxone formulation to deter people from injecting it, which would lead to precipitated withdrawal. Taken orally, naloxone isn’t bioavailable. A common misconception is that naloxone blocks the opiates.
This is false.
The truth is that buprenorphine binds so strongly to the opioid receptors that it’s actually the buprenorphine which blocks opioids.
Methadone Overview
For nearly three decades before the FDA approval of Suboxone and Subutex, methadone hydrochloride (6-dimethylamino-4, 4-diphenyl-3-heptanone hydrochloride) had been the primary means of treating opiate addiction.
Approved by the Food and Drug Administration (FDA) in 1947 for analgesic and antitussive uses, methadone was shown to be effective in treating opiate addiction in the mid-1960s and was approved by the FDA for this use in late 1972.
Methadone is a full mu-opioid receptor agonist.
Methadone is typically used as a replacement therapy for heroin or other opioid dependence.
Methadone’s slow onset of action when taken orally and long elimination half-life (24–36 hours) allows it to be used as either a maintenance therapy or detoxification agent
How is Suboxone Different from Methadone?
Suboxone and methadone are similar because they both contain opioid agonist drugs that can prevent opioid withdrawal symptoms and opioid cravings.
Suboxone and methadone are also prescribed for chronic pain, though methadone is more commonly prescribed for this health issue.
But along with some similarities, there are many differences I will now inform you of in regards to the subject of Suboxone vs methadone.
Here are the Top 12 differences between Suboxone vs methadone…
1. Agonist Effects
Methadone is a full opioid agonist. Suboxone contains a partial opioid agonist (buprenorphine) with the addition of an antagonist (naloxone).
The ratio of buprenorphine to naloxone is 4:1.
2. Formulations
Methadone comes as a tablet or liquid. Suboxone comes as a tablet or film strip, both of which taste similar to the orange Tang drink.
3. Route of Administration
Methadone and Suboxone are both taken orally. Methadone tablets and liquid methadone are swallowed. I heard the taste of liquid methadone is so strong it’s hard to make go away.
Both Suboxone tablets and Suboxone film strips are not swallowed. Instead, they are placed under the tongue and used sublingually until the medication dissolves.
4. Qualification Criteria
Only people with severe opioid addictions can qualify to receive methadone, while people with less severe addictions can easily get prescribed Suboxone.
5. Wait Time
If you want to get on methadone, you can schedule an intake at a methadone clinic, use your last opiate before bed, wake up, then go do your intake and get your first dose of methadone. Doctors typically want you to be in at least mild opiate withdrawal, but 12 hours is not so long to wait after your last dose.
For Suboxone, there is a danger of going into precipitated withdrawal if you take it when there are still opioids in your system.
Buprenorphine has a high affinity but low intrinsic value at the mu- opioid receptors.
Thus, if you still have opioids in you and you take Suboxone, the buprenorphine will “kick-out” the full agonist and not be able to “activate” the receptors as strongly, creating a precipitated withdrawal syndrome (which is an awful experience).
To be placed on Suboxone, most doctors will make a patient wait 24-48 hours or longer after their last dose of an opioid drug. The wait time depends on the half-life of the opioid and how fast the patient metabolizes it.
6. Amount of Freedom
Patients taking methadone have to dose daily at the methadone clinic for several months (before they start getting take-homes). But patients can only get take-homes if they maintain clean drug-screens and treatment compliance.
Here are the current regulations for receiving methadone take-home privileges:
Suboxone patients receive a prescription from a doctor and get to take the medicine daily from home, after the initial intake and induction with the doctor.
There are two ways to get on Suboxone. You can either go to a drug treatment outpatient program (OP), or you can get your Suboxone from a doctor that prescribes Suboxone. Either way, it’s more freedom than dosing daily in front of the nurse at a methadone clinic.
7. Medication Effects
Since Suboxone and methadone are both drugs that bind to the mu- opioid receptors, their effects can be similar or identical.
Short-term effects of methadone and Suboxone can include the following:
- Feelings of euphoria
- Sedation
- Drowsiness (or energy)
- Relaxation
- Constricted pupils
- Constipation
- Respiratory depression
The main difference between Suboxone and methadone compared to opiates is that they are sustained-release and delayed offset opioids.
The opioid effects come on much slower, then wear off much slower. It’s not a powerful high all at once, then a comedown.
Methadone is much stronger than Suboxone, and methadone is the strongest opiate replacement medication there is. A “therapeutic” dose of Suboxone or methadone is enough to prevent opioid withdrawal symptoms and cravings. Some people can get high on Suboxone and especially on methadone, but they aren’t intended to get a person high.
They are meant to be prescribed in the therapeutic dose range.
But a high percentage of patients (mostly on methadone) lie to the doctor and say the current dose is not enough to “hold them.”
In this way, they’re able to get dose increases up to a certain point, and thus are able to feel a “high” from Suboxone or methadone.
8. Medication Side Effects
Both Suboxone and methadone can cause some minor and major side effects. Below I’ll list all of them for your convenience.
Methadone major side effects:
- Black, tarry stools
- Bleeding gums
- Blood in the urine or stools
- Blurred vision
- Change in the ability to see colors, especially blue or yellow
- Changes in skin color
- Chest discomfort or pain
- Confusion
- Convulsions
- Cough
- Coughing that sometimes produces a pink frothy sputum
- Decreased urine output
- Difficult or troubled breathing
- Difficult, fast, noisy breathing, sometimes with wheezing
- Difficulty with swallowing
- Dilated neck veins
- Dizziness
- Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- Dry mouth
- Extreme fatigue
- Fainting
- Fast, slow, or irregular heartbeat
- Headache
- Hives, itching, or skin rash
- Increased sweating
- Increased thirst
- Irregular heartbeat
- Irregular, fast or slow, or shallow breathing
- Loss of appetite
- Muscle pain or cramps
- Nausea or vomiting
- Numbness or tingling in the hands, feet, or lips
- Pain
- Pale or blue lips, fingernails, or skin
- Pinpoint red spots on the skin
- Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- Seizures
- Sweating
- Swelling of the face, fingers, feet, or lower legs
- Tenderness
- Trouble sleeping
- Trouble urinating
- Unusual bleeding or bruising
- Unusual tiredness or weakness
- Weight gain
Methadone minor side effects:
- Absent, missed, or irregular menstrual periods
- Anxiety
- Blurred or loss of vision
- Confusion about identity, place, and time
- Constipation
- Decreased interest in sexual intercourse
- Disturbed color perception
- Double vision
- False or unusual sense of well-being
- Halos around lights
- Inability to have or keep an erection
- Irritability
- Lack or loss of strength
- Loss in sexual ability, desire, drive, or performance
- Night blindness
- Overbright appearance of lights
- Redness, swelling, or soreness of the tongue
- Restlessness
- Stopping of menstrual bleeding
- Tunnel vision
- Weight changes
- Welts
Suboxone major side effects:
- Cough or hoarseness
- Feeling faint, dizzy, or lightheaded
- Feeling of warmth or heat
- Fever or chills
- Flushing or redness of the skin, especially on the face and neck
- Headache
- Lower back or side pain
- Painful or difficult urination
- Sweating
- Bloating or swelling of the face, arms, hands, lower legs, or feet
- Rapid weight gain
- Tingling of the hands or feet
- Unusual weight gain or loss
Suboxone minor side effects:
- Abdominal or stomach pain
- Difficulty having a bowel movement (stool)
- Lack or loss of strength
- Nausea
- Pain
- Trouble sleeping
- Vomiting
- Back pain
- Diarrhea
- Runny nose
- Sneezing
- Stuffy nose
9. Overdose Potential
Patients on Suboxone and methadone can overdose if they take too much medication, or if they combine the Suboxone or methadone with alcohol, benzodiazepines, and certain other drugs that cause respiratory depression.
Suboxone has a “ceiling effect.” This means there is a limit to how much it can sedate a person, and taking more and more medication will not result in more opioid effects once the ceiling has been reached.
Methadone is very powerful and much easier to overdose with.
Methadone does not have a ceiling effect.
Symptoms of methadone overdose may include:
- Small pinpoint pupils
- Nausea
- Constipation
- Nausea
- Stomach or intestinal spasm
- Vomiting
- Difficulty breathing
- Stopped breathing
- Shallow breathing
- Slow breathing
- Disorientation
- Coma
- Dizziness
- Fatigue
- Drowsiness
- Muscle twitches
- Limp muscles
- Weakness
- Cold, clammy skin
- Blue lips and fingernails
Symptoms of Suboxone overdose may include:
- Blurred vision
- Confusion
- Difficult or troubled breathing
- Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- Drowsiness
- Irregular, fast, slow, or shallow breathing
- Pale or blue lips, fingernails, or skin
- Pinpoint pupils
- Relaxed and calm feeling
- Sleepiness
- Unusual tiredness or weakness
10. Price of Treatment
Methadone is typically over $200 and less than $400 a month for treatment. Suboxone can vary in price much more depending on the doctor or treatment program, the amount of Suboxone a person is prescribed, whether or not that person’s insurance covers the medicine, and whether or not the patient uses Suboxone coupons.
11. Stigma
May opposers of Suboxone and methadone claim that patients are “not clean” while taking these medications. Thus, many Suboxone and methadone patients will hide the fact that they take an opioid replacement medication.
There is a HUGE stigma associated with being on methadone. There is less of a stigma associated with being on Suboxone, but still a stigma.
12. Length of Treatment
Methadone treatment can last anywhere from 21 days to many years, decades, or life. Suboxone treatment can be as low as a few days, and up to many years or life.
People are typically on methadone for longer durations than Suboxone, though not always. I had a small percentage of patients on methadone tell me they were “lifers,” and an even smaller percentage of Suboxone patients (2 people in total) tell me they wanted to stay on Suboxone forever.
How To Choose Between Suboxone and Methadone
I hope you liked my article on Suboxone vs methadone. At this point, you may be wondering whether or not you would do better on Suboxone or methadone.
Based on my experience working at a methadone clinic, I noticed the patients on methadone typically had more and worse side effects than patients taking Suboxone.
Also, many of the patients on methadone continued to use opiates and other drugs even though they were on methadone, while the vast majority of patients taking Suboxone were able to stay clean.
Methadone is only for individuals with very severe addictions.
If it were me needing to choose between Suboxone and methadone, I would probably get on Suboxone first. Then, if it wasn’t strong enough, I would switch over to methadone (so long as I met the qualification criteria).
Suboxone and methadone can be wonderful medications when used the right way, however, many people have a difficult time trying to get off Suboxone and methadone.
Here are my best articles on how to get Suboxone and methadone with the least amount of discomfort:
Feel free to bookmark these pages in case you ever need a free, effective detox plan that has helped countless individuals.
If you have any comments or questions on the subject of Suboxone vs methadone, please post them in the comment box below.
Great article my friend !
Just read your post. Im a 35 year old male in Pittsburgh and ive been on opiates since i was 17. I quit heroin and was clean on Methadone from July 24th 2008 until July 5th 2012. I had privileges and went to 104mg daily, decreased over two years to 20 mg and decided to blind dose under 20mg until i jumped at 4mg. I lasted 27 days, it was pure agony and i feared i was going mad. Ive been on Suboxone since july 2008 and i jumped 2 days ago off 8mg suboxone daily. Feel like shit but ive been totally clean except for MAT for 10 1/2 years. Im going totally cold turkey after that long on a high dose. Decrease on methadone was much easier for me than suboxone. Ill let you know how my crazy ass does
Thanks for your comment, and looking forward to your update, Chris. 🙂
How much is ReckettBennister paying you? Methadone actually works. Suboxone is a BigPharma scam. It also rots your teeth. I’m not going to waste much time pointing out all the inaccurate info in your article, I’ll just say that as someone who’s been on both, methadone is both more conducive to long term sobriety, it is also much cheaper if not totally free. Suboxone exists purely as a money maker for the same doctors that turned a whole generation on to opiates via overprescribing of Oxycodone&Opana. Methadone has been saving lives since the 60s.
No one is paying me anything. I actually really like both of these medications. Depending on a person’s unique situation, one drug will suit them more. You said that Suboxone rots your teeth, but in fact, methadone is much worse at producing Opioid-Induced Endocrinopathy than Suboxone, and when people are switched over from methadone to buprenorphine when they have Opioid-Induced Endocrinopathy, their symptoms go away.
Why don’t you read my article on Opioid-Induced Endocrinopathy which is based on research doctors have done, and then you can continue saying how perfect of methadone is.
And my intention of this article was not to make Suboxone look better and get people on that. It was to show people the differences between the two medicines so they can choose what’s right for them. I’m sorry you felt attacked and defensive after reading the article. That was not my intention. Take care.
P.S. – Having worked as a counselor at a clinic that prescribed both those medications, from my experience, the people on Suboxone were nearly all clean, while over 1/3 of the methadone patients were not. It’s like that at most treatment programs. None of the Suboxone patients had their teeth rotting out, but many of the methadone patients did. Once you learn about Opioid-Induced Endocrinopathy you’ll understand why buprenorphine is actually less toxic to your body.
P.P.S. – I know many people that have had their lives positively impacted by Subs. They are not a scam. And neither is methadone. Everyone is in different situations and has different needs, so there are various forms of treatment and even medicines for that. Try to not to think so black and white. It’s not as simples as “Subs are a Scam” and “Methadone is a Miracle.”
Also, you might like to watch my webinar on Medication-Assisted Treatment: The Good, The Bad, & The Ugly.
It will show you exactly my feelings on this subject. You may in the future wish to not judge a person based on one article when there are hundreds of articles and videos I’ve put out on this site. Just some food for that you can chew on if you want. Try to have more compassion too. You sound so angry. That’s a very unhealthy emotion and if you’re getting angry at something like reading a blog post, it tells me you’re not too happy in life. I hope you find happiness and are able to live and let live, and not be so rigid in your way of thinking and judging. Wishing you the best.
I’m a retired health care professionals (at 55 due to back issues) and have been adicted to pain meds since my first disk surgery 30 years ago. I got clean 3 yrs after my first surgery, and maintained a successful dental practice until rupturing a few more discs over the last 10 yrs. Once again I became a user, starting with my MD prescribing Darvon which I was able to avoid abusing until they took that med off the market and had to get on Vicodin, which quickly led me at least to full blown addiction. Not being able to get enough even with “double doctoring”, I was forced to turn to street drugs to maintain my habit. I used heroin for 2 years and had the income to develop a fairly severe dependency. As for this, my final recovery…
I went to the local meth clinic to get on maintainance and tapered down to 40 mg, then paid $10k for a rapid detox transfusion thinking all my problems would be solved. Needless to say I failed at Eliminating drugs from my system and have been on Suboxone for the past 3.5 yrs. I want off and have tapered to a quarter of an 8/2 pill every 10-12 hours, increasing the time between doses. One thing I’ve noticed is the chantix and wellbutyrn I’ve been taking to quit smoking (14 days free) has helped me get to this low dose of sub in a short time with diminished wd symptoms. I want to get off so I can find out what it feels like to not be tired sore and listless all the time. I’m also not healing well either so even tho I swim a mile a day, I’m not getting the euphoria that I had hoped for from being “high school” fit from execizing daily the past two years.
My Question: I was wondering… Could I use a leftover take home 40 mg meth dose one time to get off the low dose sub dependency with the long half life of the meth helping me get thru the 3-4 bad days of no sub? Or will I still need to battle withdrawal when that wears off and the receptors give up their bonds (albeit slowly with meth’s half life). If the one time meth dose idea isn’t enough to get me thru totally abstaining, how difficult would getting back on a daily quarter dose of sub instead of the two quarters of the 8/2mg every 12 hrs. I guess I’m just going to have to live with open my receptors until my body starts making it’s own endorphins again.
Addiction sucks. I’m not like “me” I grew up with. I’m extremely depressed, and wake up feeling 90 yrs old, with a foreboding knowing that today will be painful once again, and not a thing left to look forward to also I am blessed with financial freedom and time, along with a beautiful wife that I love.
Lmk your thoughts.
If it were me, I would wait until moderate Sub withdrawal to avoid precipitated withdrawal, then use 10 mg of methadone every other day until the 40 mg is gone. So you would spread it out over about a week. In my opinion, that could help a lot, however, I would also try to use other medicines and supplements as well, and especially for after the methadone is out of your system.
Very useful post!
Thanks for mentioning all the side-effects of different medications.
Thanks for sharing!
My pleasure and you’re welcome!
Methadone in UK at least does not chain one to a clinic, but after many decades,[of methadone ] I feel like giving buprenorphine a go.
Fortunately I have ‘weekly pickup’ from the pharmacy, but the cutting down is not so easy. It is currently at just 28milligrams a day, and it just does not hold for the full 24 hrs..leg aches and ”ugh”ness start to be felt after 20 hrs.
I do feel much flatter in mood since reducing, and have less energy.
I don’t use other drugs or alcohol, not even tobacco now.
The ‘weekly pickup’ thing helps keep me on the straight and narrer…to be having to have ‘supervised consumption’ would be horrid, as one is literally chained to the blessed chemists, much as I like the staff there, I don’t want to be seeing them every day.
Did used to have supervised after they put everyone on it after a poor innocent baby [toddler] was fed methadone by his [words fail me] parents…the toddler died, and it was found he had been given methadone for months.
Kneejerk reaction: everyone went onto supervised unless they were trustworthy and ‘responsible’.
Buprenorphine,, never taken it, but know long termers who are on it, and they seem ‘livelier’ than when on methadone….
I hate feeling ”half – mastish” with low methadone levels…like now, it is 1:20 am, wind is howling down chimney like a Banshee..my muscles twitch and I am debating wether to take tomorrow’s dose early.. ”robbing Peter to pay Paul”
When dose was ‘comfier’, it never entered my mind to give it any thought. or to google ‘methadone vs buprenorphine” at 1am…the dose held.
I enjoyed reading your post, Catherine. Thanks for sharing your feedback on the subject. 🙂
Up your dose to low
Thanks for mentioning that medications like Suboxone are effective when treating opioid addiction. My sister had knee surgery three years ago, and she’s been hooked on oxycodone ever since. She hasn’t responded to traditional rehab before, so maybe taking a prescription would help her be successful in fighting her addiction.
My pleasure Hannah. Thanks for leaving a comment and I wish your sister the best of luck on her journey.