Methadone vs Buprenorphine: Here’s How They Measure Up

In this article, I’m going to provide you with an in-depth review of the similarities and differences between methadone vs buprenorphine. My knowledge and experience on these subjects come from a well-rounded background.

First, I was an opiate addict, and I used both buprenorphine 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 a buprenorphine medication (Suboxone/Subutex) 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 four 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 buprenorphine and methadone) is my Life’s Purpose and Mission.

Methadone vs Buprenorphine – Overview

Like I stated in the introduction, in this article, I’ll be covering the similarities and differences of methadone vs buprenorphine.

Both of these are very effective and proven opiate replacement 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 buprenorphine and methadone.

Choosing a powerful opiate 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 buprenorphine and methadone.

Buprenorphine Overview

On October 8th, 2002, the FDA announced the approval of Subutex and Suboxone tablets (medications with buprenorphine as the active ingredient) 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 opioid-dependent individuals were now able to be treated with buprenorphine therapy.

Some people chose to enroll in OTP’s and received Suboxone or Subutex 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 15 years now, medications with buprenorphine as the active component have continued to save lives, careers, homes, marriages, families, and much more.

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.

Buprenorphine also acts as an opioid blocker due to its high-binding affinity at the mu-opioid receptors. So if a person takes an opiate while using a therapeutic dose of buprenorphine, they won’t get high, and likely won’t feel anything.

Methadone Overview

For nearly three decades before the FDA approval of Subutex and Suboxone, methadone hydrochloride (6-dimethylamino-4, 4-diphenyl-3-heptanone hydrochloride) had been the primary means of treating opiate addiction.

Approved by the 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 Methadone Different Than Buprenorphine?

Methadone and buprenorphine are similar because they are both opioid agonist drugs that can prevent opioid withdrawal symptoms and opioid cravings.

Methadone and buprenorphine 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 methadone vs buprenorphine.

Here are the Top 12 differences between methadone and buprenorphine…

1. Agonist Effects of Methadone vs Buprenorphine

Methadone is a full opioid agonist. Buprenorphine is only a partial opioid agonist and is not as powerful as methadone.

2. Formulations of Methadone vs Buprenorphine

Methadone comes as an oral tablet or liquid. Buprenorphine products come as a sublingual tablet or film strip.

3. Route of Administration of Subutex vs Methadone

Methadone tablets and liquid methadone are swallowed. I heard the taste of liquid methadone is so strong it’s hard to make go away.

Buprenorphine formulations are not swallowed. Instead, they are placed under the tongue and used sublingually until the medication dissolves. Recently the FDA approved Sublocade, which is a once-monthly buprenorphine injection.

4. Qualification Criteria of Methadone vs Buprenorphine

Only people with severe opioid addictions can qualify to receive methadone, while people with less severe addictions can easily get prescribed buprenorphine.

5. Wait Time for Methadone vs Buprenorphine

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 buprenorphine, 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 a low intrinsic value at the mu-opioid receptors.

Thus, if you still have opioids in you and you take buprenorphine, 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 Subutex, most doctors will make a patient wait 24-48 hours or longer after their last dose of a short-acting opioid, and 72 hours or longer after their last dose of a sustained-action opioid. The wait time depends on the half-life of the opioid and how fast the patient metabolizes it.

6. Amount of Freedom of Methadone vs Buprenorphine

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:

Buprenorphine patients at treatment programs or with private doctors typically get a prescription to take the medicine daily from home, after the initial intake and induction with the doctor.

Note: If taking the injectable buprenorphine formulation, Sublocade, you would go see your doctor 1x a month to get your shot.

7. Medication Effects of Methadone vs Buprenorphine

Since methadone and buprenorphine are both drugs that bind to the mu-opioid receptors, their effects can be similar or identical.

Short-term effects of methadone and buprenorphine can include the following:

 

The main difference between methadone and buprenorphine 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 come-down.

Methadone is much stronger than buprenorphine, and methadone is the strongest opiate replacement medication there is. A “therapeutic” dose of buprenorphine or methadone is enough to prevent opioid withdrawal symptoms and cravings.

Some people can get high on buprenorphine 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 certain percentage of patients 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 buprenorphine or methadone.

8. Medication Side Effects of Methadone vs Buprenorphine

Methadonethdone and buprenorphine can cause some minor and major side effects. Below I’ll list all of them for your convenience.

Methadone major side effects:

 

Methadone minor side effects:

 

Buprenorphine major side effects:

 

Buprenorphine minor side effects:

 

One thing most doctors, patients, and treatment professionals aren’t aware of is that sustained-action opioids (especially methadone) can lead to a disorder called Opioid-Induced Endocrinopathy. It’s one of the most common yet least diagnosed negative consequences of continuous opioid therapy.

If you’re thinking about using buprenorphine or methadone, or you’re already taking one of them or another opioid, make sure you learn about Opioid-Induced Endocrinopathy signs, symptoms, and treatment by clicking here.

9. Overdose Potential of Methadone vs Buprenorphine

Patients on buprenorphine and methadone can overdose if they take too much medication, or if they combine the buprenorphine or methadone with alcohol, benzodiazepines, and certain other drugs that cause respiratory depression.

Buprenorphine has a “ceiling effect.” This means there is a limit (32 mg) 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:

 

Symptoms of buprenorphine overdose may include:

 

10. Price of Treatment of Methadone vs Buprenorphine

Methadone is typically over $200 and less than $400 a month for treatment. Buprenorphine products can vary in price much more depending on the doctor or treatment program, the amount of buprenorphine a person is prescribed, whether or not that person’s insurance covers the medicine, and whether or not the patient uses buprenorphine coupons or brand name coupons.

11. The Stigma of Methadone vs Buprenorphine

Many opposers of buprenorphine and methadone claim that patients are “not clean” while taking these medications. Thus, many buprenorphine and methadone patients will hide the fact that they take an opiate replacement medication.

There is a HUGE stigma associated with being on methadone. There is less of a stigma associated with being on buprenorphine, but still a stigma. Below is a picture of a man drinking liquid methadone at a methadone clinic.

12. Length of Treatment of Methadone vs Subutex

Methadone treatment can last anywhere from 21 days to many years, decades, or life. Buprenorphine 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 buprenorphine, though not always. I had a small percentage of patients on methadone tell me they were “lifers,” and an even smaller percentage of buprenorphine patients (1 person in total) tell me they wanted to stay on buprenorphine tablets (pictured below) forever.

How To Choose Between Methadone and Buprenorphine

I hope you liked my article on methadone vs buprenorphine. At this point, you may be wondering whether or not you would do better on buprenorphine 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 buprenorphine.

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 buprenorphine were able to stay clean.

Methadone is only for individuals with very severe addictions.

It’s a very important decision deciding whether or not to get on these medications, and if so which one. So take your time and do what’s right for your situation…

Regardless of what others think.

Methadone and buprenorphine can be wonderful medications when used the right way, however, many people have a difficult time trying to get off these drugs after they’ve been taking them for awhile.

To learn more, I encourage you to watch my Free Webinar on Medication-Assisted Treatment.

It’s in-depth and will make you an expert on the topic, and it will help you make the best decision for your life moving forward.

If you have any comments or questions on the subject of methadone vs buprenorphine, please post them in the comment box below. Be safe, and take good care of yourself.

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