Is Buprenorphine a Good Methadone Alternative?

Buprenoprhine is a partial opioid agonist that can be used alone under the brand name Subutex or paired with naloxone under the brand name Suboxone. As it is a medication that was (fairly recently) approved to treat opioid addiction in 2002, not much is known about buprenorphine by the general public compared to methadone.

Many people are wondering if buprenorphine is a good methadone alternative. In many ways, it can be. But in some cases, methadone is a better treatment for certain individuals. It is important to consider all your needs and the facts of your particular situation in order to decide if methadone or buprenorphine is right for you.

Is Buprenorphine Treatment Like Methadone Treatment?

Yes. In the way that methadone is a pharmacological treatment that is best when paired with therapy to treat opioid addiction, buprenorphine is similar to methadone. Like methadone, buprenorphine

  • Reduces cravings for opioids
  • Minimizes withdrawal symptoms
  • Makes it easier for recovering opioid addicts to live their lives while going through withdrawal and, eventually, addiction treatment
  • Can be used as both a detox and addiction treatment
  • Doesn’t cause the euphoria or intoxication that opioids cause when given in correct doses by a doctor
  • Blocks the effects of other opioid drugs (to some effect)

In many ways, buprenorphine treatment is like methadone treatment. It is very beneficial to many individuals who use it and has shown large promise as an addiction treatment. But why would someone need a methadone alternative?

Reasons to Choose a Methadone Alternative

methadone maintenance

Buprenorphine is often used as an alternative to methadone.

Methadone is an extremely helpful medication which many opioid addicts are maintained on every year. Harvard Medical School states that 100,000 Americans are “using methadone as a maintenance treatment.”  But, like all medications, methadone has its drawbacks.

  • Methadone is a full opioid agonist just like heroin, morphine, oxycodone and other opioids of abuse.
  • Methadone itself is one of the most highly abused opioids in the United States. With the exception of heroin, methadone is abused more than any other opioid (NLM).
  • Methadone does not have any built-in safety precautions that help keep it from being abused.
  • Methadone treatment has a stigma for many individuals who are unwilling to use the treatment. Harvard Medical School calls the treatment “politically controversial,” even though it has “better scientific support than any other treatment for any kind of drug or alcohol addiction.”
  • Methadone maintenance clinics are often difficult to get into, and many individuals are put on a wait list. Some people have to wait months before they are able to start methadone maintenance.
  • Methadone can only be dispensed through one of these approved clinics. They are highly controlled by the government and other regulating bodies in order to avoid abuse, but it can be difficult for someone who lives far away from a methadone clinic to visit daily in order to get their prescription.

While methadone treatment has many positives, there are also reasons why someone might choose a methadone alternative. For many, buprenorphine is a good alternative to methadone.

Buprenorphine as a Methadone Alternative

Some of the reasons buprenorphine may work for some individuals as a methadone alternative are

  • “Buprenorphine is an opioid partial agonist. This means that, although buprenorphine is an opioid, and thus can produce typical opioid agonist effects and side effects such as euphoria and respiratory depression, its maximal effects are less than those of full agonists like heroin and methadone” (SAMHSA).
  • When marketed as Suboxone, buprenorphine is combined with naloxone. This actually keeps individuals from abusing the drug on a larger scale because, once the drug is crushed and injected or snorted, the naloxone will precipitate withdrawal in the individual. This makes the drug much safer from abuse than methadone in general.
  • There isn’t a strong stigma against buprenorphine treatment the way their is against methadone treatment. Though the treatments are very similar, many individuals may choose buprenorphine because of this.
  • Buprenorphine, unlike methadone, can be prescribed by a doctor with a specific certification in a doctor’s office. This makes it much easier to get ahold of and patients don’t need to wait as long for treatment the way they might for methadone maintenance clinics.

For these reasons, buprenorphine may be a helpful alternative to methadone treatment for you. If one of the issues associated with methadone has kept you from attending treatment, you may want to consider buprenorphine or buprenorphine and naloxone combined. It has been proven to be well-tolerated by patients and is a great alternative to methadone in many cases. However, there are some cases where methadone treatment may be better for certain types of patients.

Methadone vs. Buprenorphine

Some reasons you may want to choose methadone over buprenorphine are

  • If you need long-term treatment for opioid addiction
    • Methadone is still the best long-term opioid addiction treatment. Many patients can be maintained on buprenorphine for several months at the most, but for someone who needs to stay on medication for years or more, methadone is the best choice.
  • According to SAMHSA, “Buprenorphine is unlikely to be as effective as more optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence.” If someone is incredibly dependent on opioids, they may want to choose methadone instead of buprenorphine because methadone is more effective in this case.
  • Many times, an individual who is still dependent on and incredibly addicted to opioids may choose to start with methadone and then switch to buprenorphine after they have stabilized themselves somewhat in their treatment.

Methadone and buprenorphine both have their particular benefits when it comes to treating opioid addiction. For some individuals, one drug may be more helpful at a certain time than another. Some people even switch from one to another over time at the suggestion of their doctor.

Buprenorphine is a good methadone alternative in many ways, but you should always consider a medication’s strengths and weaknesses before starting it and whether or not it can care for your needs in order for it to be a truly beneficial treatment.