Methadone Maintenance Treatment vs. Suboxone Treatment: Which is Better?

Methadone maintenance treatment and Suboxone treatment are both very specific treatment types that are used on patients who are addicted to opioids. While someone who has been abusing these drugs and needs treatment may have a difficult choice, it is hard to say which of these is better: based on an individual’s specific needs, one or the other may be much better. It all depends on the individual patient.

Methadone Maintenance Treatment

As stated by the NIJ, methadone maintenance treatment helps “opioid-addicted patients alleviate withdrawal symptoms, reduce opiate cravings, and bring about a biochemical balance in the body in order to reduce the illicit use of opioids.” Methadone is a synthetic opioid that, when used in low doses, does not cause the same effects that abused opioids cause including euphoria, intense drowsiness, etc.

Methadone maintenance is often a long-term treatment solution where a patient can be maintained on the drug to curb the issues of methadone dependence for at least a year. Sometimes this can last longer or even be indefinite.

Suboxone is usually in a sub-lingual film form while methadone is usually a liquid.

• Pros of Methadone Maintenance Treatment
  • MMT is cheap.
  • It is effective and, according to the CDC, it causes “reduced or stopped use of injection drugs,” a reduced risk of overdose, reduced chances of acquiring or transmitting the diseases associated with injection opioid abuse, and the reduction of many other issues associated with illicit opioid abuse.
  • MMT can be continued indefinitely, and many individuals are able to live fuller, more productive lives without the abuse of illicit opioids because of it.
  • Methadone “relieves the craving for opiates that is a major factor in relapse.”
  • MMT usually includes vocational counseling, resocialization, group and individual therapy sessions, and sometimes other treatment methods along with the prescription of methadone.
  • MMT has been used since the 1970s to help individuals with long-term opioid abuse issues.
• Cons of Methadone Maintenance Treatment 
  • Methadone can be abused like other opioids and is widely available from illicit sources as a substance of abuse.
  • Methadone can cause opioid overdose if an individual takes too much.
  • MMT often has long waitlists, especially for those individuals in big cities with high drug abuse rates.
  • Methadone is sometimes not properly diagnosed, and patients are given less than they should be, leading to issues like relapse.

Suboxone

Suboxone, as stated by the FDA, is “a prescription medicine used to treat adults who are addicted to (dependent on) opioid drugs (either prescription or illegal) as part of a complete treatment program that also includes counseling and behavioral therapy.” While a relatively new treatment, it is highly beneficial to many patients and often well-tolerated by those who use it.

The drug contains buprenorphine, a partial opioid agonist, and naloxone, an opioid antagonist. Because these are not opioid agonists like methadone, they can have different effects and may often be more beneficial toward the recovery of certain patients. Suboxone is a brand name drug and, while there is also a similar medication called Subutex which does not contain naloxone, Suboxone is the more commonly prescribed medication.

• Pros of Suboxone
  • According to the FDA, “Suboxone contains an additional ingredient called naloxone to guard against misuse.” The naloxone in the medication helps keep patients from abusing the drug because crushing it (which is often done by abusers who inject and snort opioids) will precipitate withdrawal symptoms.
  • Suboxone can be prescribed in specific doctors’ offices instead of only in clinics like methadone.
  • “Respiratory depression from buprenorphine (or buprenorphine/naloxone) overdose is less likely than from other opioids” (SAMHSA).
  • The effects of buprenorphine, because it is only a partial opioid agonist, are less intense than those of methadone, a full opioid agonist.
  • Patients can take Suboxone home and administer it from there.
• Cons of Suboxone
  • Suboxone is a relatively new treatment and medication so not everything is known about its full long-term effects.
  • Suboxone does cause many side effects that are similar to those of other opioids, including constipation, nausea, and vomiting.
  • The opioid withdrawal syndrome may also be precipitated by Suboxone when a user is not aware.

So… Which is Better?

As previously stated, it truly depends on the individual’s needs and their specific treatment plan when deciding whether methadone maintenance treatment or Suboxone treatment is better. For example, some patients need a long-term treatment plan; they could have relapsed several times and may need to be maintained on opioids for the rest of their lives. Others may choose a shorter maintenance phase which ends in medically-supervised withdrawal where they are weaned off the drug in about a week or so.

In these cases, Suboxone treatment is most commonly used in shorter-term maintenance as opposed to methadone maintenance treatment which is more known for long-term maintenance. If you are looking for a long-term treatment plan that you may be able to stay on for several years or longer, methadone would be more beneficial to you. However, if you are hoping to taper off the medication more quickly, Suboxone is better built for this purpose.

Other things to consider:

• Methadone does have a higher potential for being abused than Suboxone, merely because the former is a full opioid agonist and the later contains naloxone which guards against abuse. This is something to take into consideration, especially if you are responsible with your medication but in need of some sort of protection.
• Methadone maintenance clinics are often very cheap but hard to get into in some places. Because there are many doctors who are certified to prescribe Suboxone in their offices, this “provide[s] more patients the opportunity to access treatment” (FDA 2).
• Methadone maintenance can sometimes be what a severely addicted individual needs first because of all the structure and rigidity of the program in addition to therapy and other treatments that are usually offered at the methadone maintenance clinic. The person may then decide to switch to Suboxone after being maintained on methadone for a while and doing well.

It is difficult to say which of the two treatments is better because one is often better for a certain individual while, for another, it may not be. Finding out all you can about both treatments is necessary to make an informed decision about what is best for you.