When looking into chronic pain management or Medication Assisted Therapy (MAT), there are many different options that you may come across.  Suboxone (brand name for Buprenorphine) and methadone are the most common forms that you may find or hear about.  While methadone is approved to treat both chronic pain and opioid dependence, Suboxone is approved only for opioid dependence.  There are many important factors to consider when comparing Suboxone and methadone, and it’s really important to do your research before you or a loved one start the treatment process for either one of these medications.

Potential for Abuse

Methadone is considered a Schedule II controlled substance, which means that it has a high potential for abuse and could potentially lead to physiological and psychological dependence.  Other drugs in this category that are considered to have the same abuse potential include: cocaine, methamphetamine, oxycodone, Adderall and Ritalin.

Suboxone is considered a Schedule III controlled substance, which indicates a moderate to low potential for dependence.  Other drugs within this category include ketamine, Tylenol with codeine and anabolic steroids.

Depending on the method of administration, some forms of methadone and Suboxone are easier to abuse depending on how they’re taken/given and where they’re stored.  If someone is on a methadone maintenance program and receives their dose at a clinic, it’s important that the clinic staff have sufficient protocol in place in order to reduce clients diverting the dose to either save for later or sell to someone else.  For those on Suboxone, if they’re in charge of their prescription and responsible for taking the daily dose at home, it’s easier for them to misuse the medication or avoid taking doses in order to sell them.  As discussed, both drugs have potential for abuse as well as physiological and psychological dependence.

Dosing

Regardless of whether or not someone is on methadone or Suboxone, both drugs require a valid prescription from a licensed physician as well as regular oversight and monitoring from that physician.  If the physician that you’re working with isn’t particularly trained or educated in addiction medicine or treatment, I would consider doing some research to find a provider that is, so that you or your loved one can be properly treated and recommended to the best course of action for the individual.  Dosing depends on the individual’s history of drug abuse, chronic pain, and/or risk for withdrawal symptoms.  Typically, with methadone, someone is started on a lower dose and is then increased in increments to get them to a therapeutic level.

Typically, methadone is provided at a clinic that the individual has to go to every day, usually in the morning hours, to receive the dose.  Sometimes participants will be eligible for what’s called ‘take-homes’ which means that they can bring home their daily doses to take on their own. If it’s a quality clinic, they typically provide some outpatient counseling services to supplement the methadone treatment.

Suboxone is most often prescribed on an outpatient basis by an addiction treatment provider, psychiatrist or primary care physician.  The prescribing physician will order the medication from the patient’s pharmacy for them to pick up and take at home (usually ordered in 30-day increments).  The individual is in charge of taking their daily dose responsibly in this case, although sometimes family members will choose to hold on to the medication and give it to their loved one as prescribed in order to reduce the risk of abuse.

Buprenorphine has recently become available in an extended-release injectable form, which is given on a monthly basis in a physician’s office or outpatient center.  This new injectable form makes it significantly more difficult to divert and abuse the medication.

Taking too much of either of these medications can lead to overdose.  It’s important to follow physician recommendations in order to avoid overdose.

Cost and Insurance

Both the brand-name Suboxone and the generic Buprenorphine are more expensive than methadone.  Both Suboxone and methadone require a prior authorization from your physician to approve payment by the insurance company.  If you’re unsure whether or not your insurance provider will cover the cost of either of these medications, you can call the phone number on your insurance card and ask.

Withdrawal/Coming off of methadone or Suboxone

Because methadone and Suboxone are opioids, they’re going to induce a similar withdrawal experience as other opioid drugs when decreased or removed from the body.  These symptoms are uncomfortable and sometimes life threatening if not treated properly by a medical professional.  It is not advised to discontinue the use of these medications without the assistance of a licensed physician or substance abuse treatment center that can provide a medical detox.  These symptoms can include:

• Muscle aches or cramps
• Trouble sleeping (insomnia)
• Feeling hot or cold
• Nausea or vomiting
• Diarrhea
• Goose bumps (also called goose flesh)
• Watery eyes
• Runny nose
• Sweating
• Shaking

The withdrawal process for Suboxone can last around one month for complete cessation of all physical symptoms.  The first 72 hours of withdrawal are the worst.  After the first 72 hours and within the first week, the individual can expect to experience body aches, insomnia and mood swings.  While the physical symptoms of withdrawal may subside after the first month, the psychological symptoms may linger, along with cravings and depression.

Complete physical withdrawal symptoms from methadone can last anywhere from several months up to 1 year, depending on the dose and length of use the person was on.  This is known to be a very uncomfortable and challenging process for many people coming off of methadone.

Regardless of either substance, it is important for a person to be involved in a medical detox protocol in order to ensure safety of the person.  This process needs to be overseen by a physician and trained clinical team that can support and assist in the detox process.

Choosing a method of Medication Assisted Therapy is a big decision and shouldn’t be considered without some information and research on behalf of the individual involved as well as the support of their loved ones that are involved in their recovery process.  MAT is not for everyone, but it can be really helpful and beneficial to the recovery process for those that struggle with chronic use and addiction.  Before deciding if Suboxone or methadone are right for you, be sure to consult with your physician, counselor or therapist, psychiatrist, or any other professional that may be involved in your life and treatment process.  If you’re considering either one of these medications, or maybe already on one of these paths, be sure to follow the recommendations of your physician and treatment team before making any changes in your plan or regimen.