Can You Switch from Methadone to Buprenorphine-Based Treatment?

In response to the rise in opioid overdose-related deaths and emergency room visits over the last several years, there’s been an increase in the use of medications to help people wean off of opiates such as heroin and morphine.

For a long time, methadone was the only drug available for a person struggling with opioid addiction. Today there are more options, including buprenorphine-based products.  These can be a better fit for some people struggling with addiction.

You may be wondering, can I switch from methadone to buprenorphine?

The short answer is, yes. If you’ve been wondering about making this switch from methadone to buprenorphine-based products, read on to learn all the details that will help simplify this process.

What is the Difference Between Methadone and Buprenorphine?

Methadone and buprenorphine have many similarities. Both medications are used to help people suffering from opioid addiction manage their withdrawal symptoms as they wean off of the drug they are abusing.

Both of these medications have long half-lives, which means that their effects last for a long time (usually between 24 and 60 hours).  So a patient will not have to take it as often as they would the opiate they have been abusing.

Methadone and buprenorphine will also help with the cravings that a patient can experience as they start to eliminate the illegal opiates from their systems.  This will help a patient stay in recovery long-term, as they will no longer have the desire to find the other substances to take.

The main difference between these two drugs is that methadone is a full opioid agonist, and buprenorphine is a partial opioid agonist.  This means they both act on the opioid receptors.

Methadone has a stronger effect on these receptors, though, than buprenorphine. With buprenorphine, once you reach a plateau the effects from the medication will  level out.

Another big difference is that methadone can only be used to treat addiction through a licensed methadone clinic.  These clinics usually require very frequent visits.  Buprenorphine can be prescribed by any physician with the appropriate licensing.  This means you can be seen at a physician’s office at weekly to monthly intervals once stable on the medication.

So Why Make the Switch?

Due to this plateau effect, individuals suffering from opioid addiction are less likely to abuse buprenorphine.  Once the correct dosage is determined for you, you do not need to take higher levels of the medication to avoid withdrawal symptoms and cravings.  This will increase your chance of making a full recovery and possibly being able to taper off of the medication in the future.

Also, all opiates have side effects, such as constipation and sedation, but these are minimized with buprenorphine products.

How to Make the Switch?

If you’re interested in transitioning from methadone to a buprenorphine-based medication, there are some important things you need to keep in mind. The following tips will help you make the transition safely:

● Slowly reduce your dose of methadone under the care and guidance of your doctor at your current clinic

● Your methadone dosage needs to be less than 30 mg daily in order to minimize side effects when you make the switch to buprenorphine

● Discontinue methadone completely for at least 48 hours before you begin using buprenorphine – you have to be in mild withdrawal before you can start taking buprenorphine

● You may need to use other medications, such as Clonidine, to help the withdrawal process begin

● Once you’re in withdrawal, you can begin your first dosage of buprenorphine

Prescription

As you can see, it is possible to switch from methadone to buprenorphine-based medications. For some people struggling with opioid addiction, this switch can be one of the best decisions they ever make.

If you’ve been considering making this switch, be sure to keep this information in mind. It will decrease your risk of relapsing and help you transition in a safe way.

About the Author

Paula Nicola, M.D.
Dr. Nicola is the Facility Director at Renu. She is a trained and board certified medical doctor with specialized training in addiction medicine.