Methadone vs. Suboxone

Methadone and Suboxone are two popular medications used to treat opiate addictions. Both can be used as part of drug replacement therapy, in which they replace more potentially harmful opiates such as heroin or morphine.

Because someone with a severe opiate dependence can face severe health risks if they quit “cold turkey,” these replacement medications are used to help wean patients off gradually and safely. While both drugs are used as part of drug detox and recovery treatment, they differ slightly in their benefits and risks. Learn more about the difference between methadone and suboxone, and how they can be used as part of a safe opiate rehab program.

Methadone Treatment

Methadone is a synthetic opioid introduced in 1947 that has been used in the decades since as part of opiate recovery treatment. Methadone is available under other brand names, including:

  • Dolophine
  • Methadose
  • Diskets

The goal with methadone treatment is to help those struggling with addiction to manage their side effects in a controlled manner. Methadone acts on the same brain receptors as other opioids, but lasts longer and has a cumulative effect over time. The result is fewer cravings and diminished withdrawal symptoms. After a maintenance period, the amount of methadone used in treatment is stabilized; and the individual is maintained on this dosage for the longterm.


The major advantage to methadone is its ability to satiate opioid cravings in a way that is relatively controlled. It is classified as a “full agonist opioid,” which means it fully stimulates the opioid receptors in the brain. This is particularly useful for severe cases of opiate addiction that may not be as responsive to other types of drug replacement therapy.

Because of this effect, methadone also can block the euphoric effects of other opioids, such as heroin and prescription opiates.

Disadvantages and Risks

Methadone is generally considered safer than abusing opiates such as heroin, but it is still a drug that carries risk of dependence and abuse. While methadone helps far more people than it harms, methadone addiction and overdose is a risk that must be managed. There are also some rare cardiac side effects associated with methadone which can lead to sudden death while taking.

It is for this reason that dispensing of methadone is typically done in a highly controlled, clinical environment. This allows for supervised administration of the medication and minimizing risk for abuse. However, this can also make it more difficult for some to receive treatment as they must physically visit a clinic or other medical facility for each dose, usually daily when they first begin treatment.

Suboxone Treatment Overview

A relatively new option for opioid addiction, Suboxone is the brand name for a medication that actually contains two separate drugs: buprenorphine and naloxone.


Like methadone, buprenorphine is a synthesized opioid that is used as part of opioid drug replacement therapy. It is classified as a “partial agonist opioid,” which means it binds to the brain’s opioid receptors but does not fully stimulate them like methadone or other opioids can, resulting in less of a drug high.


Naloxone, also known by the trade name Narcan, is a medication that blocks the effect of opioids. On its own, it is often used to treat cases of opiate overdose and help mitigate its life-threatening health risks.


Because it is only a partial agonist, the buprenorphine in Suboxone has a “ceiling effect.” This means that the effects of the opioid will level off after a certain point, even if more of the drug is consumed. This built-in limit to the euphoric effects of the opioid reduces the physiological incentive to take more. The intended result is a lower risk of dependence, abuse and side effects.

Buprenorphine also blocks certain opioid receptors. This has the benefit of directly blocking the effects of other, more dangerous opiates if they are taken subsequently.

When taken in pill form, the naloxone in Suboxone does not have a significant effect as it is poorly absorbed by the body when taken orally. Its primary purpose is to prevent users from crushing the pills and injecting the opioid intravenously for an increased high. In that instance, the naloxone is more readily processed and will effectively block the effects of the buprenorphine. Suboxone is also available as a film that dissolves in the month to encourage proper consumption.

When risk for abuse is deemed low, those in recovery may be able to take Suboxone on their own like a typical prescription. This allows for more flexibility and ease in medication administration than methadone, which usually must be dispensed in a clinical environment.

Disadvantages and Risks

Because it is a partial agonist, Suboxone may not be as effective as methadone for managing cravings and withdrawal side effects for more severe cases of addiction.

Although buprenorphine is considered a relatively safer option for addiction treatment, it is still an opioid and carries its own side effects and risks for dependence, especially when taken with alcohol or benzodiazepines.

Side Effects

Methadone and Suboxone are both opioids and present similar side effect risks, especially if abused or taken with alcohol or other sedating medications. Commonly reported side effects are similar to those seen with all opiates and include:

  • Difficulty breathing
  • Drowsiness or sleeplessness
  • Loss of coordination
  • Headache
  • Dizziness
  • Sweating
  • Blurry vision
  • Vomiting or nausea
  • Difficulty concentrating
  • Dry mouth
  • Sexual difficulties

Side effects may increase in severity when medications are used in excess or otherwise outside prescribed direction. These side effects will also decrease with the lower dosages used in Buprenorphine/Naloxone treatment. Over time, as you adjust to the dosage, these side effects will be less bothersome.

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.

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