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Methadone vs. Suboxone: What choice is best?

I’ve got to be clear right from the beginning, there’s no magic bullet if you’re addicted to opiates.  At some time or another opiate addicts will with out a doubt, experience some withdrawal.  In my experience, the fear of withdrawal was the main motivating factor that drove me to seek out more drugs.  This is part of the addiction cycle.  Getting the drug, doing the drug, getting the high, coming down, seeking ways to get more drugs, and finnally getting the drugs.  So while the goal of any rehab or therapy program is to get 100 % clean and off of substances, it is not realistic to expect most opiate addicts to just quit “cold turkey”.  In this circumstance the best approach to freedom is through a maintenance program.

We’re going to take a look at two different types of maintenance therapies:  Methadone and Suboxone.  We call them maintenance therapies because both drugs offer the patient’s body to be free from physical withdrawal so they can focus on dealing with life and recovery instead of constantly planning how to get their next fix.

The use of methadone and Suboxone are a great way to manage your life around the mental therapy that an addict most certainly needs if they are to be successful.  There are people that use them for years, and that’s OK, as long as you are attending your treatment sessions. Personally, I was on Suboxone for 2 years before I tapered off.  Some patients end their maintenance program within weeks or months of starting treatment. This approach has worked great as well. Every patient’s circumstances are different. Which ever scenario you choose, these medications have their pros and cons, and that’s what we’re here to find out about. 

Agonists, Partial Agonists, and the Ceiling Effect

These are the three main terms that you need to be familiar with while learning about maintenance methods.

Opiate agonists  The brain has these things called receptors that  play a part in regulating our mood and the way that we feel pain.  The reason opiates affect people the way that they do is because of the brain’s opiate receptors.  In very simple terms, when you ingest heroin the drug crosses the blood/brain barrier very quickly and then attaches itself to the opiate receptors.  While these receptors are filled with the opiate a user will feel euphoria and become less sensitive to pain.   When the receptors become empty (after the drug wears off) the body will start to go into withdrawal. (Not Pleasant)..  This is what an opiate agonist like Vicodin, Heroin, Methadone, or Morphine does.  In other words, an opiate agonist will make you high.

Opiate antagonists  are drugs that when ingested, attach themselves to the opiate receptors in place of actual drugs like Heroin.  The receptors for those drugs would already be filled with the antagonist, therefore no effect would be felt.  Popular opiate antagonists include Naltrexone and Naloxone.

Partial opiate agonists have what is called a ceiling effect. One way to describe this effect is: Imagine that there was a drug on the market that had most of the effects of an opiate agonist except after ingesting a certain amount the intoxicating effects of that said drug could not get any more intense.  Put very simply, that is what a partial opiate agonist is.  The two most popular partial opiate agonists are Suboxone and Subutex. (Both Buprenorphine). When taking Suboxone or Subutex, once you have filled all of the holes in the receptors there can be no more effect from the drug.  You have reached the ceiling effect of it.  That does not mean that you can’t overdose!  There is a bit of controversy among doctors about how many tablets a day are necessary for the patient to be medicated properly. What they’re finding out is that patients don’t need more then 2 8 mg tablets per day. It used to be common to give highly tolerant users 3 8 mg tablets per day, but anything over 2 is just a waste of money, as the opiate receptors are already maxed out.

Putting It All Together  Buprenorphine, being a partial opiate agonist, is widely considered a safe maintenance drug. While there are cases of overdosing from Buprenorphine, they are mostly associated with abusing alcohol or barbiturates at the same time.  If taken as directed Suboxone and Subutex will reach the ceiling effect before any major harmful side effects can take place.  Because of this,  Suboxone patients do not really need to be monitored full time. It is possible to over dose if any barbituate and/or alcohol is taken with Suboxone. Your doctor will go over that with you in detail. There are cases when Suboxone’s ceiling effect can make the drug less effective, especially for patients who have very severe, and long-term opiate habits. In these cases, a partial opiate antagonist might not do the job well enough, therefore the patient will still feel quite uncomfortable and have moderate to severe withdrawal symptoms.

 Enter the topic of Methadone.  Methadone is a full opiate agonist.  It does not have a ceiling effect.  So, if a patient is still experiencing withdrawal symptoms, the doctor can adjust the dosage until the issue is compensated. I feel that as a responsible source of information, I should inject the necessary cautions and warnings about using methadone. Most doctors today are against methadone therapy (unless they own the local methadone clinic).  I will tell you that I was abusing methadone for about a year and it did not turn out well when my source disappeared. Methadone withdrawal is much more painful then other opiate withdrawal.  However, In all fairness I never did taper down so I don’t want to paint an inaccurate picture here.  I just am a little cautious about using it because of how i know that personally it would not work out for me.  I would still be abusing heroin.  Everyone is different!

Take A Look At More Information To Help You Decide:

Suboxone takes more time to go through your system than methadone does. Methadone has a much shorter half life.  What this means is, methadone will cause withdrawal to kick in really sudden and on the dime when about 24 hours goes by between doses.  Suboxone is way more lenient and usually will last in your system for a good 36 hrs.  Don’t pay any attention to that though.  It is very important to take these medications on a strict time schedule. This is because it is proven that they are more effective that way.

Can’t someone Abuse These Drugs Too?   Methadone is often abused by people who have no intention of trying to eventually stop.   Because it takes about 45 minuets for Methadone to kick in,  a new user might try and take more then prescribed to feel the high that they are used to. Then once it all really kicks in, it’s too late and overdose could occur.  Both Suboxone and Methadone are sold on the black market and many patients will sell their scripts for money to buy actual Heroin!  It is a growing problem, but in my opinion these treatment drugs help so many people that are not trying to game the system and to be honest one can never conquer corruption 100% of the time.  It is possible to feel a euphoric effect when first starting Suboxone treatment, but that will go away in awhile. Soon you won’t even know that you’re on it!

What About Overdose?  Overdose is always a concern for any medication.  I recently read that over 3,000 people die of Methadone overdose per year. Mostly none of those deaths were  methadone maintenance patients.  Remember Suboxone overdose can happen too!  Mixing it (or any other opiate agonist/partial agonist) with drugs like xanax and alcohol are sure ways to overdose.  If Suboxone is crushed and injected, the abuser is in for a painful surprise. The Naloxone will most likely induce severe withdrawal symptoms.

Withdrawal?  The answer is YES!   Both of these drugs will cause withdrawals if stopped suddenly.  You must follow you doctor’s maintenance program and don’t stray off course.  It is possible to ween off of Suboxone without too much discomfort. I did it myself and the trick for me was a very slow taper.  Don’t let any doctor push you around!  Go down to 1/2 a milligram if you have too.  That’s what I did.

What about Price?  Methadone is about $50 a week.  Suboxone is quite expensive. The usual price is 6-7 dollars per pill. I think that it’s worth the cost to get well again. Both of these drugs have helped many many people. Be sure to take them exactly as directed for best results. Good Luck, and stay strong!  It is achievable to turn this nightmare around!

10 Comments

  1. sarrigo says:

    Can you please provide published (as in scientific journals) evidence that Methadone has a negative effect on bones? Quite the myth there.

    Also withdrawal when done properly–which means slow is manageable–meaning little side affects. Most of the horror stories one hears about methadone withdrawal is from individuals who were incarcerated and decided to go cold turkey–against medical recommendations. Many medications have side effects if stopped suddenly.

    1. admin says:

      Well said Sarrigo! Yes, you are correct. Methadone does not store in the bones. I stand corrected. You are also correct for calling me out about the withdrawal statement. When used properly, Methadone is a painless transition( maybe a little discomfort in the end). Thank you for visiting this page and setting the record straight.

      1. Sp1414 says:

        well i disagree totally about it being painless… i was on 70mg of methadone and i slowly tappered down 1 mg every other day.. i went all the way down to 1mg and i thought for sure that i would be fine.. first day went by and i was a little sore.. 2nd day wasnt terrible but by the third day i was hurting BAD… i swear i hurt for 3 weeks and i eventually gave up and started using oxy’s again… except after the methadone.. my tolerance had went through the roof and it took double what it used to take to feel high… Methadone is HELL… I have been on suboxone now for about 6 months and im really hoping the slow taper will work without severe withdrawls.. if its anything like methadone idk if ill ever quit..

        1. admin says:

          I’m sorry to hear about the pain that it put you through. It is way worse than heroin in my opinion.. I wish you luck with Suboxone. It was what I consider painless to get off for me. I tapered real Slowly. I went down to one mg (Half of a 2 mg strip) a day. The first day without it was OK. The second I felt a little weird, and the third a little weird, but overall it really was fine. It worked out real good for me.
          Thanks for the comment!

  2. alexa says:

    suboxone withdrawal sucks. .it’s worst then heroin withdrawal. so you’re wrong. sorry

    1. admin says:

      Hey Alexa, It sucks that you had to go through it that way. One thing that I’ve learned over the years is that everyone is affected in very different ways by all of this stuff. I guess what I meant to say was that if you follow the program and taper off as slowly as you feel comfortable, It will be relatively painless. I don’t know any one that has had a horrible experience getting off of Suboxone if it was done properly.

      If you’re taking 2 8mg a day for a few weeks and then just stop, then You could be in a lot of trouble!

  3. Joe says:

    hello I have been in methadone maintanence for a little over 4 months now. My current dose is 100mg a day and my clinic is 1.5 hours away and one big helper in relapse prevention is marijuana for me. unfortunatly though i cannot get takehomes because of my dirty urine screens. I was told today that there are suboxone doctors in close proximity to me and i can get a months worth of medication for 300 to start and the following months are $150. Which is a great improvement from the $800 im spending in gas and clinic fees. It has become a financial burden for me and i need a switch. Is suboxone the route i should take? I really need some feedback on this issue because the methadone clinic is a second full time job and i work my ass off all week long just to pay for my treatment. any feedback will be greatly appreciated i dunno what to do

    1. admin says:

      Joe, In my opinion going for the Suboxone would be way cheaper and less stressful for your situation. 1.5 hours drive both ways? Every day? That’s an awful amount of trouble to go through!

      The first time that I got on Suboxone it was to get off of Methadone. I was taking 40-60 mg (of Methadose) per day that I was getting on the streets regularly. The Doc prescribed me 1 8mg Suboxone per day and it worked well. I was tapered off in about 1 month. I was impressed how smooth it got me turned around.

      I would guess that you just want to continue doing maintenance therapy so they will likely prescribe you 2 8mg tablets per day at first since you are currently dosed at 100mg of methadone daily. After a short time they might try and get you down to 1 8mg tablet per day, but it all depends on how you react to it. I would try to get it down to 1 a day because the cost is much better.

      Hope this was helpful!

  4. jimbo says:

    “Suboxone also causes withdrawal, but it’s generally milder than the types of withdrawal associated with full agonists.”
    I beg to differ. Suboxone withdrawal was one of the worst withdrawal experiances I have ever had. I switched from methadone to Suboxone (waited 34 hours at reduced dose of the done,40mg`s) and went into precipitated withdrawal, I would rather die than go thru precipitated withdrawal again. I almost died in the hospital, they did the pattle/shock thing on my heart to get it beating again, and have never felt such pain and misery in my life. 2 days later went back to Doc`s office and we started me on the Subox; ended up at the max 32mg`s a day, was on that for 1.5 years and decided to go to a detox. Not many detoxes want to detox Subone . I`ve withdrawn from all of the opiates at one time or another, I`ve been a HARD-core opiate addict for over 29 years, so I have vast experiance in the field.
    Suboxone was one of the worst withdrawals that I have ever been thru, about even with a 5 year methadone maint.(120mg`s a day) withdrawal. Way ,way harder than Heroin;Dilaudid 8mg`s; oxy-contin 80mg`s. I went thru the detox and the 28 day rehab(been thru at least 10 prior r`habs) and came home and that same day I was shooting Dilaudid. I got back on the methadone maint. program the next day and I am up to 1 month of take home doses of 80mg per day. Life has never been better. But you have to take your medicine correctly and want to quit getting high for the Methadone program to work. I have never known this kind of life, I don`t even think about dope now. And if I do I only see the bad stuff that goes along with it , not the good. Methadone has saved my life. And GOD too of course. I look at my methadone the same way I look at my high blood pressure medicine, if I don`t take them like I am directed to , I can die. Okay enough rambling, thanks . Jimbo!

    1. admin says:

      Thank you for your honest comment! Suboxone is not for everyone, as you have described, and while I tend to not recommend Methadone to most, there are definitely folks like yourself that really do well with it. I could never get over really liking the “high” part of Methadone so it kept me in that drug seeking behavior. Good for you, and keep it up!

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