Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
If you are exploring treatment for opioid use disorder, you have probably heard of Suboxone and methadone. Both are medications approved by the U.S. Food and Drug Administration to treat opioid use disorder, and both have strong research support. They also work differently, are provided in different ways and fit different people’s lives and needs.
This article compares the two in plain language so you can have a more informed conversation with a medical provider. It is general information, not medical advice, and the right choice for you depends on your history, health and preferences. No one should start, stop or change either medication without guidance from a qualified clinician.
Why Medications for Opioid Use Disorder Matter
Opioid use disorder changes how the brain responds to reward, stress and craving. Medications for opioid use disorder help stabilize those systems. According to federal health agencies, these medications reduce cravings and withdrawal, help people stay in treatment and are associated with a lower risk of overdose.
A common worry is that taking a medication like methadone or buprenorphine just replaces one addiction with another. The Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse both describe these medications as evidence-based treatment. Physical dependence on a prescribed medication taken as directed is different from addiction, which involves compulsive use despite harm.
How Suboxone Works
Suboxone is a brand name for a combination of buprenorphine and naloxone. Generic versions are also available.
- Buprenorphine is a partial opioid agonist. It activates opioid receptors enough to ease withdrawal and cravings, but its effects level off at higher amounts. This ceiling effect lowers, but does not eliminate, the risk of dangerously slowed breathing.
- Naloxone is included to discourage misuse by injection.
Buprenorphine can be prescribed by qualified clinicians in many medical settings and filled at a pharmacy. It usually comes as a film or tablet that dissolves under the tongue or in the cheek, and long-acting injectable forms of buprenorphine are also available.
One important detail: buprenorphine is generally started once a person is already experiencing some withdrawal. Starting too soon after other opioids can trigger sudden, intense withdrawal. This is one reason buprenorphine should be started with medical guidance.
How Methadone Works
Methadone is a long-acting full opioid agonist. It fully activates opioid receptors, but because it works slowly and steadily, it can prevent withdrawal and reduce cravings without the highs and lows of short-acting opioids.
For opioid use disorder, methadone is dispensed through certified opioid treatment programs. People typically visit the program regularly to receive their medication, especially early in treatment, and may become eligible for take-home doses over time. Many programs also provide counseling and other support on site.
Methadone doses are adjusted gradually because the medication builds up in the body. It can interact with a number of other medications and can affect heart rhythm in some people, so medical monitoring is part of care.
Comparing the Two
- How it is provided: Buprenorphine can be prescribed in many medical settings and picked up at a pharmacy. Methadone for opioid use disorder comes from a certified opioid treatment program.
- How it acts: Buprenorphine is a partial agonist with a ceiling effect. Methadone is a full agonist.
- Starting treatment: Buprenorphine generally requires some withdrawal before the first dose. Methadone does not, but it is increased slowly.
- Structure: Methadone programs offer built-in structure through regular visits. Buprenorphine may offer more flexibility.
- Who may benefit: People who did not do well on buprenorphine, or who need more structure, sometimes do better on methadone. Others prefer the convenience of buprenorphine.
A third option, extended-release naltrexone, blocks opioid effects rather than activating receptors. It requires a person to be free of opioids for a period before starting.
Questions to Bring to Your Provider
When you sit down with a clinician to discuss medication options, it can help to have a few questions ready:
- Based on my history, which medication do you think fits me, and why?
- How would I start, and what should I expect in the first weeks?
- How often would I need appointments or program visits?
- How does this medication interact with my other prescriptions?
- What is the plan if the first option does not work well for me?
Safety Considerations for Both
- Combining either medication with alcohol, benzodiazepines or other sedatives increases the risk of dangerously slowed breathing. Withdrawal from alcohol and benzodiazepines can also be life-threatening, so do not stop them abruptly without medical guidance.
- Store medications securely, away from children and others.
- Keep naloxone at home, and make sure others know where it is.
- Do not stop either medication suddenly. Any change should be planned with your provider.
Call 911 for signs of overdose. If you are in crisis or having thoughts of suicide, call or text 988.
How Promises Dallas-Fort Worth Can Help
At our Lewisville campus, opioid detox provides medically supervised withdrawal management, and medication-assisted treatment may be used during detox when clinically appropriate. Our team can talk with you about medication-assisted treatment options and how they fit your goals.
Medication tends to work well alongside therapy and support. Our opioid addiction treatment includes individual and group therapy, cognitive behavioral therapy and family therapy. Every client receives aftercare planning, which can include connecting with ongoing medication providers after treatment.
Frequently Asked Questions
Is Suboxone safer than methadone?
Each has different risks and benefits. Buprenorphine’s ceiling effect lowers some risks, while methadone may work better for some people. The safest choice is the one that fits your medical needs and that you can take consistently.
How long will I need to take medication?
There is no set timeline. Many people benefit from staying on medication for an extended period. Decisions about tapering should be made with your provider.
Can I switch from one to the other?
Switching is possible but requires careful medical planning to avoid withdrawal or other problems.
Talk With Our Team About Your Options
Choosing a medication is a personal decision, and you deserve clear information and support. Our admissions team is available 24/7, and same-day admission is often possible when a bed is available.
We offer free, confidential insurance verification. Visit our insurance options page, call (469) 546-9303, or contact us online.