How prevalent is the opioid drug crisis?
Consider this: An estimated 2 million people in the U.S. have a substance use disorder related to prescription opioids. That estimate alone surpasses the individual populations of cities like Philadelphia, San Diego, and Dallas. It also exceeds the combined people of Las Vegas, Baltimore, and Milwaukee.
That figure does not account for the scores of individuals addicted to illicit opiates like heroin. Some experts believe the death toll from this relentless scourge, fueled mostly by deadly synthetic opioids like fentanyl, could reach nearly 500,000 by 2027.
The severity of the opioid epidemic requires answers in the form of treatment medications like Suboxone and methadone, which are employed to stave off opioid cravings and prevent withdrawal symptoms.
How do they differ? How are they alike? Read on to learn more.
Methadone and Suboxone: The Skinny
Methadone has been around for generations. Though methadone was introduced to treat pain in the late 1940s, it gained use as a heroin treatment medication in 1964. Like other opioids, methadone attaches to opioid receptors in the brain.
This action allows it to block pain signals from reaching the brain, but it also leads to the release of dopamine. Ordinarily, when an opioid stimulates those receptors, it produces a surge of dopamine, causing users to experience a rush of euphoria.
However, unlike other drugs in its class, methadone has a gradual onset of action, which prevents users from experiencing those euphoric effects. In other words, a single dose can last anywhere from 24 to 36 hours. This unique attribute allows it to act as a maintenance medication for people addicted to heroin or other opioids.
The brand names for methadone include Dolophine, Methadone HCI, Methadose, and Intensol. It comes in these forms: tablet, solution, oral concentrate, injectable solution, and as a dispersible tablet.
As an opioid maintenance medication, the initial dose of methadone should be between 30 to 40 mg. The standard dose range for people taking methadone as a maintenance medication is between 80 to 120 milligrams (mg), according to Drugs.com.
Despite its intended purpose, methadone is still capable of being a substance of abuse. The U.S. Drug Enforcement Administration (DEA) designates it as a Schedule II controlled substance, which means it has a high potential for abuse that could lead to severe psychological or physical dependence.
Suboxone is composed of buprenorphine and naloxone. In 2002, the U.S. Food and Drug Administration (FDA) approved it to treat opioid addiction.
Like methadone, it works to curb opioid withdrawal symptoms and cravings. The buprenorphine component binds to the same receptors as other opioids, but it does not stimulate them as emphatically, as for example, heroin or oxycodone.
This partial binding causes the buprenorphine to produce weaker effects. What’s more, buprenorphine’s effects eventually level off with each dose, yielding a “ceiling effect” that deters abuse. Naloxone simply blocks the effects of the opioid.
Suboxone comes as an oral film, which dissolves when placed under the tongue or between the cheek and gum. The generic version of the drug comes as a film or tablet that is placed under the tongue. The recommended maintenance dosage for the suboxone/naloxone medication is between 4 mg/1 mg to 24 mg/6 mg, states Rxlist.com.
Though Suboxone has been formulated to deter misuse, it is still recognized as a controlled substance. The DEA deems it a Schedule III drug, which means that “abuse may lead to moderate or low physical dependence or high psychological dependence.”
Differences Between Suboxone and Methadone
Methadone is only available at federally sanctioned opioid treatment facilities or clinics. A doctor has to observe you receiving your daily dose of the medication.
Once a treatment physician determines you are stable with your methadone treatment, you may be allowed to take the medication at home between clinic visits. Even if you take methadone at home, you still need to receive it from a federally sanctioned opioid treatment clinic, according to Healthline.
The advantage Suboxone has over methadone is that you do not have to get it from an approved clinic. A doctor can simply prescribe it to you. At the start, your treating physician may monitor you.
You may be required to come to their office to receive the Suboxone, and they may also have to observe you taking the drug.
If you are allowed to take it at home, you may only be administered a few doses at a time. However, the doctor can allow you to manage your treatment, says Healthline.
Suboxone and Methadone Side Effects
Suboxone and methadone, which have opioid properties, have several side effects in common, according to Healthline. Those effects include:
- Nausea and Vomiting
The severe side effects they both produce are:
- Severe breathing trouble
- Allergic reaction
Suboxone-Only Side Effects
Suboxone has unique side effects, including fainting, mouth numbness, swollen or painful tongue, mouth redness, faster or slower heart rate, trouble paying attention, and blurry vision.
The severe side effects from Suboxone include hypotension (low blood pressure), liver problems, opioid withdrawal, and coordination problems.
Methadone-Only Side Effects
The common and serious side effects exclusive to methadone include stomach pain, seizures, and heart rhythm issues.
Suboxone and Methadone Withdrawal
Although they are approved treatment medications, Suboxone and methadone use can lead to addiction. Thus, they are both capable of producing uncomfortable withdrawal symptoms.
The withdrawal symptoms from methadone and Suboxone are as follows:
Methadone-Only Withdrawal Symptoms
Methadone withdrawal produces hot and cold flashes, hallucinations, and tremors.
Suboxone-Only Withdrawal Symptoms
Suboxone can generate further withdrawal symptoms such as fever, chills, sweating, headache, and concentration issues.
Methadone and Suboxone Costs
Methadone and Suboxone are comparable in price, according to the National Institute on Drug Abuse (NIDA). Methadone treatment, along with medication and integrated psychosocial and medical support services, costs about $126 per week or $6,552 annually.
Buprenorphine for a stable patient in a certified opioid treatment program, including twice-weekly visits and medication, costs $115 a week or $5,980 annually, says NIDA.
Methadone vs. Suboxone: Which is More Effective?
Because methadone has been around a lot longer than Suboxone, there are far more studies on it, particularly the kind that measures treatment effectiveness.
Two metrics can determine whether treatment is effective: rates of criminal activity and treatment retention.
A treatment program’s effectiveness is measured by its ability to reduce patient criminal activity, which is often associated with heroin use. By this measure, there was no difference between Suboxone and methadone in the reduction of criminal activity or heroin use, according to this study.
Treatment retention, which measures the ability to keep a patient in treatment long enough to realize a successful outcome is another useful metric. The retention rates of first-year methadone treatment are between 70 to 80 percent, compared to the rates of Suboxone, which are between 56.9 and 90 percent, according to this published report from the Journal of Addiction Research & Therapy.
According to that same report, “All studies examined for methadone outcome success found a significant reduction in illicit drug use, risky behaviors, and health problems. However, one study found that there was a significant reduction in the percentage of opioid found on urine drug screens of patients receiving Suboxone therapy over those receiving methadone.”
Essentially, several studies have concluded that methadone and Suboxone are effective treatment approaches for opioid and opiate addiction.
Suboxone, Methadone, and the Importance of MAT
A reputable opioid treatment program will administer Suboxone or methadone as part of a medication-assisted treatment (MAT) program, which is known as the “whole patient approach.” MAT is regarded as the most effective method in treating opioid addiction.
A MAT program provides patients with medication, therapy, and counseling, which addresses the physiological, psychological, and emotional aspects of addiction.
MAT has been shown to decrease opioid use, opioid-related overdose, infectious disease transmission, and criminal activity, according to NIDA.
Patients were also more likely to remain in therapy with MAT than those who received treatment without medication. MAT treatment with methadone or buprenorphine can also improve the outcomes of babies born to opioid-dependent women.