Does suboxone or methadone work better for opiate-addicted patients?

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Answered by: Will, An Expert in the About Substance Dependence Category
Suboxone and methadone are anti-addiction drugs used in the treatment of chronic opiate addicts. These maintenance medications help the patient avoid abusing heroin, oxycodone, and other narcotics.

While synthetic opioid drugs like methadone have been used to treat addicts since the 1920s, Suboxone is a relatively new anti-addictive substance. The debate over these two main forms of opiate addiction therapy revolves around their function. The two substances act differently on the brain to achieve the same desired effect.



Suboxone is the brand name of a drug owned by Reckitt Benckiser. It's a combination medicine, blending a long-acting synthetic opiate (buprenorphine) with a pure opioid antagonist (naloxone). The naloxone prevents the user from receiving the "high" effect from opiates, were they to be inject, snorted, or swallowed while the naloxone is present in the body. Suboxone's other ingredient - buprenorphine - prevents the withdrawal symptoms typical of opiate cessation.

Methadone is an older drug that performs just one of those functions. As an "opioid agonist," methadone fully binds to the opiate receptors and mimics the endorphins an opiate addict receives from using. It prevents withdrawal symptoms, like Suboxone, but it does so without the addition of naloxone. That makes methadone more likely to be abused, because methadone patients can continue to use other opiates to achieve a euphoric high. A high which Suboxone's opioid antagonist would prevent.



When choosing a medical treatment for opiate addiction, it's important to consider a few lifestyle factors of the patient being treated:

•How likely is the patient to attempt to sell or give away their medication in exchange for drugs? This activity, called "diversion," is much easier with Suboxone due to the way it is supplied. Methadone is generally given in a clinical setting, in liquid form, which makes exchanging or selling the substance more difficult.

•If given the methadone treatment, how likely is the patient to continue to abuse opiates? A substitution of Suboxone (and its naloxone counterpart) can put to rest many concerns about continued abuse of opiates. Patients who take advantage of the fact that methadone does not prevent continued drug abuse should be considered for controlled Suboxone therapy.

•A final question to ask patients considering Suboxone or methadone – how important is convenience? Most methadone clinics require weekly or even daily visits, which can involve transportation issues and costs. Suboxone is supplied like any pharmaceutical medication, and can be picked up from the majority of American pharmacies like any controlled substance. Methadone is far less convenient of an addiction treatment than Suboxone.

Ultimately, the choice of Suboxone or methadone treatment is up to each patient and their team of care-givers. Both methods have shown success clinically and in the field. Both have their positive and negative aspects. Selecting one method of treatment over another means looking at the lifestyle of each patient and making a choice that makes sense for their circumstances. Consider the likelihood of abuse, the convenience factor, and the need for the presence of an opioid agonist like naloxone.

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