In our last post we discussed what medication-assisted therapy (MAT) for opioid addiction is. We briefly highlighted that the most commonly used medications for MAT are either Methadone or Suboxone. In this post we want to discuss each medication and the differences between the two.
Methadone is a long acting opiate that has been used for the treatment of opiate addiction since the 1950s. It was developed in Germany for treatment of pain on the battlefield. While at first using an opiate to treat opioid addiction may seem contradictory, the reasoning is based on science. Methadone is a long acting opiate. It acts on the same receptors as other opiates but works more slowly and does not produce the high associated with other opiates. It works to alleviate opiate withdrawal symptoms and cravings.
The premise behind methadone therapy (and really all MAT) is that by using prescribed medications, cravings and withdrawal symptoms are minimized, reducing the need or desire to use illicit, harmful opiates. Because cravings and withdrawal are managed, patients are able to, stop using illicit drugs, focus on counseling, decrease the risks associated with drug use, and address the issues that lead to their opiate dependence. Clients are able to repair damage to their lives and begin building a hopeful future.
Over time the goal is to taper the methadone dose with eventual abstinence. It should be pointed out that this is often a process that can take months to years. Studies have shown that using maintenance therapy as opposed to just providing medication during the withdrawal period result in decreased relapse rates.
From the very beginning Methadone treatment was controversial because many saw it as substituting one addiction for another. This controversy remains today. The fact remains that methadone maintenance therapy has been research proven to be the most effective form of therapy for opiate addiction.
Suboxone is the trade name for the combination for buprenorphine and naloxone. Suboxone was specifically designed to treat opiate addiction. Buprenorphine is a partial opiate agonist. It works at the same receptor in the brain as opiates causing pain relief but doesn’t have the same level of activity as other opiates to cause euphoria . Naloxone is an opiate antagonist that is used to counteract opiates. Specifically it works by occupying the opiate receptors in the brain and preventing opiates from occupying these receptors. The addition of naloxone reduces the abuse potential of suboxone.
So what are the differences and similarities in practical terms? Both Methadone and Suboxone are most often administered orally. At this point Suboxone is more expensive than Methadone, but this depends on your payer (insurance type ect.).
The regulatory restrictions surrounding Methadone are greater than those for Suboxone. Methadone is only given at certified opioid treatment programs, meaning you begin treatment by taking the medication nearly exclusively onsite. As you progress in your treatment, you are given progressively increasing daily doses to take home with you. The maximum number of take home doses is a one month supply, typically reserved for well-established patients who have demonstrated a high degree of dependability. With Suboxone you will receive a prescription and can take the medication at home while your treatment progress is monitored. Typically, a two-week or one-month prescription is provided at a time.
Methadone has been shown to be more effective than Suboxone in treating opioid addiction. However, Suboxone is often a better fit for some patients. Studies have shown that both drugs are superior to abstinence based therapies with respect to decreased chance of relapse.
We often find patients have a preference when they first come to us. We offer both medications so as long as the therapy is a good fit for the individual.