Methadone Vs. Suboxone

What are Methadone and Suboxone?

Methadone and Suboxone are both FDA-approved medications used to treat opioid use disorder. Methadone is a full opioid agonist and is generally given through a certified opioid treatment program. Suboxone combines buprenorphine, a partial opioid agonist, with naloxone, and it can be prescribed through an office or an eligible telehealth visit.

Both treat opioid use disorder by relieving withdrawal symptoms and cravings, and both can support long-term treatment. Choosing between them depends on your treatment history, symptoms, preferences, medical needs and access. Neither one is the right choice for every person. CDC: Treating Opioid Use Disorder

We will dive into more of what the differences are below.

More about Methadone and Suboxone

Methadone is sold as a generic and under brand names such as Dolophine, Methadone HCl Intensol and Methadose. Suboxone also has a generic, which is called buprenorphine-naloxone. Another brand of buprenorphine-naloxone is Zubsolv. Which product you are prescribed is up to your medication assisted treatment provider.

Both methadone and Suboxone treat opioid use disorder. This includes prescription pain medications as well as illegal substances such as heroin. Methadone is also prescribed for pain. Suboxone is used to treat opioid use disorder. For more on that question, see Is Suboxone used for pain relief?

In Suboxone, buprenorphine provides the main treatment effect. Buprenorphine binds strongly to opioid receptors. The naloxone is included to discourage certain kinds of misuse. It is not the main daily treatment effect, and it is not a substitute for rescue naloxone during an overdose. FDA Suboxone prescribing information

Methadone and Suboxone both carry a risk of withdrawal if you come off the medication without a plan. This "taper" should be managed by the prescribing Suboxone or methadone doctor, based on what they know about your treatment. We highly recommend that patients do not try to take themselves off either one of these medications. Both methadone and Suboxone have the potential to be misused. Methadone is a schedule II controlled substance and Suboxone is a schedule III controlled substance. As an online provider of medication-assisted treatment, we do not prescribe methadone, only Suboxone.

Both medicines can cause sedation and dangerous slowed breathing, particularly with alcohol or other sedatives. Methadone also requires attention to accumulation and heart-rhythm risk. Buprenorphine's partial-agonist properties reduce some risks compared with full agonists, but they do not remove the risk of overdose. Keep naloxone available and make sure someone knows how to respond to an overdose. CDC: Responding to an Overdose

When it comes to taking the medications, here is how they compare. In opioid use disorder care, methadone is commonly given as an oral liquid. Methadone can be administered the following ways:

• Oral liquid
• Tablet
• Injection
• Dispersible Tablet (dissolved in a liquid)

Suboxone, as the brand name, is delivered by an oral film. This film dissolves under the tongue, which is called sublingual, or it can be placed between the gums and cheek to dissolve, which is called buccal. The generic version of Suboxone, buprenorphine-naloxone, is available in both the oral film and a tablet (pill).

Difference in Cost Between Methadone and Suboxone

The difference between methadone and Suboxone when it comes to cost depends on the program, the medication and your coverage. When you compare, ask about medication, clinical visits, testing and transportation. A quoted drug price alone does not describe the cost of a treatment program. There will also be variation based on dosage amount.

At Recovery Delivered, you pay for each medical visit when you book. The first visit is $89. After that, visits are $50 weekly, $75 every two weeks or $89 monthly. Visits are cash pay, and the clinic does not bill insurance. Medication is priced separately, and your insurance may cover it at your own pharmacy.

Generic buprenorphine-naloxone may be available. Coverage and out-of-pocket costs depend on the exact prescription, so ask your provider and your pharmacist whether a generic is an option for you.

Access to Methadone and Suboxone

As these medications are classified as schedule II and III, there are restrictions on how someone can access them. Based upon how the medication is being used, we see differences between methadone and Suboxone.

Methadone can be prescribed by a doctor for chronic pain. However, not all pharmacies carry it. The prescribing physician of methadone should be able to tell you which pharmacies carry the medication.

The major difference in accessing the two medications is during the treatment of opioid use disorder. Both methadone and Suboxone are used to reduce withdrawal symptoms and for ongoing maintenance. Methadone for opioid use disorder is generally dispensed through certified opioid treatment programs, and visits may be more frequent when you start. Federal rules updated in 2024 allow more individualized take-home decisions, including take-home doses early in treatment under appropriate circumstances. State rules and program decisions still affect access. SAMHSA's updated opioid treatment program rules

Suboxone may be prescribed through office-based or eligible telemedicine care and is taken at home. Appointment requirements and pharmacy access vary.

There are areas of the country that have a hard time maintaining a supply of Suboxone. We have had patients who could not get a prescription from our online doctors filled because the pharmacy ran out. New Recovery Delivered patients pick up their medication at a local pharmacy, so it helps to call ahead and confirm the pharmacy has it in stock. Delivery is available only for patients on monthly visits.

Inpatient opioid treatment centers around the country also use these medications, not only during withdrawal from opioids but in long-term treatment as well.

What is the Difference in Treatment Between Methadone and Suboxone?

The major difference is that Suboxone is usually taken at home from the start, while methadone for opioid use disorder is generally given through an opioid treatment program. In the beginning, that can mean frequent visits to the clinic. Take-home doses depend on the program, state rules and an individual assessment.

With Suboxone at Recovery Delivered, your provider decides how often you are seen. Visits can be weekly, every two weeks or monthly. The prescribing provider writes a prescription for the given amount of time.

A main component of treatment with both methadone and Suboxone is that neither is a magic pill. Many people also benefit from counseling with a certified addiction counselor and from group therapy. RecoveryDelivered.com also recommends that patients join a 12-step group or another peer group to help build a community of supportive people. The medication helps, and it also helps to look within, find the why and work on the underlying issues.

If one approach is not meeting your needs, reassessment can include a dose review, a different care setting or another medication. Transitions between the two medicines should be managed by a clinician. Do not stop one and start the other on your own.

Withdrawal Differences

Both of these medications can cause physical dependence, and therefore withdrawal when they are stopped. Physical dependence during appropriate care does not mean the treatment is simply another addiction.

The timeline for withdrawal varies by person. The symptoms of withdrawal from both methadone and Suboxone are:

• Shaking
• Sweating
• Hot or Cold flashes
• Runny Nose
• Watery Eyes
• Goosebumps
• Diarrhea
• Vomiting
• Muscle Aches

Do not stop either medication on your own. If you do, the symptoms of withdrawal can continue and get worse. RecoveryDelivered.com suggests speaking with your provider about a taper, which lowers the amount of medication at each step so the patient can stop taking it as comfortably as possible.

Start Suboxone treatment online. Recovery Delivered's online Suboxone doctors see patients by video. The first visit is $89. Follow-up visits are $50 weekly, $75 every two weeks or $89 monthly. Visits are cash pay, and medication is priced separately.