What’s the Difference Between Methadone and Suboxone?

Suboxone and methadone are two different medications that are both used to treat opioid use disorder. 

  1. Suboxone is a combination of two medications: buprenorphine and naloxone.
    1. Buprenorphine is a partial-agonist opioid used to reduce cravings and withdrawal symptoms. 
    2. Naloxone is an opioid blocker added to discourage abuse.
  2. Methadone is a synthetic opioid used to reduce cravings and withdrawals.

Is Suboxone the same as methadone?

No, but they share many similarities in treating the same condition, opioid use disorder.

How Suboxone and Methadone Work in the Brain

Empty Opioid Recptor in the Brain
Methadone and Suboxone Going into Opioid Receptors

What is the difference between methadone and Suboxone?

Even though both help people with opioid use disorder, they are different medications.

MedicationMethadoneSuboxone
(Buprenorphine)
MechanismFull opioid (agonist)Partial opioid (agonist)
Route of AdministrationOral (Dissolvable tablet, Pill, Liquid)Film dissolved in mouth
Oral Pill
Injection in stomach (Subloclade)
DosingDailyDaily for film / pill
Monthly for injection
Available for Substance UseSpecialized Opioid Treatment Program (OTP) licenseDoctors that apply for specialized certification

Methadone is only dispensed at a methadone clinic.

Because it’s a full-agonist opioid, methadone is tightly regulated. Patients must report to a methadone clinic to get their dose dispensed to them. After several months of success, patients can take home several days of methadone dosage at a time.

Suboxone can be filled at the pharmacy like any other medication, but pharmacies too often refuse to provide Suboxone. suboxone clinic can dispense onsite.  (See What is a Suboxone Clinic?)

Suboxone is usually the first choice.

Suboxone is usually the first choice for opioid use disorder because it’s people are less likely to abuse it and the naloxone blocker prevents overdose in case they do. However, methadone has been successfully treating opioid addiction for years and is a good option if you’ve already had success with it. Some switch to methadone if they haven’t been successful with Suboxone or want the extra daily accountability.

Suboxone vs. Methadone FAQs

No, they are different medications with different ingredients. 

  1. Methadone only has one ingredient, methadone hydrochloride. 
  2. Suboxone is a combination of two medications, buprenorphine and naloxone.
Yes, methadone fully activates the opioid receptor while Suboxone only partially activates it. Though, both medications satisfy the brain’s craving for opioids.  

Suboxone and methadone have similar side effects, including:

  • Constipation 
  • Nausea and vomiting
  • Drowsiness and fatigue
  • Dilated pupils
  • Insomnia
  • Sweating
  • Respiratory distress
  • Double-vision

The biggest difference is that Suboxone doesn’t cause the feel-good, euphoric feelings of traditional opioids. It’s less intense than heroin or fentanyl, but you can get high off of methadone, which is why it’s given only at a clinic.

See also: Methadone Side Effects

Methadone and Suboxone are equally effective at treating opioid use disorder, though one study showed individuals on low doses of Suboxone (6 mg or less) are less likely to stay in treatment compared those taking methadone.

Can you take methadone and Suboxone together?

No, you have to choose either Suboxone or methadone. Combining both medications is dangerous because both are opioids, and this could cause an overdose. 

Should you switch from methadone to Suboxone?

If a patient is successfully treating their opioid addiction with methadone, there is no need to switch to Suboxone. But, if they continue to relapse or are non-compliant with the methadone program, Suboxone may be a better fit.

How To Switch From Methadone To Suboxone

A patient’s methadone dose should be tapered down to 30 mg before starting Suboxone and Suboxone shouldn’t be taken until at least 24 hours after the last dose of methadone.
 
Those on a low methadone dosage can usually transition without noticing an increase in symptoms or cravings. In one study, all 25 out of 25 participants transitioned successfully.
 
That said, withdrawals often lead to relapse, so the switch should be carefully coordinated by your doctor(s). 
 

Should you switch from Suboxone to methadone?

It’s not as common to switch from Suboxone to methadone, but can be a good option when patient’s aren’t successful on Suboxone

How To Switch From Suboxone To Methadone

Switching from Suboxone to methadone is easier because methadone does not have an opioid blocker. Methadone should be started 24 hours after the last dose of Suboxone. The initial dose of methadone will be adjusted based on the patient’s last Suboxone dose. 

See also: How to Get Off Suboxone

Discuss Your Medication Options

Symetria is a top-rated medication-assisted treatment (MAT) clinic, with locations throughout Chicago, as well as Fort Worth and Houston. All locations are in-network with insurances and offer both Suboxone and Methadone. 

Get Methadone or Suboxone Here

If you don’t happen to live in Illinois or Texas, try calling the number on the back of your insurance card. If you don’t have insurance, visit FindTreatment.gov and type in your zip code. Then, on the next page, use the free or slider scale filters.

Still Have Questions?

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Ruthie Lawrence
Ruthie Lawrence

I have been on Suboxone for about 6 years taking a little bit of a strip daily now. I got some methadone to get off subs. Will this work?

Dr. Abid Nazeer MD, FASAM
Dr. Abid Nazeer MD, FASAM

If your goal is to get off medications, keep tapering down instead. Don’t just stop taking Suboxone but have patience. No need to get methadone involved when it sounds like you’re almost there! The end of the tapering process can be difficult when it comes to Suboxone. It is helpful to speak with your Suboxone treatment provider about being prescribed temporary medications to use as needed for any withdrawal symptoms that develop after completely stopping it. Since methadone itself is an opioid, it can cover up the withdrawals from Suboxone but they will return when you stop taking the methadone too.

Amanda Carter
Amanda Carter

I have been on Suboxone for 1 month, but I want to go back to the methadone program because I don’t like the way I feel on Suboxone. Is that possible? And how long do I have to wait to take the methadone?

Arthur Underwood
Arthur Underwood
Reply to  Amanda Carter

I just changed back to methadone from suboxone. I had to restart methadone dosing, but getting back to it. Good luck!

Stephen Quartly
Stephen Quartly

Can I have methadone even though I’ve been on 32mg of Suboxone for about 6 mths? If I only have 25ml of methadone will I go into instant withdrawal?!

Dr. Abid Nazeer MD, FASAM
Dr. Abid Nazeer MD, FASAM

You won’t go into withdrawal, but that’s a really high amount of Suboxone. You’d be at high risk of an overdose by adding methadone on top. Please don’t do it!

Instant withdrawals, known as “precipitated withdrawals” occur in the opposite scenario of taking Suboxone when your body is already physically dependent on opioids (including methadone).

P Miller
P Miller

I’m on 34 mg of methadone. I’m switching to Suboxone and I have been clean for 9 years. How much Suboxone should I need?

Courtney Potempa, PA-C
Courtney Potempa, PA-C
Reply to  P Miller

You will need to be in moderate withdrawal from methadone before you can start Suboxone. Otherwise, you may go into precipitated withdrawal (instant 10/10 opiate withdrawal). You may want to consider tapering off the methadone slowly then discuss naltrexone/Vivitrol with your provider as it will block opiate cravings but you will not become dependent on it.

If you do go to Suboxone, there’s no equivalent dose of methadone to Suboxone. You’ll just need to find the dose that prevents withdrawal symptoms and minimizes cravings.

Robert Revord
Robert Revord

How can a person be considered an addict of hydrocodone when there is no rush or euphoria only pain relief from chronic pain?!

Bailygirl
Bailygirl
Reply to  Robert Revord

Nuts isn’t it?! I’ve been on opiates due to severe chronic pain (which has gotten worse over the last 23 years) and it’s offensive to be called an addict. Of course, my body is dependent and would go into withdrawal if I stopped cold turkey but there’s a difference between addiction and dependence. After the 3rd day of taking Oxycontin I never felt the slightest buzz, fuzziness, absolutely nothing. And, we are being cut off now, from something that means the difference as to whether we have a life or not. In the meantime, I’m my husband’s caretaker which is painfully physical. People just don’t get it.

The physicians at Symetria cite only trustworthy sources, including peer-reviewed journals, academic organizations, highly regarded nonprofit organizations, government reports and their own expertise with decades in the field.

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Casadonte, P. (2013). Transfer from Methadone to Buprenorphine. Providers Clinical Support System. https://pcssnow.org/wp-content/uploads/2014/03/PCSS-MATGuidanceTransferMethadonetoBup.Casadonte.pdf

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Lintzeris, N., Monds, L. A., Rivas, C., Leung, S., Dunlop, A., Newcombe, D., Walters, C., Galea, S., White, N., Montebello, M., Demirkol, A., Swanson, N., & Ali, R. (2018). Transferring Patients From Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines. Journal of addiction medicine, 12(3), 234–240. https://doi.org/10.1097/ADM.0000000000000396

NIDA. 2021, April 13. How much does opioid treatment cost?. Retrieved from https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-much-does-opioid-treatment-cost on 2022, February 1

NIDA. 2021, December 3. How effective are medications to treat opioid use disorder?. Retrieved from https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder on 2022, February 1

Salsitz, E. A., Holden, C. C., Tross, S., & Nugent, A. (2010). Transitioning stable methadone maintenance patients to buprenorphine maintenance. Journal of addiction medicine, 4(2), 88–92. https://doi.org/10.1097/ADM.0b013e3181add3f5

Shulman, M., Wai, J. M., & Nunes, E. V. (2019). Buprenorphine Treatment for Opioid Use Disorder: An Overview. CNS drugs, 33(6), 567–580. https://doi.org/10.1007/s40263-019-00637-z

(2022, January 1). Methadone (Oral Route). Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/methadone-oral-route/side-effects/drg-20075806

(2022, January 24). Buprenorphine. SAMHSA. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine

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